UK Nurses Research Articles

The Clinical Need for New Diagnostics in the Identification and Management of Patients with Suspected Sepsis in UK NHS Hospitals: A Survey of Healthcare Professionals.

Development of a new diagnostic is ideally driven by an understanding of the clinical need that the test addresses and the optimal role the test will have within a care pathway. This survey aimed to understand the clinical need for new sepsis diagnostics and to identify specific clinical scenarios that could be improved by testing. An electronic, cross-sectional survey was circulated to UK National Health Service (NHS) doctors and nurses who care for patients with suspected sepsis in hospitals. Two hundred and sixty-five participants completed the survey, representing 64 NHS Trusts in England. Sixty-seven percent of respondents suggested that the major cause of delay was during the initial identification of sepsis and the subsequent recognition of patients who were deteriorating. Existing blood tests did not enhance the confidence of consultants making their diagnoses. Those surveyed identified a role for a near-patient test to “rule out” suspected sepsis and, thereby, stop or postpone use of antibiotics. Current diagnostic tests are slow, non-specific, and do not reliably identify patients with a high suspicion of sepsis. As a result, they have a limited use in patient management and antibiotic stewardship. Future development of sepsis diagnostics should focus on overcoming these limitations.

Self-Perceived Knowledge and Comfort Discussing Palliative Care and End-of-Life Issues among Professionals Managing Neuroinflammatory Diseases

Background: The growing trend in providing palliative care and end-of-life services has dictated that healthcare providers be adequately trained to care for people with serious illnesses, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). These progressive inflammatory diseases lead to physical, cognitive and emotional deficits and have exceptionally high care demands leading to high levels of distress. Because the impact on the delivery of patient care is influenced by the specialists' knowledge and comfort discussing end-of-life issues, it is concerning that interventions to address unmet palliative care needs in MS and NMOSD rarely include clinician-patient dyads. Objectives: To evaluate the neurology clinicians' knowledge and level of comfort discussing palliative care and end-of-life issues. Design: A cross sectional survey was conducted. The statistical analyses included frequencies, chi square statistics and logistic regression. Setting/Subjects: 414 MS specialists answered an online anonymous survey. The survey was conducted using email distributions to MS professionals through the Consortium of MS Centers (CMSC), the International Organization of MS Nurses (IOMSN) and the UK Nurses' MS Organization. Measurement: The "End of Life Professional Caregiver Survey" (EPCS) was used to collect data. Results: The majority of the multidisciplinary professionals were female, white, nurses, and older than 40 years of age. 41% had their own advance directives and 57.6% had end-of-life basic training. There was a statistically significant association between end-of-life training or having advance directives and comfort discussing palliative care and end of life issues. Professionals that had basic end-of-life training and their own advance directives had higher comfort discussing code status, specific end-of-life issues, and advance directive planning. Conclusions: Basic end-of-life training and having advance directives among MS professionals were associated with better communication of palliative care and end-of-life domains with patients and their care partners.

Dementia in prisons: the Admiral Nurse offer

Background: Dementia is an increasingly common condition, affecting over 50 million people worldwide, with approximately 850 000 living with dementia in the UK. In recent years, there has been a significant rise in the number of older prisoners, many of whom may also have dementia; however, there is little in the literature about the needs of this population. This is the first in a series of clinical articles on dementia in underserved populations. Aims: To explore current literature; academic, policy and guidance to develop an understanding of what is currently known about this population. Methods: A literature review. Findings: There is insufficient data on the amount of dementia in the ageing prison population and limited research that defines the needs of this underserved population. This results in prison services often failing to meet the needs of this underserved population, with prison staff struggling in this regard due to limited knowledge, resources and training. The Prisons and Probation Ombudsman argues the failure to strategically respond to this population leads to each prison and its local healthcare providers being left to respond in a piecemeal fashion. Conclusions: This paper discusses the demographic changes related to prisoners with dementia and details how Dementia UK and Admiral Nurses can support a specialist care solution to this underserved population.

Outrage and the emotional labour associated with environmental activism among nurses.

