Routine antenatal anti‐D prophylaxis – is the protection adequate?

Background/Aims: Prophylactic anti‐D given during pregnancy can be detected in current indirect antiglobulin tests (IAT). Using this to measure the persistence of prophylactic anti‐D, this study set out to determine whether there is an association between anti‐D detectable at delivery and the RhD status of the foetus and/or the duration of the pregnancy post the standard 28 week dose of routine antenatal anti‐D prophylaxis (RAADP). The study also investigated the detection rates of anti‐D at delivery when given in a two dose regime or a one dose regime. Method: All IAT screening was undertaken using fully automated Diamed gel technology. The results from 407 women were included in the two dose regime study, and 157 in the one dose regime study. Results: 160/407 (39%) women receiving one dose of prophylactic anti‐D had no detectable anti‐D at delivery. 123/157 (78%) women on the one dose regime had no detectable anti‐D at delivery. No association was found between detectable anti‐D at delivery and the RhD status of the infant in either study arm. A strong association was found between detectable anti‐D Ig at delivery and the duration of the pregnancy post the 28 week dose in each study arm. Conclusion: Our data show that neither the two dose nor the one dose regime appear to provide adequate cover at delivery for a large percentage of pregnant women. This appears to be associated with the duration of the pregnancy past the 28 week dose but not associated with the RhD status of the foetus.     

Assessing children's spirituality: what is the way forward?

This article identifies the difficulties facing nurses working with the spiritual experiences of children. There is a lack of literature and education available in this field and as a consequence paediatric nurses are forced to use adult-based research. The benefits, as well as the drawbacks of this approach, are examined. In doing so it is hoped that the article might generate debate and discussion as to how to address this valued but under-investigated area of nursing practice.     

Audit or research – what is the difference?

• ? Audit and research are activities which have some characteristics in common and others which are rather different.
• ? This paper presents working definitions of each process and then examines their attributes and interrelationships in some detail.
• ? Areas covered include their purposes, what types of process they are, their theoretical bases, the methods used in each, sampling, the use of findings, confidentiality and the time frame of each.
• ? If nurses are to use or undertake research and/or audit appropriately in their practice, it is important that the similarities and differences between the two are clear.

     

Bed‐rest post‐femoral arterial sheath removal – What is safe practice? A clinical audit

Numbers of patients undergoing coronary angiography and angioplasty procedures have increased in England due to targets within the National Service Framework for Coronary Heart Disease. Little evidence is available regarding optimal bed-rest duration for patients post-femoral arterial sheath removal following these procedures. Through literature review and clinical benchmarking, we aimed to identify what best practice was in the UK and whether bed rest times at our centre could be reduced without increasing complications to enable increased day case procedures. An audit tool was designed to collect data regarding method of obtaining haemostasis, length of bed-rest post-sheath removal and any post-procedural complications experienced by the patient. From a convenience sample of consecutive patients, 195 complete sets of baseline data revealed an average (median) period of 6-h bed rest. This was reduced to 3h and audit repeated yielding 176 complete data sets using the same audit tool. Femoral wound site complication rates were not significantly affected by reducing bed-rest time for diagnostic or interventional procedures. These findings contributed to an important change in practice, reducing length of stay post-procedure and should be re-explored due to increased use of femoral arterial closure devices.     

Caffeine as a promoter of analgesic‐associated nephropathy – where is the evidence?

