Medicines use reviews: what they are for and how to make use of them

Many people are not able to take their medication as it has been prescribed, for many reasons. Medicines Use Reviews (MURs), introduced as part of the 2005 Community Pharmacist Contract, provide the opportunity for pharmacists to offer NHS consultations, held privately, to discuss their customers' medication with them. The MUR can help to identify any side-effects or reasons why the medication might be ineffective or simply not taken, and agree an action plan which will then be shared with the general practitioner and other significant people involved in their care. This article highlights what this process entails, and how MURs offer an opportunity for even greater multi-disciplinary working, enhancing communication and ensuring best use of NHS resources.     

Informal carers of older family members: how they manage and what support they receive from respite care

Aims. To describe informal carers’ coping strategies and their experiences of the support provided by respite care. Background. The target set in the Finnish national old age policy strategy is that 90% of the population over 75 should be able to live at home. A major source of support for older people and their families is respite care in an institution. Design. Survey. Methods. The data were collected among informal carers who regularly use respite care services (n = 143). Two structured questionnaires were used: the Carers’ Assessment of Managing Index ( Nolan et al. 1995 ) and an index developed by the researchers. Results. Informal carers who provided care for younger individuals or people who needed less help had a better quality of life. Spouse carers and older informal carers were less satisfied with their quality of life than younger carers. Periods of respite care had a major influence on informal carers’ quality of life: 93% said they felt invigorated. Care periods remained rather isolated episodes in the lives of the older patients in that there was hardly any discussion at the institution about the family’s situation, the objectives of respite care, or about how the informal carer was coping. Altogether, 47% of the nurses remained fairly distant. The most useful coping strategies involved creating alternative perspectives in the caring relationship. Conclusions. The results strengthen the knowledge base of informal caregiving by showing how caregivers cope and what kind of support they need in their demanding caring role. Relevance to clinical practice. Respite care nurses should invest greater effort in supporting informal carers. The service should be developed as an integral part of home care for older people. Nurses and informal carers should see each other as partners who share a common goal, i.e. the well‐being of the entire family.     

Do you use social media? A study into new nursing and midwifery graduates' uptake of social media

Social media use is expanding rapidly, so too is its use within hospitals and amongst healthcare professionals. This study describes the use of social media by Australian and New Zealand nursing and midwifery graduates of the Graduate e‐Cohort study; there were 112 (93%) respondents from a 2014 sample of 121 nurses and midwives. Findings suggest that the professional peak body goal of using social media as a vehicle for professional education requires consideration of the social media platforms that are actually being used by new graduates. We recommend that work by the respective professions at both an undergraduate and graduate level needs to focus on the implications of social media use or policy and practice to ensure that everyone is aware of when and how to engage in social media platforms and what to do and how to behave when using social media.     

Diagnostic image quality in gynaecological ultrasound: Who should measure it,what should we measure and how?

Assessment of diagnostic image quality in gynaecological ultrasound is an important aspect of imaging department quality assurance. This may be addressed through audit, but who should undertake the audit, what should be measured and how, remains contentious. The aim of this study was to identify whether peer audit is a suitable method of assessing the diagnostic quality of gynaecological ultrasound images. Nineteen gynaecological ultrasound studies were independently assessed by six sonographers utilising a pilot version of an audit tool. Outcome measures were levels of inter-rater agreement using different data collection methods (binary scores, Likert scale, continuous scale), effect of ultrasound study difficulty on study score and whether systematic differences were present between reviewers of different clinical grades and length of experience. Inter-rater agreement ranged from moderate to good depending on the data collection method. A continuous scale gave the highest level of inter-rater agreement with an intra-class correlation coefficient of 0.73. A strong correlation (r = 0.89) between study difficulty and study score was yielded. Length of clinical experience between reviewers had no effect on the audit scores, but individuals of a higher clinical grade gave significantly lower scores than those of a lower grade (p = 0.04). Peer audit is a promising tool in the assessment of ultrasound image quality. Continuous scales seem to be the best method of data collection implying a strong element of heuristically driven decision making by reviewing ultrasound practitioners.     

What we know and what they do: nursing students' experiences of improvement knowledge in clinical practice

Nations around the world face mounting problems in health care, including rising costs, challenges to accessing services, and wide variations in safety and quality. Several reports and surveys have clearly demonstrated that adverse events and errors pose serious threats to patient safety. It has become obvious that future health professionals will need to address such problems in the quality of patient care. This article discuss a research study examining improvement knowledge in clinical practice as experienced by nursing students with respect to a patient-centred perspective, knowledge of health-care processes, the handling of adverse events, cross-professional collaboration, and the development of new knowledge. Six focus groups were conducted, comprising a total of 27 second-year students. The resulting discourses were recorded, coded and analysed. The findings indicate a deficiency in improvement knowledge in clinical practice, and a gap between what students learn about patient care and what they observe. In addition the findings suggest that there is a need to change the culture in health care and health professional education, and to develop learning models that encourage reflection, openness, and scrutiny of underlying individual and organizational values and assumptions in health care.     