To investigate the emotions associated with environmental activism among nurses. Nursing has a long history of political activism in relation to social justice issues. Some nurses are environmental activists. Ethnography. Focus groups and individual interviews were triangulated with additional observational data. The 40 participants (USA=23, UK=17) were nurses actively engaged with environmental/sustainability issues. Data collection was from March-October 2017. Data were analysed using discourse analysis. The trigger for nurses' environmental activism was a strong emotional response to recognizing risks to human health. Their activism results in an additional emotion burden above which they routinely experience in caring for patients. Many feel over-whelmed by the magnitude of the issues. Nurses in America feel more supported and empowered to be activists than UK nurses. This study reveals for the first time that advocating for the environment is emotional labour, additional to the previously recognized emotional labour associated with caring for patients. Encouragement and support from others, particularly fellow nurses, helps nurse environmental activists continue to fight for the health of communities and the planet. Outrage at threats to human health triggers nurses' environmental activism. Environmental activism creates an additional emotional burden above that routinely experienced in caring for patients. Nurses in America feel more supported and empowered to be activists than UK. Nurses whose practice embraces environmental activism need practical and emotional support from other nurses.

Embracing diversity: when is it OK to speak languages other than English in the consulting room?

It is well recognised that language is central to good communication in all clinical consultations. The national focus on clinical staff being fluent in English is important and proportionate. Recently, a midwife was suspended from the UK Nursing and Midwifery Council Register because of deficient competency in English1 until she is able to demonstrate that she has reached the necessary standard of English for safe practice.2 The General Medical Council (GMC) similarly expects all licensed doctors to: ‘… have the necessary knowledge of the English language to provide a good standard of practice and care in the UK.’ 3 For those European doctors who are not required by the GMC to pass a national English language test, the current GMC guidance states that: ‘To practise safely in the UK doctors must have sufficient knowledge of English.’ 4 So why, in Central Midlands, has NHS England felt it necessary to develop guidance for clinicians who may be tempted to consult in languages other than English? The answer lies in the language competencies of our international recruits to general practice in Lincolnshire and the patients who consult them. Lincolnshire, a predominantly rural county in the East Midlands of England, where recruitment and retention of GPs has long been a significant challenge to delivery for the NHS, is the site of an innovative collaborative approach to international recruitment into general practice. Since 2016, the Lincolnshire Local Medical Committee, working with NHS England and Health Education England (HEE), has recruited a cohort of 26 doctors from several European Union countries, all of whom were trained in family practice in their home countries and eligible for entry to the …

Becoming and being an environmentally ‘woke’ nurse: A phenomenological study

BackgroundIncreasing numbers of nurses view environmental activism as part of their role. No studies have explored the reasons. AimThis study aimed to identify what awakened and shaped US and UK nurses’ environmental activism. DesignA Gadamerian hermaneutic phenomenological study. MethodsForty nurses were recruited in 2017 using purposive sampling (USA n = 23, UK n = 17). Four focus groups were followed by individual interviews. Iterative, fully immersive phenomenological analysis was conducted with corroboration of themes and a final “shared horizon.” FindingsParticipants described “lightbulb” events whereby they recognized environmental threats to people and the planet. Their nursing-centered values of social justice, generational fairness, and alleviating suffering underpinned a shared belief in their ability to help mitigate those threats. They believed it was their duty as nurses to take action on behalf of individuals, communities, and the planet. DiscussionThe nursing skill set of these nurses makes for effective leadership and environmental activism. Environmentally “woke” nurses have the skills to create solutions and systems approaches that increase sustainability, improve health and make a difference to people's lives, now and for future generations.

