Basic husbandry and common health problems associated with Mediterranean tortoises

ABSTRACT:

Knowledge of tortoise husbandry and welfare has come on by leaps and bounds in the past few years and nurses can now achieve much more in the education of clients in practice. The aim of this article is to provide and encourage implementation of a basic knowledge of tortoise husbandry. Common problems associated with poor husbandry will be included to enable the nurse to promote the welfare of these challenging patients.     

Hedgehogs – basic care and first aid

ABSTRACT:

This article gives a general overview on the basic care and first aid of hedgehog casualties for Veterinary Nurses in practice. It contains information on examination techniques, anaesthesia, common problems and their treatment, care of orphaned hoglets, feeding, husbandry and release.     

Problems No One Looked For: Philosophical Expeditions into Medical Education

Abstract

Issue: Medical education has “muddy zones of practice,” areas of complexity and uncertainty that frustrate the achievement of our intended educational outcomes. Slowing down to consider context and reflect on practice are now seen as essential to medical education as we are called upon to examine carefully what we are doing to care for learners and improve their performance, professionalism, and well-being. Philosophy can be seen as the fundamental approach to pausing at times of complexity and uncertainty to ask basic questions about seemingly obvious practices so that we can see (and do) things in new ways. Evidence: Philosophy and medical education have long been related; many of our basic concepts can be traced to philosophical ideas. Philosophy is a problem-creation approach, and its method is analysis; it is a constant process of shifting frames and turning into objects of analysis the lenses through which we see the world. However, philosophy is not about constant questioning for the sake of questioning. Progression in medical education practice involves recognizing when to switch from a philosophical to a practical perspective, and when to switch back. Implications: In medical education, a philosophical approach empowers us to “slow down when we should,” thereby engaging us more directly with our subjects of study, revealing our assumptions, and helping us address vexing problems from a new angle. Doing philosophy involves thinking like a beginner, getting back to basics, and disrupting frames of reference. Being philosophical is about wonder and intense, childlike curiosity, human qualities we all share. Taking a philosophical approach to medical education need not be an unguided endeavor, but can be a dialog through which medical educators and philosophers learn together.     

An integrative review of simulation,senior practicum and readiness for practice

Readiness for practice (RFP) is essential as new nurses will practice in a nursing shortage climate, with high acuity patients and complex technology. Nurse educators are challenged to foster readiness for practice.AimThe aim of this integrative review was to explore the impact of simulation and senior practicum on graduating senior nursing students' readiness for practice.BackgroundReadiness for practice has been a point of concern for healthcare for quite some time. This has led to a need for better understanding for what RFP means including their perceptions of various stakeholders. Further, it is important to address what teaching and learning strategies can be implemented to assist in ensuring the graduating senior nursing student is ready for practice on graduation and for their first professional practice. Readiness for practice is defined as the ability to safely and competently care for patients by synthesizing theory, skills, attitudes and values in applying clinical reasoning in practice settings.MethodAn integrative review identified 48 published papers on simulation and senior practicum that met the inclusion criteria.ResultsThemes identified from the senior practicum/preceptor literature included clinical reasoning, skills, barriers to the senior practicum and transition. Themes identified regarding simulation as a strategy included preparation, competence development, clinical reasoning and the number of human patient simulators used.ConclusionAlthough the evidence is not conclusive, simulation and senior practicums have the promise of preparing graduating nursing students for their first professional practice. However, nurse educators must ensure simulations are well-organized with clear objectives and that preceptors are supported in teaching and assessing students.     

Caprine care and capers!

ABSTRACT:

Many people are ‘feeling the pinch’ at the moment and backyard pets with a purpose, such as goats, are becoming more popular. Even in small animal practice, it is helpful to understand goat care. This article covers the key aspects of caprine husbandry, behaviour, diet, reproduction, legislation and welfare.     

Letter to the Editor: Fallacies in the Refutation of Causality

Abstract

In three patients with severe acute cyanide poisoning, a cyanosis was observed instead of the bright pink skin coloration often mentioned as a sign in textbooks. Treatment of cardiopulmonary insufficiency is as essential as antidotal therapy and the use of sodium nitrite and 4-DMAP is not without risk as, in practice, the methemoglobin-level induced is difficult to control.     