Taiwanese nurses' attitudes towards and use of complementary and alternative medicine in nursing practice: a cross-sectional survey

BACKGROUND: Increasingly, nurses in Western countries express positive attitudes to complementary and alternative medicine (CAM) but lack knowledge, access to education and organisational policy to guide practice. It is unclear whether nurses in developed Asian countries mirror or differ from this profile. OBJECTIVES: To determine the attitudes towards and use of CAM by registered nurses in Taiwan. DESIGN: Cross sectional survey. SETTING: A Nursing College in eastern Taiwan. PARTICIPANTS: Registered nurses (N=170) working in various clinical settings who were studying a post registration Bachelor of Nursing conversion course. METHODS: Questionnaire distributed to nurses during class time. RESULTS: Most nurses had positive attitudes to CAM and most used therapies, like massage, occasionally in practice. However, none had formal qualifications in CAM and most perceived that there were insufficient resources or organisational policy to facilitate practice. CONCLUSIONS: Taiwanese nurses need more formal education about CAM and require access to clear policies regarding the safe use of CAM in nursing practice.     

Uncontested categories: the use of race and ethnicity variables in nursing research

Classifying human beings according to race and ethnicity may seem straightforward to some but it, in fact, belies a difficult process. No standard procedure exists for categorizing according to race and ethnicity, calling into question the variables' use in research. This article explores the use of race and ethnicity variables in the nursing research literature. Content analysis was conducted of a sample of 337 original research studies published in Nursing Research from the years 1952, 1955, and then every 5 years through to 2000. Of the 337 research articles reviewed, 167 mentioned race, ethnicity, or their 81 code words or phrases. Out of the 167 articles, 153 used race or ethnicity to describe the study sample, and 45 of the 167 articles included race or ethnicity as an element of data analysis. Throughout the sample, there was substantial inconsistency related to race and ethnicity categorization, meanings of the terms, and use of these variables. Specificity related to conceptual assumptions, definitions, and context was missing and, as a result, data interpretation and understanding are suspect. The integrity of nursing knowledge requires that nurse researchers recognize and address the difficulties inherent in using race and ethnicity in health research.     

An exploration of ruling relations and how they organize and regulate nursing education in the high-fidelity patient simulation laboratory

LIMOGES J. Nursing Inquiry 2010; 17 : 58–64
An exploration of ruling relations and how they organize and regulate nursing education in the high-fidelity patient simulation laboratory
Recently, schools of nursing have adopted the use of high-fidelity human patient simulators in laboratory settings to teach nursing. Although numerous articles document the benefits of teaching undergraduate nursing students in this way, little attention has been paid to the discourses and texts organizing this approach. This institutional ethnography uses the critical feminist sociology of Dorothy E. Smith to examine the literature and interviews with Practical and Bachelor of Science in Nursing students, and their faculty about this experience. The research shows how discourses rationalize and sustain certain processes at the expense of others. For example, ruling discourses such as biomedicine, efficiency, and the relational ontology are activated to construct the simulation lab as part of nursing and nursing education. The analysis also highlights the intended and unintended effects of these discourses on nursing education and discusses how emphasizing nursing knowledges can make the simulation lab a positive place for learning.     

Nursing scholars appropriating new methods: the use of discourse analysis in scholarly nursing journals 1996-2003

Nursing scholars appropriate the analysis of discourse. "Discourse analysis" covers a wide spectrum of approaches to analysing meaning and language and there is no widely accepted definition of either a concept or an analysis of discourse. A sample of the discourse analyses indexed in the CINAHL database was analysed in order to identify what notions of discourse and discourse analysis are preferred by nursing scholars. The results showed that nursing scholars prefer approaches to discourse that resemble mainstream qualitative research avoiding social life and interaction. Explanations for these findings are briefly outlined.     

Metaphor in illness and nursing: a two-edged sword. A discussion of the social use of metaphor in everyday language, and implications of nursing and nursing education

Study of the use of language, and in particular metaphor, is a valuable approach to an understanding of the experiential, lived world of the patient. There is an emerging focus on the need for nursing care to be informed by an appreciation of the experience of the phenomena of illness and patient hood. Related nursing epistemological issues are discussed as background. The anatomy and social use of metaphor in language in general are described. The metaphors surrounding cancer are examined to illustrate the two main functions of metaphor; the instrumental and the expressive. Illness metaphors may have negative consequences, imbibing myth, fear and stigma. However, the author concludes that awareness of the expressive function of metaphor provides a valuable focus for listening to and understanding the experience of the patient. Finally, some of the implications of both functions of metaphor in nurse education are outlined.     

Fatigue, depression and quality of life in cancer patients: how are they related?

In a study concerning a group of cancer patients undergoing radiotherapy three research questions were addressed. (1) Is fatigue a valid criterion for depression in these somatically ill patients? (2) What is the 'cause-and-effect' relation between fatigue and depression? (3) To what extent are fatigue and depression related to patients' quality of life. A heterogeneous sample of cancer patients (n?=?250) were interviewed before treatment, 2 weeks after treatment and 9 months later. Fatigue was measured using the MFI, a self-report instrument covering five dimensions of fatigue. Depression was assessed with the non-somatic items of the CES-D. Quality of life had to be indicated on a Cantrill ladder. Fatigue and depression do not follow the same course over time. Just after radiotherapy, fatigue had either increased or remained stable, depending on the dimension under consideration. Depression, in contrast, decreased. Nine months later fatigue had decreased, whereas levels of depression remained stable. Concurrent relations between fatigue and depression were mostly moderate. There was no strong evidence for a cause-and-effect relationship between depression and fatigue. Depression showed highest concurrent relationships with quality of life, especially before treatment. Prospectively, depression and the dimension of physical fatigue were the main predictors for quality of life. Fatigue is not a valid criterion for depression in these patients. Nor is there a strong cause-and-effect relationship. Both depression and physical fatigue are relevant to patients' quality of life.