Work harassment in the UK and US nursing context

AbstractThis paper examines one type of negative work behaviour, work harassment, using two theoretical frameworks: Social Exchange Theory (SET) and Similarity-Attraction (SA). SET explains work harassment as a product of poor management practices, whereas using SA theory explains it as a result of the growing normalisation of high workloads. The study undertakes latent mean and path model comparison analysis using structural equation modelling of data from 189 nurses in the UK and 401 nurses in the USA. The findings indicate a good model fit showing a significant path from Leader Member Exchange (LMX) to work harassment, wellbeing and subsequent turnover intentions, with LMX fully mediating the path from LMX to wellbeing for UK nurses, but only partially mediating the same path for nurses in the USA. The findings suggest SET provides a better explanation for work harassment for UK nurses, whereas SA theory better explains the US nurse experience.

When safety climate is not enough: Examining the moderating effects of psychosocial hazards on nurse safety performance.

To examine the association between components of safety climate and psychosocial hazards with safe work behaviours and test the moderating effects of psychosocial hazards on the safety climate-safety performance relationships. The effects of a strong safety climate on safety performance are well cited, however, the conditions that have an impact on this relationship warrant attention. While the psychosocial hazards commonly reported by nurses are predictors of well-being and job attitudes, evidence suggests that these may also place boundaries on the effects of safety climate on safe work practices. This study used a cross-sectional design to collect data from 146 nurses. Participants were recruited through convenience sampling and snowball sampling methods in 2017. Nurses completed an online questionnaire and received a $5 e-gift card as compensation. SPSS v.23 and PROCESS v3.0 were used to analyse the data. A strong safety climate was positively associated with nurses' safety performance. While psychosocial hazards did not predict safety performance, they did moderate the safety climate-performance relationship. High levels of perceived stressors weakened the association between promoting two-way safety communication, the use and implementation of procedures to promote safe work practices and management's endorsement of health and safety with safe work performance. The positive effects of safety climate on nurses' safety performance are contingent on the levels of psychosocial hazards nurses experience. When aiming to improve safety performance among nurses, it is important for efforts to also focus on the psychosocial conditions of the work environment.

Use of Sharesource in Remote Patient Management in Peritoneal Dialysis: A UK Nurse's Perspective.

In June 2015, Sharesource, a cloud-based, bi-directional connectivity platform, was launched by Baxter Healthcare in the UK. With this came the ability to use remote patient management (RPM) with peritoneal dialysis (PD) patients in an easy, standardized manner across dialysis units. Improved nursing efficiency and patient outcomes, achieved utilizing RPM include individualized PD patient prescriptions, early detection and prevention of potential PD complications, reduced planned and unplanned hospital attendance, reduced drop off, and increased healthcare professional and patient/carer confidence in self-care. These are illustrated with Case Studies. The potential to reduce glucose exposure is explored and for PD units yet to use RPM, lessons learned during the implementation of Sharesource are shared.

Implementing online evidence-based care pathways: A mixed-methods study across primary and secondary care.

AimTo understand what contextual influences, mechanisms and outcomes affect the implementation and use of localised, online care pathways (HealthPathways) in primary and secondary care.Design and procedureMixed-measures design. Quantitative data included number of page views and conditions viewed. Qualitative data from semistructured interviews and focus groups were gathered over a 6-month period, and analysed using NVivo software.SettingThe first HealthPathways UK site, South Tyneside, England.ParticipantsGeneral practitioners, nurses, practice managers, hospital consultants and system leaders (managers, commissioners) (n=76).ResultsUse of the pathways significantly increased over time. Themes were developed showing how online care pathways were used—leadership, pre-existing networks and relationships; development of systems and processes for care pathways, the use of online care pathways to support decision-making and referral, and perceived availability of resources. Inter-related themes were arranged into configurations consisting of contextual influences, mechanisms and outcomes. Recommendations were made for future implementations, such as improved data collection processes to understand how and why there was variance in the use of pathways.ConclusionsThis study was early in the implementation process; however, emerging themes will facilitate the future implementation and use of online care pathways. Recommendations are made for further research to include other health and social care users and patients to inform future developments.

What and how … but where does the why fit in? The disconnection between practice and research evidence from the perspective of UK nurses involved in a qualitative study.