Missed infection control care and healthcare associated infections: A qualitative study

BackgroundResearch on missed nursing care reveals individual and systems failure. Research on infection control missed care is minimal.AimsInvestigate nurse perceptions of missed infection control.DesignQualitative in-depth interviews with 11 Australian infection control nurse experts.MethodsParticipants were asked whether nursing and hospital-wide care tasks fundamental to infection control were missed, and what were the underlying causes and contributing factors for these omissions. Qualitative data was mapped against fundamental nursing practice and Australian infection control guidelines.FindingsOmission of infection control care occur at the individual clinician and organisational level. Nurses describe failure to perform standard precautions as well as failure to perform basic care activities. Participants identified a range of institutional and cultural factors which contributed to cascade iatrogenesis resulting in healthcare associated infections for patients. Some factors are outside nurses’ control and include: environmental cleanliness; ward layout; ward culture; resourcing and staffing; integration of infection control into clinical governance; action following audit results; and reviewing evidence base of protocols.DiscussionCare occurs in complex and conflicted settings, with prioritisation essential. Potentially harmful practices are generally done with the intention of care. Nurses are key, but not sole performers in the creation of quality infection control.ConclusionMapping missed care related to infection control against standard frameworks of nursing practice revealed “gaps in the chain of infection” that contribute to “cascade iatrogenesis” with negative outcomes for patients.     

Information and communication in the emergency department

BackgroundEffective communication between healthcare providers and patients represents an important caveat in healthcare, both nationally and internationally. Providing information to patients about their care and condition can be challenging, particularly in demanding, time-pressured environments such as the Emergency Department (ED). Understanding the process of communication and information between patients and staff in the ED is essential to ensuring patients are satisfied with their treatment and care.AimThis study aimed to develop a holistic understanding of the informational and communicational requirements of patients and staff in the ED.MethodsAction Research involving patient qualitative interviews and a staff focus group were used.ResultsFifteen patient and family interviews identified four main themes associated with information and communication in the ED. Six ED staff participated in the focus group, which identified three emergent themes echoing some findings from the patient qualitative interviews.DiscussionMeaningful and informative interactions between patients and healthcare providers are an imperative and pragmatic component of a positive patient experience. Establishing communicative procedures that are practical, functional and reflective of the service can improve communications between patients and staff and have implications for practice on a local, national and international level.     

Online Module Builds Skills for Internal Medicine Interns in Responding to Emotions During Complex Serious Illness Conversations

ContextResponding to emotion cues is an essential skill for communicating with patients and families, but many health care trainees have difficulty applying this skill within the context of a complex conversation.ObjectivesWe created an original online module to facilitate deliberate practice of a three-skill framework for responding to emotion cues during complex or nonlinear serious illness conversations.MethodsOur original online module uses a gamebook format, which prompts trainees to engage in focused and repetitive practice of three well-defined skills for responding to emotion cues in a simulated family conference. We implemented the module as a part of a communication skills curriculum for interns rotating in the intensive care unit. After completing the module, all interns answered an open-ended survey question about their perceived skill acquisition. Results were analyzed by a qualitative method and coded into themes.ResultsAbout 71% of interns (n = 65 of 92) completed the online module and open-ended survey question. About 89% of participants responded that they would use a naming, understanding, respecting, supporting, or exploring statement in response to an emotion cue. Nearly two-thirds of participants articulated their rationale for using naming, understanding, respecting, supporting, or exploring statements (e.g., preparing patients to process complex medical information, eliciting information about patient perspective.)ConclusionOur online emotion cue module is a novel tool for deliberate practice of advanced skills for responding to emotion cues in serious illness conversations. In future studies, we will investigate whether our module's efficacy is enhanced by using it as a part of a flipped classroom curriculum with an in-person simulation session.     

Are physiotherapists comfortable with person-centred practice? An autoethnographic insight

Abstract

Purpose: This study aimed to understand our shared conflicting response and discomfort to person-centred rehabilitation within the context of our physiotherapy rehabilitation culture by reflecting on our own experiences as research physiotherapists and clinicians. Method: This study used autoethnographical methods to explore the personal and professional experiences of two physiotherapists in neurological rehabilitation. Data were collected through ten written reflections and five joint discussions. The data were analysed collaboratively through focused conversations and writing. We looked for patterns in our data and the literature to triangulate our findings. Joint narratives were structured based on three headings: Where we have come from, Challenges to our position and Where we are now. Results: The four main topics of discussion were goal setting, hope, the physiotherapy paradigm and person-centred practice. Physiotherapy practice is typically underpinned by a biomechanical discourse, which separates the mind and the body. This paradigm limits our ability to manage aspects of person-centred practice, such as valuing patient preferences, fostering hope, managing expectation and building a positive therapeutic relationship. Conclusion: Awareness of existing influences on theory and practice is necessary to move the physiotherapy profession towards a greater degree of understanding and application of the principles of person-centred practice.

