Sharp debridement: the need for training and education

Until recently there has been a lack of courses demonstrating how to undertake sharp debridement. The clinical governance framework has highlighted that nurses frequently perform the procedure without having received formal education and training (Fairbairn et al, 2002). Clinical governance, which includes risk management, clinical audit and evidence-based practice, aims to help all clinicians to improve quality and safeguard standards of care. The framework seeks to ensure that health professionals have the right training, skills and competencies to deliver the care needed by patients.     

Evaluating interprofessional education: the tautological need for interdisciplinary approaches

This paper explores some issues associated with evaluating interprofessional education (IPE) programs. It proposes options that harness the synergy made possible through interdisciplinary and multi-method approaches. Both qualitative and quantitative research approaches are suggested. It is argued that traditional, control group experimental designs may not be adequate, appropriate or reasonable as the sole means of evaluating interprofessional education. The example of the four-year Rural IPE (RIPE) project, from southeastern Australia, is provided to suggest ways to identify indicators and implement features of successful IPE programs. It offers an interdisciplinary approach to measuring the effectiveness of IP programs. A particular focus is the use of self-assessment to both monitor and promote structured reflective learning and practice. Sample triangulatory data are presented from a range of evaluation methods collected from the RIPE project. The results suggest evidence of some significant educational gains as a result of this intervention. The data, the methods and the analyses may be useful for others interested in implementing or strengthening interprofessional education. The paper suggests a judicious, customized and balanced blend of methods and methodologies may offer more useful ways forward than relying on single method controlled studies which are, in any case, rarely feasible.     

Alcohol education for patients: some nurses need persuading

Nurses form the largest group of health care workers and given their repeated contact with patients are in a good position to develop their health education role. Alcohol is the third major cause of morbidity and mortality and alcohol education is an important part of patient care. As part of a prospective study to assess the effects of early identification and education for those patients drinking to excess, we assessed nurses' attitudes towards screening patients for alcohol related problems, their knowledge of what constituted harmful drinking and their views on alcohol education for those at risk of harming their health. While nurses themselves were receptive to alcohol education a sizeable proportion remained unconvinced of the long term benefits of education for those who drink to excess. Alcohol researchers and health education still have some way to go in persuading health professionals of the benefits of incorporating health education into their everyday practices.     

Quality in post-basic nurse education: the need for evidence-based provision

BACKGROUND: As one means of addressing the problem of providing high quality health care within a context of diminishing resources, the British National Health Service (NHS) has promoted the concept of evidence-based clinical care. In order to integrate this concept effectively within routine practice, nurses need a sound knowledge of fundamental research methods. Unfortunately, the research skills courses that have been provided have typically relied on assumption to determine course content and chance factors for recruitment. Unsurprisingly, such haphazard provision is highly wasteful of resources, targeting neither the real skill deficits of the workforce nor the personnel most in need of this type of training. AIM: To demonstrate a more systematic approach to identifying the skill deficits of any specified workforce. METHODS: A survey was conducted with a random sample of nurses, who covered a range of grades and clinical specialities, using a psychometrically valid and reliable training needs analysis tool. FINDINGS: The results revealed both common training needs as well as skill deficits pertinent to a given locality and clinical area. CONCLUSIONS: Using more objectively derived information affords the commissioning of customized research skills courses that have the capacity to meet the needs of both the local organization and its employees. In this way, limited training budgets can be more effectively targeted.     

Dysphagia, medicines and older people: the need for education

Dysphagia is particularly common in elderly patients and may contribute towards difficulties in swallowing solid dose medications. Two recent community surveys have revealed that the problem might be more prevalent in primary care than previously thought. The community nurse is particularly well placed to help identify patients with dysphagia and provide appropriate support and advice.     

Osteoporosis in persons with spinal cord injury: the need for a targeted therapeutic education

Fattal C, Mariano-Goulart D, Thomas E, Rouays-Mabit H, Verollet C, Maimoun L. Osteoporosis in persons with spinal cord injury: the need for a targeted therapeutic education.

Objectives

To identify circumstances surrounding the onset of fracture and common risk factors in persons with spinal cord injury (SCI) and to suggest an alternative or complement to the pharmacologic approach by evaluating the need for a prospective study based on the impact of a targeted therapeutic education on risk management of fractures in this population.

Design

Retrospective study.

Setting

Hospital and Rehabilitation Center Setting.

Participants

Women (n=7) and men (n=25; N=32; with ≥1 fracture after the initial SCI that occurred at home or in a hospital setting; mean ± SD age, 53±12y at the time of clinical review) with bone mineral density (BMD) measurements.

Interventions

Not applicable.

Main Outcome Measures

Demographics, main circumstances of onset, and complications of fractures, as well as transversal bone mineral density evaluation.

Results

Nine patients had more than 1 fracture and 23 patients had only 1 fracture (total, 43 fractures; mean age at onset of fracture, 49±12y; median time since injury, 13.9y; mean delay in diagnosis, 6.5±15d). Fractures occurred mostly in the lower limbs. The circumstances of onset of these fractures were different and very stereotyped. In 3 cases, no trauma was reported. The most frequent mechanisms identified were forced maneuvers by the patient or a third party and falls. In 10 cases, the fracture occurred during a wheelchair transfer with forced maneuver or a fall from the wheelchair. Twenty-five patients were confined to bed after the fracture (mean duration of bed confinement, 18±28d; range, 0–120d). Postfracture follow-up showed that for 43 cases of fractures, 19 had at least 1 orthopedic complication, 15 had local complications, and 23 had general complications. Patients (23 of 32) benefited from dual-energy X-ray absorptiometry to assess BMD a few months or years after the fracture (mean femoral neck BMD, 0.574±0.197g/cm²; mean femoral neck T score, −3.8±1.5).

Conclusion

With this retrospective analysis of common risk factors and circumstances of onset of secondary fractures, there is a clear future for a prospective study to evaluate the impact of targeted therapeutic education on risk factors for secondary fractures in patients with SCI.