Should nurse academics engage in clinical practice?

The education of nurses has traditionally been conducted in the hospital based setting. This changed over the last few decades, with nursing education now being a tertiary based course in many countries. There were numerous reasons for this move, the main goal being to improve the educational experience of students and thus the competence of graduates. Nurse academics whose role is to educate students are faced with the challenge of ensuring their teaching reflects the contemporary nursing environment. One way of doing this is by actively engaging in clinical practice. However there are arguments for and against (as well as barriers to) them doing so and little empirical evidence to support either argument. Individually, nurse academics must make a decision about whether engaging in clinical practice is beneficial to their career and the students they teach.     

The role of the NxTAG® respiratory pathogen panel assay and other multiplex platforms in clinical practice

Introduction: The advent of nucleic acid amplification tests has significantly improved the aetiologic diagnosis of respiratory infections. However, multiplex real-time polymerase chain reaction (PCR) can be technologically challenging.

Areas covered: This paper reports the results of the main published studies on the NxTAG Respiratory Pathogen Panel (RPP) and discusses the advantages and disadvantages of extensive use of multiplex assays in clinical practice.

Expert commentary: Currently available data seem to indicate that routine use of multiplex assays, including NxTAG RPP Assay, should be recommended only when epidemiological data concerning circulation of viruses and bacteria have to be collected. Their use in clinical practice seems debatable. They have limited sensitivity and specificity at least in the identification of some infectious agents or, as in the case of NxTAG RPP, they have not been evaluated in a sufficient number of patients to allow definitive conclusions. In the future, the clinical relevance of multiplex assays, including NxTAG RPP, could significantly increase, mainly because a number of new antiviral agents effective against several respiratory viruses for which no drug is presently available will be marketed. In addition, it is highly likely that the efficiency of multiplex assays will be significantly improved.     

The value of continence training: does it change clinical practice?

It is estimated that one in six people over 40 are incontinent 'several times a month' and that most of them will not have sought help (Perry et al, 2000). Containment of the problem is no longer the first-line treatment and patients should be given access to an assessment, with a management plan addressing the cause of incontinence. It is thought that around 70% of the estimated population with continence problems in the UK would show a good response to treatment (Royal College of Physicians (RCP), 1995). However, it is recognized that healthcare professionals need knowledge and training to deliver care (Brittain et al, 2001). Previous studies have shown continence education, for both professionals and users, to be cost-effective because investment in techniques to promote continence can reduce dependence on incontinence containment products (Bradley and Morgan, 1998; Williams et al, 1999). This study was based on the belief that there is an educational gap between what is taught and what is practised (Macleod, 1998; Severinsson, 1998). The study drew on an opportunistic sample of students attending continence-training courses. They were asked to complete pre- and post-course questionnaires. Using a follow-up research design, three periods of data were collected. Data were analysed using Microsoft Excel and the Statistical Package for Social Science (SPSS). The results conclude that there was a statistically significant change in the quantitative measure - the test result - but qualified nurses were experiencing some difficulty relating the theory to clinical practice.     

The role of the cerebellum in procedural learning--are there implications for physiotherapists' clinical practice?

Motor learning is the means by which we acquire skilled movements and consign them to permanent memory. Multiple brain areas are involved, and patients with neurological damage often experience difficulty when attempting to relearn previously learned skills. For these patients, the location of the lesion may be critical in influencing their motor skill relearning. The cerebellum has been described as an "on-line" comparator and corrector of movement, but recent research suggests that the cerebellum may also have a role in the later stages of motor learning, including the automation of movement patterns, although conflicting research in this area means that there is as yet no consensus. This knowledge may have implications for the way physiotherapists treat patients with cerebellar lesions. Some treatments in regular use by physiotherapists are discussed, and possible implications for practice are considered.     

Does implementation of a paediatric asthma clinical practice guideline worksheet change clinical practice?