• Implications for Rehabilitation

• Physiotherapists need to recognise that our clinical practice is currently dominated by a biomechanical perspective, which limits our adoption of person-centred practice.

• Our usual way of working as an expert focuses on our own perspective that makes it difficult to work in a person-centred way. Strategies to incorporate a more person-centred approach include using communication strategies that help us actively seek patients’ perspectives.

     

Observation of the effect of one-to-one education on high-risk cases of diabetic foot

BACKGROUNDDiabetes is a common chronic disease, and its global incidence is on the rise. The disease is directly attributed to insufficient insulin efficacy/secretion, and patients are often accompanied by multiple complications. Diabetic foot is one of the most common complications of diabetes. Diabetic feet have ulcers and infections, which can eventually lead to amputation. Basic nursing care, such as lowering blood pressure and preventing foot skin infections in clinical nursing work, has positive significance for the prevention and control of diabetic feet.AIMTo explore the positive significance of one-to-one education in high-risk cases of diabetic foot.METHODSThis observation included 98 high-risk cases of diabetic foot in our hospital during the period from August 2017 to October 2019, and these patients were randomly divided into the basic nursing group and the one-to-one education group with 49 patients per group. The basic nursing group only received routine basic nursing, while the one-to-one education group gave patients one-to-one education on the basis of basic nursing. After nursing, the self-care ability and compliance behavior of the two groups were evaluated and compared between these two groups. The knowledge mastery of the patient and the satisfaction of nursing were accounted.RESULTSThe assessment results of patients (self-care responsibility, self-care skills, self-concept and self-care knowledge) were significantly higher in the one-to-one education group than in the basic nursing group. The scores of compliance behaviors (foot bathing, shoes and socks selection, sports health care) in the one-to-one education group were significantly higher than those in the basic nursing group. Patients in the one-to-one education group had a significantly higher level of knowledge mastery and satisfaction of nursing than the basic nursing group.CONCLUSIONOne-to-one education for high-risk cases of diabetic foot is helpful to improve the cognition and self-care ability of patients with diabetic foot, to ensure that patients follow the doctor’s advice of self-care and to improve their nursing satisfaction.     

Ultrasound-assisted triage of ankle trauma can decrease the need for radiographic imaging

BackgroundAn ankle sprain is a common injury, and patients are usually examined with plain radiographs to rule out a fracture despite the fact that only a small minority actually have one.PurposeTo investigate if ultrasound (US)-guided triage can decrease the need for radiographic imaging in patients with ankle trauma.HypothesisOrthopedic surgeons can use point-of-care US with limited training to triage ankle trauma that requires standard radiographs.MethodsSeven junior orthopedic surgeons underwent a 30-minute standardized training session using a basic US musculoskeletal examination designed to exclude ankle fractures.One-hundred twenty-two patients with ankle trauma were included at the emergency department and underwent clinical investigation, including examination according to the Ottawa ankle rules as well as US and standard ankle radiographs. In this study group, radiographs identified 23 significant fractures. Ultrasound-guided triage could not exclude a fracture in 37 patients. All of the 23 fractures seen on radiographs were among the 37 patients where US could not rule out a fracture. Ottawa ankle rules managed to exclude the need for radiographs in 28 of the 122 patients, whereas 85 who underwent the US-guided triage could have avoided a radiograph. Avulsion fractures at the tip of the fibula were not considered significant.ConclusionThis study demonstrates that with limited standardized training a junior, an orthopedic surgeon is able to use US-guided triage during the primary examination at the emergency department to exclude at least significant ankle fractures. This practice could decrease the need for radiographic imaging, avoiding a mandatory radiographic investigation in many patients with ankle trauma. It would also make it possible to treat many patients with ankle trauma more rapidly and to reduce costs and radiation exposure.     

Exploration of the graduate nursing program in a forensic mental health setting: A qualitative enquiry

BackgroundForensic mental health nursing is a specialised practice area. Graduate programs are essential for recruitment and retention. There have, however, been very few studies exploring forensic mental health graduate programs.AimThe aim of this study was to explore the experience of graduate nurses who completed a 2-year graduate program in a forensic mental health service in the state of Victoria Australia, and the nurses who support the graduates in the program.MethodsAn exploratory study was conducted gathering data via one-to-one interviews, with purposive sample of 20 forensic mental health nurses.FindingsAnalysis resulted in the interpretation of two themes; essential ingredients and ‘hitting hurdles’.DiscussionGraduate nurses commence with limited knowledge, experience challenges, and organisational pressures.ConclusionTransition to practice was enhanced with consistent support, university education, and program structure.     

