Does non-medical prescribing make a difference to patients?

This article examines the literature on non-medical prescribing to establish its impact on UK healthcare. It discusses how better access to medication through non-medical prescribing can improve patient safety and patient-centred care, and how nurse prescribing can help ensure quality of care in the NHS during the current financial crisis.     

Can education make a difference to undergraduate nursing students' attitudes to psychiatric nursing?

The introduction of undergraduate nursing education throughout Australia has had serious implications for the position of psychiatric nursing in attracting graduates into this field. There is some evidence from the results of limited research that a more positive view of psychiatric nursing can emerge as the result of education. However, such a relationship has not been found to be strong. This paper reports the findings of a quasi-experimental research study, which compared student nurses' attitudes towards psychiatric nursing as a career option both before and after completing the psychiatric nursing component of the course. The post-test results demonstrate a strong and statistically significant increase in the popularity of psychiatric nursing. Analysis of the open-ended responses suggests that exposure to the theory and practice of psychiatric nursing has dispelled many myths regarding this area of practice. The possible impact of problem-based learning on these results is discussed.     

Education in palliative care: making a difference to practice?

This article presents part of a multiphase evaluation project, which aims to investigate the effectiveness of a number of palliative care educational programmes provided by a hospice education network in the north of England. Information is reported from four cohorts of students (n = 46) who undertook courses between October 1998 and April 2000. Particular emphasis was placed on the views of students and whether education made a difference to their clinical practice. An action research approach was used which asked the question 'Does education develop competent confident practitioners, who are able to initiate changes in their practice?' Early indications suggest that education does make a difference to practice. Students reporting feeling more confident, having a greater knowledge of palliative care and being more skilled in caring for patients and their families. Furthermore, students have made recognizable changes to their practice, some of which are detailed here.     

Schizophrenia,Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and number needed to treat: how can CATIE inform clinicians?

The schizophrenia medication study conducted as part of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) provided a large quantity of data. However, placing these data into a clinically meaningful context for the individual practitioner has been challenging. Effectiveness and safety outcome data were extracted from the three principal publications that documented the results of phases 1 and 2 of the CATIE schizophrenia study. Number needed to treat (NNT) and number needed to harm (NNH) were calculated from the categorical results, together with their confidence intervals. Olanzapine and clozapine demonstrated advantages over comparators in terms of all-cause discontinuation, largely driven by efficacy advantages. NNT for olanzapine compared with perphenazine, quetiapine, risperidone and ziprasidone ranged from 5.5 to 10.1 in phase 1. NNT for clozapine compared with risperidone or quetiapine was approximately 3 in phase 2. There were marked differences in association with weight gain and metabolic effects, with olanzapine demonstrating a NNH ranging from 12.4 to 17.7 in terms of discontinuation of treatment in phase 1 because of these effects. Results from phase 2 reflect phase 1 in this regard, and demonstrated an advantage for ziprasidone in terms of discontinuation because of weight gain or metabolic effects, with NNT ranging from 10.6 to 20.8. However, these notable differences in association with weight gain and metabolic effects did not seem to drive the differences in overall time to all-cause discontinuation. NNT and NNH can help place the wide array of CATIE results into clinical context, and permits quantification of the differences observed between the antipsychotics that were tested.     

Summary measures of number needed to treat: How much clinical guidance do they provide in neuropathic pain?

Background: Several systematic reviews of randomized controlled trials (RCTs) of drugs to treat neuropathic pain have reported summary estimates of efficacy – specifically, the number needed to treat (NNT). Aims: To examine whether summary NNTs for drugs to treat neuropathic pain provide useful guidance for clinical decision making. Methods: We examined the methods used to pool data across RCTs in systematic reviews – in particular, the extent of heterogeneity of agents (and dosages), neuropathic pain syndromes, and outcome measures. Results: Published summary estimates of NNTs of drugs to treat neuropathic pain embody substantial heterogeneity, in that they reflect a pooling of data across agents with different mechanisms of action, across patients with different neuropathic pain syndromes, and/or across different outcome measures. Conclusions: Summary NNT estimates may have limited clinical relevance, due to problems of heterogeneity. The most that can be extracted from systematic reviews published to date is the identity of drugs that have demonstrated efficacy for specific types of neuropathic pain, and the strength of such evidence.     

Are mentors ready to make a difference? a survey of mentors' attitudes towards nurse education

This paper reports on a survey of practitioners who act as mentors to student nurses from a Higher Education Institution in Northern England. The aims of the survey were to gain a profile of mentors, and to seek their views regarding their degree of support in undertaking the mentoring role, and their experience of mentors' update sessions. Respondents were experienced as mentors. As a group, they felt supported by their work colleagues, but fewer felt that they had adequate support from the HEI or their managers. Respondents wanted more time for mentoring activities, closer links with the HEI before, during and after practice placements, and more user friendly assessment documentation. Respondents did not report difficulty in spending enough time working with students, although this is a frequent complaint of students. Mentors update sessions were often not attended, either through staff shortages, or through lack of information.     

Pre‐registration education: making a difference to critical care?

This paper aims to discuss the development of a pre-registration high-dependency nursing programme and evaluate its effects on student's perceived learning and confidence in managing critically ill patients. The programme consists of two modules that compliment one another, 'Care of the Acutely III Adult' focuses on a variety of disease processes and subsequent nursing care. Whilst the second module titled 'Caring for the Highly Dependant/Critically III Adult' focuses on assessment skills related to critically ill patients. The paper explores the content and delivery of the modules including the advantages and disadvantages of implementing them. Student evaluation from 59 nursing students found that student's knowledge, assessment skills and management of the critically ill patient had improved since completing the modules. Nurse Consultants, intensive therapy unit matrons and Critical Care Outreach nurses have acknowledged an increase in the number of nursing students identifying and referring critically ill patients to outreach teams. They also stated improvements in nurse recruitment in critical care since commencement of the modules.     

Do interventions make a difference to bereaved parents? A systematic review of controlled studies

The provision of bereavement support for parents who have lost a child is based on the assumption that it will lead to better subsequent adjustment. To determine the validity of this assumption, a systematic review of studies was undertaken, looking at bereavement support programmes for parental grief between 1990 and 2001. This review focused on controlled studies. The exclusion of non-controlled studies, case studies and those using only participant evaluation as an outcome measure, left only three studies. No overall benefit for the interventions was shown. However, for highly distressed mothers, psychological symptoms and marital dysfunction were significantly reduced. Disparities in the findings, such as the effects of interventions on fathers, may be explained by flawed methodology. Applied to practice, these findings suggest that only some bereaved parents benefit from bereavement support programmes. A targeted approach may therefore be the best use of resources.     

Self and peer assessment – does it make a difference to student group work?

The use of group projects as an assessment strategy is increasing in popularity in education. However problems can arise if members of the group do not contribute equally to the process and required outcome. Self and peer assessment has been advocated as one means of overcoming the problem of `free riders'. A review of the literature would suggest that the vast majority of research in the area of self and peer assessment has been carried out in disciplines other than nursing and midwifery. This paper provides a brief overview on the available literature on self and peer assessment and reports on an action research approach to the development and evaluation of a self and peer assessment strategy, designed to promote student participation in a group project. While further research is needed to substantiate the findings, the results support its continuing use within the programme. To aid the lecturer who is new to self and peer assessment and who may wish to pursue the idea within their own programme the assessment tool and guidelines used in the project are also included.