Background

Despite the development of evidence-based practice guidelines in many countries for asthma treatment in children, there is limited evidence that using such guidelines improves patient care.

Aims

Our aim was to evaluate whether the implementation of an evidence-based asthma clinical practice guideline (CPG) worksheet changes clinical practice.

Methods

The study was a before and after study of the implementation of a paediatric asthma CPG in a tertiary paediatric emergency department (ED). All children aged 2–16 years who had a diagnosis of asthma were included. Clinical data were obtained by retrospective chart review for time periods before (May to September 2003) and after (May to September 2005) the introduction of the CPG worksheet. Primary outcomes were: use of spacers for salbutamol instead of nebulisers, use of ipratropium and use of corticosteroids. Secondary outcomes were use of an ED action plan, ordering chest X-rays (CXR) and admission rate.

Results

Before implementation, 240 children presented with asthma and after implementation, 286 children presented. The two groups had similar ages, asthma severity, admission respiratory rate (RR) and oxygen saturation. Following implementation there was an increase in spacer use from 17 to 26% [+9%; 95% confidence interval (CI): 2–16%; p?=?0.015] and a reduction in ipratropium use from 58 to 44% (?13%; 95% CI: ?22 to ?5%; p?=?0.0029). The proportion of patients treated with corticosteroids did not change. The number of patients with an ED action plan increased. The number of CXR ordered decreased and the hospital admission rate decreased.

Conclusions

The study demonstrates that implementation of an asthma CPG worksheet in a tertiary paediatric ED resulted in modest changes in clinical practice, mainly by increasing clinician adherence to the guidelines.     

Clinical coaching for veterinary nurse practice – managing the struggling student in practice

ABSTRACT:

This second article focuses on the management of the struggling or failing student in practice. Most students perform well in practice and require relatively little support in achieving their learning objectives whilst in clinical placement. Some students, however, may be challenged by a range of issues whilst in the practice setting. This article focuses on the identification and management of veterinary nursing students who are struggling in practice.     

The impact of paediatric oncology education on clinical practice – A phenomenological study

PurposeOver the past 40 years, 5-year survival rates for children and young people with cancer have risen dramatically in the United Kingdom (UK), an improvement largely attributable to the increasingly effective treatments and the centralisation of care. Registered nurses in clinical roles, both within the hospital and the community setting, require on-going and relevant education and training programmes to equip them with the necessary professional and personal skills to ensure they are fit for purpose.MethodThis research study reports on Child Health Nurses (CHN's) perceptions of the impact of paediatric oncology education on their practice. Using a phenomenological approach, this study explores this phenomenon in depth, constructing meaning through the individual participants ‘lived experiences’. A purposive sample was selected to participate in semi-structured interviews within their clinical environment.ResultsFindings suggest that formal paediatric oncology nurse education is perceived to positively impact on certain aspects of the practitioners practice. All the CHN's felt empowered through their newly found knowledge, confidence and attitude and ability to apply evidence-based care. All participants perceived a need for education at all levels, most enjoyed the blended approach to the teaching, learning, and assessment, however all experienced great support from one another and the sharing of personal and professional experiences.ConclusionsFrom this study it is acknowledged that paediatric oncology education is required and is important for the delivery of quality care. However, there is a dearth of research-based literature which truly analyses the effectiveness and impact of education on paediatric oncology practice.     

Movement analysis of sit-to-stand – research informing clinical practice

Abstract

Background:

Sit-to-stand (STS) is a crucial transfer influencing a person's independence in daily activities, as well as safety and quality of life, and is thus vital to evaluate in research and in practice. Clinical STS tests provide single values in seconds or numbers of STS. There is, however, increasing numbers of research papers reporting spatial and temporal kinematic and kinetic process STS data.

Objectives:

To provide an overview of research findings from laboratory-based movement analyses regarding phases and determinants of typical STS, characteristics of successful versus failed STS transfers, and finally STS performance in some neurological conditions.