Organ donation education initiatives: A report of the Donor Management Task Force

PurposeIt is essential that hospitals and health professionals establish systems to facilitate patients' organ donation wishes. Donation education has been neither standardized nor systematic, and resources related to donation processes have not been widely accessible. This report describes 2 free, publicly available educational resources about the organ donation process created to advance the mission of basic education and improve donation processes within hospitals and health care systems.Materials and methodsMembers of the Donor Management Task Force of the Organ Donation and Transplantation Alliance (the Alliance) and the Health Resources and Services Administration of the US Department of Health and Human Services convened annually in person and by teleconferencing during the year to develop 2 educational vehicles on organ donation.ResultsTwo educational products were developed: the Organ Donation Toolbox, an online repository of documents and resources covering all aspects of the donation process, and the Educational Training Video that reviews the basic foundations of a successful hospital donation system.ConclusionsThere is a need for more research and education about the process of organ donation as it relates to the medical and psychosocial care of patients and families before the end of life. The educational products described can help fill this critical need.     

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

BackgroundPoint-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs).AimTo explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process.Design and settingQualitative study conducted in office-based general practice in Denmark.MethodsSemi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study.ResultsThe participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training.ConclusionThis study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills.

Key points

• Little is known about the educational needs of general practitioners striving to achieve ultrasound competences.
• General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills.
• Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.

     

Exploring how Australian occupational therapists and physiotherapists understand each other’s professional values: implications for interprofessional education and practice

Abstract

This article provides insight into the values Australian occupational therapists and physiotherapists consider essential for their practice and the values that they perceive as important for each other. Findings from a study that employed the Delphi technique to identify the values occupational therapists and physiotherapists consider essential for their practice were compared with interview results that provide insight into how these professionals perceive one another’s values. The results from this comparison indicate that occupational therapy and physiotherapy participants have limited knowledge of each other’s values. This is evidenced by participants only identifying a minority of the values considered essential within the other profession and not identifying many of the values that guide daily practice within the other profession. The results hold implications for interprofessional education and practice, where knowledge of the values of other professions in the team is essential. To enable interprofessional collaboration, professions need to make their values explicit and provide their students, practitioners and educators with opportunities to learn about their own values and the values of other professions.     

Fatigue and pain limit independent mobility and physiotherapy after hip fracture surgery

Purpose: The patient’s ability to complete their planned physiotherapy session after hip fracture surgery has been proposed as an independent predictor for achieving basic mobility independency upon hospital discharge. However, knowledge of factors limiting mobility is sparse. We therefore examined patient reported factors limiting ability to complete planned physiotherapy sessions as well as limitations for not achieving independency in basic mobility early after hip fracture surgery.

Methods: A total of 204 consecutive patients with a hip fracture (mean (SD) age of 80 (9.9) years, 47 patients were admitted from a nursing home) were treated in accordance with a multimodal program. The Cumulated Ambulation Score was used to evaluate the patient’s independency in three basic mobility activities: getting in and out of bed, sit-to-stand-to-sit from a chair and indoor walking. Pre-defined limitations; pain, motor blockade, dizziness, fatigue, nausea, acute cognitive dysfunction and “other limitations”, for not achieving a full Cumulated Ambulation Score or inability to complete planned physiotherapy sessions were noted by the physiotherapist on each of the three first postoperative days. This period was chosen, because of its importance on how well the patients had regained their pre-fracture functional level.

Results: Fatigue and hip fracture-related pain were the most frequent reasons for patients not achieving an independent basic mobility level (>?85%) or not fully completing their planned physiotherapy (>?42%) on all three days. At hospital discharge (median day 10), only 54% of the patients had regained their pre-fracture basic mobility level.

Conclusion: Based on the patient’s perception, fatigue and pain are the most frequent limitations in not achieving independent basic mobility and not completing physiotherapy after hip fracture surgery. This raises questions whether multimodal peri-operative programs can be further optimized to enhance the early recovery of these frail patients.

• Implications for rehabilitation

• Early postoperative mobilization is essential for patients undergoing hip fracture surgery to regain the pre-fracture functional level, in not only the short but also in the long term.

• The most frequent reasons for not achieving an independent Cumulated Ambulation Score or completing physiotherapy, early after hip fracture surgery, are fatigue, pain, and the habitual cognitive status of patients.

• Knowledge concerning postoperative fatigue is important for rehabilitation professionals and should contribute as an essential factor when planning physiotherapy.