Individual groups of nephrologists - in their responsibility for their patients - initiated a most controversial discussion whether or not caffeine - coformulated to analgesics - might initiate or sustain analgesic overdosing. The original sources (data) of such suspicion have got lost during the debate of the last two decades. Therefore, it seemed to be appropriate to investigate the original data background and the reasons why nephrologists started to suspect caffeine as a stimulant of analgesic overdosing by employing a systematic and exhaustive review of primary nephrological publications. Their selection followed a precise selection plan, including all epidemiological studies on analgesic-associated nephropathy, the original papers of all groups having been involved in those studies, further originals from the mainly involved countries (academically, politically), and any literature thereof cited as a proof. The following results emerged from the investigation: (i) The epidemiological studies warranted no conclusion about a role of caffeine in prompting excessive analgesic use. (ii) The identified groups of nephrologists provided not substantial data to advocate the said suspicion, except for the observation of a preferential choice of phenacetin-containing combinations, especially powder preparations. (iii) Only two cited original data sources revealed drug-seeking behaviour with phenacetin-containing preparations which subsided, after phenacetin was banned from the respective markets. Conclusively, it appears that there is no substantial data to support a pivotal role of caffeine in initiating or sustaining analgesic overdosing. However, there is strong data that phenacetin, by its psychotropic properties, may have caused drug-seeking behaviour and thus led to analgesic overdosing. This conclusion is convincingly supported by thorough pharmacokinetic investigations. Note: All caffeine-related statements within the reviewed literature have been collected in tables (referred to as Table SX) which are provided in full text for check on the following website: http://www.blackwellpublishing.com/products/journals/suppmat/FCP/FCP174/FCP174sm.htm     

Embracing healthcare technology – What is the way forward for nurse education?

Digital technology is regarded as increasingly important in the provision of safe, consistent and optimal health care in the future. However considerable challenges exist in relation to how it can best be used and integrated to support, transform and facilitate user engagement and provide individualised care. Many forms of digital health technology exist already that have improved diagnosis and treatment in terms of early diagnosis and treatment. That said, healthcare, and nursing in particular, remains largely at the periphery of the digital technology transformation and as a result is failing to capitalise on its potential for improving health care and services. Awareness of the level of change in terms of professional and cultural ideology is needed when introducing technology in health care. Participation in the introduction, adaptation and acceptance process by all staff using soft and hard data to create a vision, set clear goals and develop a mutually agreed implementation strategy is essential for success. A positive approach by management towards the use and benefits of digital technology for improving and transforming healthcare in conjunction with education support has been effective in some UK and US projects. Education needs to commence at undergraduate level and continue across the nursing career trajectory. This will help nurses to re-conceptualise how both patients and health care professionals can benefit and that technology can serve to enhance and support patient centred communication rather than limit it.     

Good work – how is it recognised by the nurse?

Aim. The aim of this paper is to shed light on how nurses describe situations that reflect achievement and provide confirmation that they have done good work. Background. Nurses’ recognition of good work does not seem to have been the object of direct investigation, but is indirectly reflected in studies focusing on nurses’ perceptions on work environments and the multifaceted nature of nursing. However, acknowledging high‐quality performance in professional nurses can facilitate nurses in maintaining and strengthening the goals and values of the profession. This in turn can help nurses shoulder the multifaceted responsibilities they have to patients and next of kin. Design. This paper is part of the Professional Learning in a Changing Society project, Institute of Educational Research, University of Oslo, funded by the Research Council of Norway. The project involves four professional groups. This paper, however, focuses on a group of 10 nurses, nine of whom work in hospitals and one in an outpatient clinic. A qualitative approach was chosen to gain insight into how nurses, as well as the other professional groups in the project, engage in processes of knowledge production and quality assurance work. Methods. Data presented in this paper derive from semi‐structured in‐depth interviews conducted during spring 2005 and focuses on the recognition of good work. Results. The following themes were identified as essential in confirming that one did good work: securing fundamental needs of patients and next of kin; managing the flow of responsibilities; positive feedback. Conclusions. Good work seems to be related to specific situations and a sense of achievement by the respondents. Relevance to clinical practice. Recognition of good work is not only rewarding and enjoyable; it may also serve as a source of consciousness raising for professional and ethical guidelines in the work place.     

Role boundaries – research nurse or clinical nurse specialist? A literature review

This paper focuses on issues relating to the role components of clinical nurse specialists and clinical research nurses working in breast cancer care. Identified issues relate to the lack of agreement as to the role and definition of clinical nurse specialists. At the same time there has been an increase and emergence of clinical research nurses, both within the NHS and university departments. The review fails to reveal the relationship between these two specialist groups in terms of role overlap and role boundaries. The lack of knowledge in this area substantiates the need for further research to be carried out.