An emphasis has been placed on evidence during nurse training and practice over recent decades. A qualitative study was undertaken to explore the meaning of and involvement in evidence-based practice for recently qualified general nurses. A purposive sample of 11 general nurses was recruited. Semi-structured interviews were conducted between March-June 2017. All were audio-recorded and transcribed verbatim. Thematic analysis was applied to transcripts. An overarching theme of disconnection between research and evidence and the participants' perceptions of contemporary nursing practice was underpinned by three themes: 1) We should be using it … but we're not; 2) Leaving research behind at graduation; 3) Research is other people's business. Participants had been exposed to evidence-based practice during their training, but once qualified they appeared to move into a culture where this was not seen as a priority. Nurses on wards were unaware of research taking place locally and had limited contact with research staff in their organisation. Approaches to overcoming the disconnection between research/evidence and practice could include how it is introduced during training, and changes in nursing culture and leadership. This could include placements for student nurses within research teams.

TRANSITIONS IN DEMENTIA CARE: POST-ACUTE NEEDS AND CHALLENGES

Older adults with dementia have greater nursing facility utilization, hospital and home health use, and relocation transitions per person-year than those without dementia. Hospital to nursing home/skilled nursing facility transfers are particularly stressful and associated with challenges to rehabilitation and functional recovery. There is a growing international attention to the need to customize post-acute transitional care practices to the needs of the person with cognitive impairment. A critical first step is understanding the intrinsic and extrinsic factors influencing the health, functional recovery and quality of life for persons with dementia admitted to post-acute care. This symposium will offer five presentations that address this objective. The first presentation describes the patient-level factors to consider when developing the rehabilitation plan for persons with dementia newly admitted to US skilled nursing facilities after hospitalization. The second presentation builds on the first, exploring UK nurses’ perspectives on the key components of quality care during the transition from hospital to care homes, and their role in optimizing this transition. Next, a predictive model for discharge disposition of persons with dementia post-rehabilitative care is offered. The fourth presentation describes the post-acute utilization and outcomes, by German care setting, of individuals living with dementia. Finally, the emotional expression in persons with dementia is examined as a functional measure of interventional efficacy. Our discussant, Professor Murna Downs, will synthesize the research presentation findings, offer perspective on the conceptual similarities/dissimilarities across settings and geographies, and lead a discussion of future directions for policy and practice

RCNi set to launch interactive decision tool for UK nurses

RCNi set to launch interactive decision tool for UK nurses

Research roundup: July 2018

In brief Cochrane review assesses efficacy of vaccines against typhoid fever Consensus on priorities for respiratory nursing research in the UK Nurses' experiences of challenges in administering medicines reflect existing evidence on medication administration errors and highlights the long-term effect on nurses and repercussions for the profession

Effects of Individual Differences and Job Characteristics on the Psychological Health of Italian Nurses.

The Demand Resources and Individual Effects Model (DRIVE Model) is a transactional model that integrates Demands- Control-Support and Effort-Reward Imbalance models emphasising the role of individual (Coping Strategies; Overcommitment) and job characteristics (Job Demands, Social Support, Decision Latitude, Skill Discretion, Effort, Rewards) in the work-related stress process. The present study aimed to test the DRIVE Model in a sample of 450 Italian nurses and to compare findings with those of a study conducted in a sample of UK nurses. A questionnaire composed of Ways of Coping Checklist-Revised (WCCL-R); Job Content Questionnaire (JCQ); ERI Test; Hospital Anxiety and Depression Scale (HADS) was used. Data supported the application of the DRIVE Model to the Italian context, showing significant associations of the individual characteristics of Problem-focused, Seek Advice and Wishful Thinking coping strategies and the job characteristics of Job Demands, Skill Discretion, Decision Latitude, and Effort with perceived levels of Anxiety and Depression. Effort represented the best predictor for psychological health conditions among Italian nurses, and Social Support significantly moderated the effects of Job Demands on perceived levels of Anxiety. The comparison study showed significant differences in the risk profiles of Italian and UK nurses. Findings were discussed in order to define focused interventions to promote nurses’ wellbeing.