Major Findings:

The STS transfer, previously regarded as mainly requiring lower limb muscle strength, is increasingly recognized as a complex transfer skill. Muscle strength, balance, foot position, chair height and the movement strategy are major determinants influencing STS performance. Scaling and timing of momentum generation throughout STS seems critical for success or failure. Sit-to-stand in stroke and Parkinson's disease (PD) is characterized by asymmetry in force generation and difficulties in switching movement direction, respectively. In-depth, knowledge regarding mechanisms of momentum control during STS sub-phases, STS failures, as well as exploration of variability in normal and atypical STS is still lacking.

Conclusions:

Recent research based on instrumented movement analyses has generated better understanding of movement control during STS, but the specifics are not yet reflected in clinical assessments. There seems to be a call for clinical tools capturing determinants and process characteristics of the STS transfer for a more comprehensive evaluation in rehabilitation.     

The COVID-19 pandemic – A focus on nurse managers’ mental health,coping behaviours and organisational commitment

BackgroundThe emergence of COVID-19 has substantially impacted frontline health care workers, including nurse managers. To date, no studies have been conducted to examine the impact COVID-19 has had on Nurse Managers’ mental health, coping strategies and organisational commitment.AimTo investigate the mental health, coping behaviours, and organisational commitment among Nurse Managers during the COVID-19 pandemic.MethodsCross-sectional study involving 59 Nursing Managers from one Local Health District in Sydney Australia during the first wave of the COVID-19 pandemic. Data were collected relating to demographics, anxiety, coping strategies and organisational commitment.ResultsOverall, approximately three quarters of the Nurse Managers had high anxiety scores. Managers who had worked longer as a nurse had higher scores for adaptive coping strategies and 41% of Nurse Managers considered leaving their jobs.ConclusionsStrategies to minimise anxiety and enable coping as part of organisational disaster, emergency or crisis planning for Nurse Managers may result in decreased anxiety and stress levels, increased use of adaptive coping strategies and lower intent to leave the organisation and the nursing profession.     

The role of the chinese medicine nurse in Taiwan: professional or assistant?

Personal participation in first line Chinese medicine nursing practice made the author aware of a significant gap between learning and practice in traditional Chinese medicine nursing. For this paper, she interviewed physicians, nurses and patients, researched hospital system and regulatory requirements. She found that "an assistant" is what Chinese medicine physicians expect of nurses, while patients expect a nurse to be able to help them complete treatment while having a good attitude. In order to distinguish clearly nursing from medicine, nursing scholars, with the help of the Chinese Medicine Committee have designed a Chinese medicine nursing training program. Administration is the main content of front-line nurses in this field. They typically have limited responsibilities related to health problem assessment, prevention, or providing guidance / advice. This article raised difficulties and contradictions between the role and practice of Chinese medicine nurses. Three suggestions are provided, including: clearer demarcation of job responsibilities; renewed respect for nurses as professionals; and including traditional Chinese medicine nursing into the formal nursing curricula in order to support a better future for Chinese medicine nurses.     

Moral distress in nurse leaders—A scoping review of the literature

Nurse leaders face immense organizational pressures exacerbating their distress, which has not been prioritized as much as frontline nurses. This review synthesized the literature to examine theoretical models, measures, contributing factors, outcomes, and coping strategies related to moral distress in nurse leaders. PubMed, Embase, CINAHL, and PsycINFO were searched, and 15 articles—2 quantitative and 13 qualitative studies were extracted. The scoping review identified one study using a theoretical model and two measures—the ethical dilemmas questionnaire and the Brazilian moral distress scale. Contributing factors of moral distress include internal and organizational constraints, increased workload, and lack of support impacting physical and emotional well-being and intention to quit. This review did not yield any intervention studies emphasizing the need for research to identify specific predictors of moral distress and examine their relationship to nurse leader retention, so organizations can explore targeted interventions to promote coping and mitigate distress.