Enhancing students’ preparedness to care for older people: A mixed methods analysis

BackgroundNursing students’ positive attitudes towards ageing and older people are central to developing person-centred care. Perceptions about older people are influenced by social and generational values and beliefs, including a general understanding that older people need to be cared for. Nursing students often undertake early clinical placements in aged care settings, where residents’ needs are complex, yet the nursing experience is often considered ‘basic’ care. Illustrating that older people have rich personal histories and are valuable contributors to society can balance students’ perceptions and expectations and outcomes of clinical placements. Educational interventions using photo-elicitation and in-depth dialogue may surface students’ assumptions and challenge their misperceptions of older people before the first clinical placement.AimTo examine the impact of the innovative Depth of Field: Exploring Ageing © (DOF) resource as preparation for nursing students’ clinical placement in residential aged care facilities.MethodsMixed methods, block randomised controlled study with first year students. Students attending clinical laboratory groups received either usual preparation (control, n = 108) or DOF plus usual preparation (intervention, n = 99). Pre/post surveys included: Geriatric Attitudes Scale (GAS) and demographics. Eight students from the intervention group participated in focus groups post-clinical.FindingsGroups were similar at baseline. There were statistically significant changes following the intervention (p ≤ .05) for 9/13 individual GAS items and difference in overall mean scores (intervention group: M = 0.26; SD = 0.27; control group: M = 0.01; SD = 0.27). Focus group themes included: preconceptions toward older people; feelings of being emotionally unprepared; and perceptions of the DOF intervention in preparing students to connect with the older person.DiscussionThe DOF vignette provided opportunity for students to preflect on ageing. Translation to practice was evidenced with students seeing beyond residents’ physical care requirements to the value of connecting with the older person’s story to facilitate person-centred care.ConclusionsThe DOF intervention assisted students to adopt positive attitudes and a broader perspective of older people, as preparation for placement in residential aged care facilities.     

Advanced practice: A clinical or political issue?

Advanced practice is characterized by a greater degree of clinical competence, critical thinking and professional accountability in the areas of organizational management, decision-making and leadership. Advanced practice is praised in clinical and academic settings for its beneficial effects on peoples' health. However, the authors believe that advanced practice also confers specific (corporate) benefits, particularly with respect to acquisition of authority, credibility and legitimacy compared to, and in the eyes of, other health professionals. This article takes a critical look at the specialization phenomena in nursing and encourages dialogue on underlying motivations and the quest for professional status     

Evaluation of Postsurgical Hyperalgesia and Sensitization After Open Inguinal Hernia Repair: A Useful Model for Neuropathic Pain?

Cutaneous mechanical hyperalgesia can be induced in healthy volunteers in early phase analgesic studies to model central sensitization, a key mechanism of persistent pain. However, such hyperalgesia is short-lived (a matter of hours), and is used only for assessing only single drug doses. In contrast, postsurgical peri-incisional hyperalgesia may be more persistent and hence be a more useful model for the assessment of the efficacy of new analgesics. We undertook quantitative sensory testing in 18 patients at peri-incisional and nonoperated sites before open inguinal hernia repair and up to the 24th postsurgical week. The spatial extent of punctate hyperalgesia and brush allodynia at the peri-incisional site were greatest at weeks 2 and 4, but had resolved by week 24. Heat allodynia, suggestive of local inflammation or peripheral sensitization, was not observed; instead, there were deficits in cold and heat sensory detection that persisted until week 24. The findings suggest that central sensitization contributes significantly to mechanical hyperalgesia at the peri-incisional site. The prolonged duration of hyperalgesia would be advantageous as a pain model, but there was considerable variability of mechanical hyperalgesia in the cohort; the challenges of recruitment may limit its use to small, early phase analgesic studies.PerspectivePeri-incisional mechanical hyperalgesia persists for ≥4 weeks after open inguinal hernia repair and reflects central sensitization; this may have usefulness as a model of chronic pain to assess the potential of antineuropathic analgesics.     

Paper 1: Conceptualizing the Transition from Advanced to Consultant Practitioner: Career Promotion or Significant Life Event?

BackgroundThe diversification of nursing and allied health profession (AHP) roles has seen unprecedented growth as organizations have sought to optimize limited health care resources. Within the UK health care system, the nonmedical consultant is viewed as the pinnacle of the clinical career ladder. Yet, nearly 15 years after their introduction, recruitment to these positions remains slow. Criticisms of nonmedical consultant practice include a lack of role clarity, a failure to work across the four domains of consultant practice, a lack of suitable applicants, and poor preparedness of new appointments. Although there is evidence exploring the nature and effectiveness of established consultant roles, little research addresses the development phase of aspiring consultants.ObjectivesTo explore the transitional journey experienced by trainee consultant radiographers as they move from advanced to consultant practitioner within a locally devised consultant development programme.DesignLongitudinal qualitative enquiry.Methods and SettingsFive trainee consultant radiographers were recruited to a locally devised consultant practice development program within a single UK hospital trust. Semistructured interviews were undertaken at 1, 6, and 12 months with the trainees.ResultsA challenging journey was recounted involving five key emotional stages that occurred in a consistent and predictable order (ie, elation, denial, doubt, crisis, and recovery). The identified stages had close parallels with Hopson's Life Events model, suggesting that transition to consultant practice is a significant life event rather than a straightforward job promotion.ConclusionsCurrent emphasis on the four domains of practice, although providing a clear framework for expected external role outcomes, overlooks the importance of the internal or subjective career development on the perceived success or failure of the role. Employers, educators, and professional bodies have a responsibility to facilitate aspirational consultants to explore and enhance their internal career development, offering more time to define themselves and their role with support to guide them through the transition journey.     