Promoting Best Practice in Assessment and Intervention: The Challenges of Working in Times of Cutbacks and Change

Promoting Best Practice in Assessment and Intervention: The Challenges of Working in Times of Cutbacks and Change

Safe and sustainable staffing

Essential factsIn September, the RCN published a survey of 30,000 UK nurses, of whom 55% said shifts did not have the planned level of nursing staff, while 53% warned that staff shortages were compromising care.

Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children.

To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada. The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs. We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings. Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance. Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power. Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice. Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families.

Experiences of physiotherapist independent prescribers: impact, facilitators and barriers

Purpose: In 2013 the UK became the first country in the world to grant independent prescribing (IP) rights to physiotherapists. UK nurses and pharmacists have had IP rights since 2006 with noted positive impact on practice and patient experience. Despite the reported benefits, implementation of prescribing by nurses and pharmacists has been inconsistent both within and across healthcare organisations. Research has found that these prescribers have experienced multiple barriers and facilitators to their prescribing role which may help to explain these inconsistencies. The aim of this research was to explore the experiences of physiotherapist IPs working in one musculoskeletal service (MSK) with regards to the impact of IP on practice, and barriers and facilitators to the their prescribing role.

Caring for those who care.

British Journal of NursingVol. 26, No. 20 Silver Anniversary SupplementFree AccessCaring for those who careJohn OrchardJohn OrchardSearch for more papers by this authorJohn OrchardPublished Online:10 Nov 2017https://doi.org/10.12968/bjon.2017.26.20.S13AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail Congratulations to the whole team at the British Journal of Nursing for a hugely successful ‘silver’ anniversary. A quarter of a century is a long time and, just like nursing, publishing has experienced significant change in that time. It is a tribute to the team and British Journal of Nursing's contributors, peer reviewers and readers that the journal has been so successful for so long.Cavell Nurses' Trust's ‘history’ began not long after British nurse Edith Cavell was executed by firing squad in WW1 after being implicated in the escape of Allied soldiers from German occupied Belgium. That was in 1915 and two years later, after public appeals in the Telegraph and Daily Mirror, Edith Cavell Rest Homes for Nurses was founded.Of course, a great deal has happened to Cavell Nurses' Trust in the century since, especially in recent years. Cavell Nurses' Trust works hard to be here for nurses every day. We are the national charity that supports UK nurses, midwives and healthcare assistants—both working and retired—when they are suffering personal hardship, often due to illness, disability, older age and domestic abuse.Whether it's signposting to partner organisations, maximising benefits, funding new clothes after weight loss due to illness, repairing a broken boiler to heat the family home or funding towards setting up a new home as the result of suffering domestic abuse, Cavell Nurses' Trust can transform a nurse's life.We are experiencing a very significant increase in demand for our help—in fact, we had 32% more nursing professionals asking for our help in the first half of 2017 than in 2016.In parallel, more is being demanded of the nursing profession as our population changes and demands on our health system shift and increase.‘Cavell Nurses' Trust works hard to be here for nurses every day—both working and retired—when they are suffering personal hardship, often due to illness, disability, older age and domestic abuse’In response, this noble caring profession does what it has done for decades: it rises to the challenge of keeping the needs of people in its essence.It is impossible to calculate the impact the profession has had on society in the last 25 years since British Journal of Nursing's first edition. The countless interactions with vulnerable, desperate people. The often intangible yet vital exchanges of humanity with people who are at the very limits of their ability to cope, or who are elated with their recovery or from good news. The sheer breadth and depth of clinical knowledge and expertise. The lives saved. The families consoled. Laughter. The fabric of life.I am not a nurse but I am immensely proud that Cavell Nurses' Trust is here for nurses. If we as a team at Cavell Nurses' Trust can rise to the challenge of soaring demand for our help, and I am confident we will, then we will be immensely proud to walk alongside the profession, offering a helping hand long into the future.Here's to the next 25 years of British Journal of Nursing and to meeting the challenges of the future. FiguresReferencesRelatedDetails 9 November 2017Volume 26Issue 20ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 10 November 2017 Published in print 9 November 2017 Information© MA Healthcare LimitedPDF download