Do they practise what we teach? A survey of manual handling practice amongst student nurses

Experience of training students of nursing in manual handling suggested that they did not practise the techniques they had been taught. A search of the literature revealed that there was indeed a theory-practice gap. The aim of the project was to answer three questions: do students know what they should be doing, do they do what they should be doing, and if not, why not. A survey design was used, with questionnaires designed specifically for the study. Self report questionnaires were distributed to students of nursing (n = 148) on the adult branch in one higher education institution in England. One hundred and thirty-nine completed questionnaires were returned. Results showed that students' knowledge of whether particular techniques were 'recommended' was fair. They indicated however, that they were frequently unable to use recommended techniques in practice. The most frequent explanation given was the influence of other nurses. Results of this small study indicated that male students and younger students were more susceptible to socialization into poor ward practice than others. Other reasons for not using recommended techniques were unavailability of manual handling aids, lack of time and patient needs. The complexity of relationships within the nursing team emerged, with students ever aware of the impression they were making with regard to their assessment of practice, and their need to be accepted as a member of the team. Changes to training are suggested, to help reduce the theory-practice gap.     

Use of Pressure Offloading Devices in Diabetic Foot Ulcers: Do we practice what we preach?

OBJECTIVE—Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers. We therefore discuss characteristics and considerations associated with the use of offloading devices.RESEARCH DESIGN AND METHODS—A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and treatment of diabetic foot ulcers in each center.RESULTS—Of the 895 respondents who treat diabetic foot ulcers, shoe modifications (41.2%, P < 0.03) were the most common form of pressure mitigation, whereas total contact casts were used by only 1.7% of the centers.CONCLUSIONS—This study reports the usage and characteristics of offloading devices in the care of diabetic foot ulcers in a broadly distributed geographic sample. Less than 2% of specialists use what has been termed the “gold standard” (total contact cast) for treating the majority of diabetic foot ulcers.In the treatment of diabetic foot ulcers, pressure modulation, commonly referred to as “offloading,” is most successful when pressure is mitigated at an area of high vertical or shear stress (1). Common methods to offload the foot include bed rest, wheel chair, crutch-assisted gait, total contact casts, felted foam, half shoes, therapeutic shoes, and removable cast walkers (2). Although it is well known that pressure mitigation through offloading devices is crucial for the healing of plantar diabetic foot ulcers, there are, to the best of our knowledge, no reports in the literature that describe the characteristics and considerations associated with the use of pressure mitigation devices in a broad geographically diverse sample of specialists. Therefore, the purpose of this study was to describe the characteristics and considerations associated with the use of offloading devices in foot clinics in the U.S.     

Do we need to innovate in critical care practice?

Fever is prevalent in the majority of patients after aneurysmal subarachnoid hemorrhage and is associated with worse outcome. Treatment of fever is highly recommended, but with low-grade evidence in current guidelines. The analysis by Schiefecker and colleagues reveals that the situation may be more complicated than at first glance and careless treatment may introduce further harm. The importance of this study lies in analyzing real-world multimodal neuromonitoring data, showing a pitfall in incautiously applied treatment paradigms.     

The advanced practice nurse. Changing the practice law: what did we learn?

The nurse practice statute was changed in Connecticut during the 1999 Legislative session in an effort to more accurately reflect the current practice of advanced practice nurses. The effort to make changes began in 1990, when the psychiatric clinical nurse specialists organized and incorporated to improve the practice status of this nurse specialty group and to improve patient accessibility to their services. This article describes the changes that were made in the practice statute and the lessons that were learned along the way. It elaborates on the need for strong organizational identification, coalition building, choosing legal and lobbying support carefully, negotiating with the opposition, and grassroots lobbying. Compromise was reached and statutory changes were made so that advanced practice nurses moved from being under the direction of physicians to a mutually agreed-on collaborative relationship with physicians. The article provides insights and learning experiences that may help others moving along the road to more independent practice laws.     

Do patients and their families expect what we really offer them?

Frequently we evaluate user satisfaction for the treatment procedures provided (quality perceived), but we do not study the prior expectations (quality desired). Our objective is to discover what these patient and their family expectations are about treatment procedures and nurses' role so that we can make improvements and contribute to maximizing the quality of treatment provided. The aspects which cause greatest concern so that a patient's hospital stay is comfortable are the interpersonal relationships with family members, room mate, and professionals. Furthermore, the authors evaluate the treatment with nurses as a primary aspect in quality treatment.     

Do we know what people die of in the emergency department?

Objective: To establish the discrepancy rate between the predicted cause of death and the actual cause of death as determined by postmortem examination result, for all deaths in the emergency department reported to the Scottish Procurator Fiscal and subsequently undergoing postmortem examination. Methods: A prospective study of all patients who were dead on arrival or died in the emergency department of a busy Glasgow hospital over a 12 month period. The most senior emergency physician present at the time of death predicted the cause of death. This was then compared to the actual postmortem examination determined cause of death and was considered either to be correct or incorrect. Results: During the study period, 146 patients were pronounced dead in the department. Of these, 81 patients (age range 39–99 years, median 71; male:female 2.5:1) had death certificates issued, 63 patients (age range 26 days to 99 years, median 48; male:female 2.4:1) had a postmortem performed by the forensic pathologist, and two patients underwent a "view and grant". Of the 63 deaths reported to the Procurator Fiscal, the emergency physician attributed 51 (80.1%) to non-trauma, 9 (14.2%) to trauma, and in 3 (4.7%) cases were uncertain. Of the 63 (39.7%) deaths, 25 were inaccurately predicted (99% confidence interval 24.3% to 56.6%; p<0.0)1. Cardiovascular related and drugs poisoning deaths occurred most commonly. They were also the most accurately predicted cause of deaths. Intracranial events, pulmonary thromboembolism, and airway obstruction were also frequently predicted, but were often wrong. Conclusions: This study highlights the difficulties in accurately identifying cause of death for patients who die suddenly. This could have implications for the accuracy of health service statistics.