Content validity testing of the ESAT©: A decision aid tool for performing endotracheal suction in children

Background and purpose

Endotracheal tube suction performed in children can affect clinical stability. Previous research has identified clinical indicators used to perform endotracheal suction. These were used to develop the Endotracheal Suction Assessment Tool^© (ESAT^©). This study sought to evaluate the degree to which the ESAT^© items as a whole constitute an operational definition of the construct used to determine whether a paediatric intensive care nurse should perform the endotracheal tube suction procedure.

A Review of: “Death and Grief: A Course for Nurses”

Abstract

The purpose of the study was to evaluate death attitude change among university students involved in a death education instructional unit within an introductory health education course. A quasi-experimental research design was employed. Pre-and post-tests of death attitudes, utilizing the Hardt Death Attitude Scale and the Watts-Andrews Death Attitude Questionnaire, were conducted in both the death education group (N = 39) and the control group (N = 40). A one-way analysis of covariance using pretest mean scores as the covariate showed significant posttest mean differences between the groups on both death attitude measures. Thus it was concluded that death-related attitudes can be favorably influenced as a result of a death education instructional unit within an introductory health education course.     

What Do Medical Students Do for Self-Care? A Student-Centered Approach to Well-Being

Phenomenon: Despite the promotion of medical student health and wellness through recent program and curricular changes, research continues to show that medical education is associated with decreased well-being in medical students. Although many institutions have sought to more effectively assess and improve self-care in medical students, no self-care initiatives have been designed using the explicit perspectives of students themselves. Approach: Using concept mapping methodology, the research team created a student-generated taxonomy of self-care behaviors taken from a national sample of medical students in response to a brainstorming prompt. The research team examined how students’ conceptualizations of self-care may be organized into a framework suitable for use in programming and curricular change in medical education. Findings: Ten clusters of self-care activities were identified: nourishment, hygiene, intellectual and creative health, physical activity, spiritual care, balance and relaxation, time for loved ones, big picture goals, pleasure and outside activities, and hobbies. Using results of the two-dimensional scaling analysis, students’ individual self-care behaviors were organized within two orthogonal dimensions of self-care activities. Insights: This concept map of student-identified self-care activities provides a starting point for better understanding and ultimately improving medical student self-care. Students’ brainstormed responses fit within a framework of varying levels of social engagement and physical-psychological health that included a wide range of solitary, social, physical, and mental health behaviors. As students’ preferred self-care practices did not often include programmatic activities, medical educators may benefit from consulting this map as they plan new approaches to student self-care and in counseling individual students searching for more effective ways to ease the burdens of medical school.     

Central Line–Associated Bloodstream Infections and Advanced Practice Providers: Identifying Opportunities for Prevention Efforts

Central venous catheters can be a vital part of patient care in the hospital setting but are at high risk of infection. Central line–associated bloodstream infections pose a high risk of morbidity, mortality, and increased hospital costs. The purpose of this project is to assess the practices and learning needs of advanced practice providers (nurse practitioners and physician assistants) in the provision of evidence-based care to patients with central venous catheters in the hospital setting. This can guide further educational initiatives for central line–associated bloodstream infection prevention.     

Predictive Importance of Antenatal Depressive Rumination and Worrying for Maternal–Foetal Attachment and Maternal Well-Being

Rumination and worrying are relevant to the onset and maintenance of depression and anxiety. Yet, it is unclear, whether depressive rumination and worrying are predictive for depressive and anxious symptomatology during pregnancy. Likewise, the potential role of depressive rumination and worrying for maternal–foetal attachment has been rarely explored. In the present longitudinal study, N = 215 pregnant women were assessed within the first 4 months of pregnancy and again in the last 4 months of pregnancy. Using regression analysis, associations between worrying and depressive rumination on the one hand and maternal–foetal attachment, depression and anxiety on the other were studied—controlling for age, number of children, social support and baseline antenatal depressive and anxious symptoms. Baseline rumination was a significant predictor of impairments in maternal–foetal attachment in later pregnancy. Baseline worrying was a significant predictor of heightened depressive symptoms and anxiety. These effects were of modest magnitude. Nonetheless, our findings reveal that different types of perseverative thinking (i.e., rumination vs. worry) might have differential effects on maternal well-being and maternal–foetal attachment.