Learning from history: Frances Gillam Holden,a leadership perspective then and now

BackgroundCritical evaluation of leadership styles through a historical lens is uncommon. There could be missed opportunity for current and emerging nurse leaders to critically evaluate the leadership styles of the past in order to discerningly reflect on their own current leadership.AimTo critically examine the work of Australian nurse Frances Gillam Holden as she developed her vision for servant leadership for nursing in Australia in the late 19th century.MethodsExploration of, and critical reflection on, literature outlining Frances Gillam Holden's work.FindingsHolden's work and experience demonstrate the challenges faced by the profession's leaders at the turn of the century as they attempted to negotiate new ‘scientific’ knowledge and integrate this into nursing leadership. An examination of Holden's experience also demonstrates the difficulties faced by Australian nurse leaders during this time and consideration is given to what leadership in nursing looks like in the present day.DiscussionWithin the wealth of historical narratives, along with their complexities, the impact of this knowledge can have a demonstrated effect that can be far reaching and long lasting. This is particularly evident in regard to the role of nurses, nursing, and the development of modern approaches to nursing leadership, particularly with regard to the rise of nurse leaders in the form of ‘e-nurses’ and the use of social media to inform and lead the profession.ConclusionUnderstanding the influence and impact of nursing history, and historical nursing leaders such as Holden, on current leadership practices is being recognised more as contributing to contemporary nursing identity.     

Starting up adolescent canine and feline nurse clinics

ABSTRACT:

This article focuses on adolescent nurse clinics, designed for pets of around four to five months of age. It discusses the pets familiarisation to the practice environment, as well as the importance of client education on young pets; and examines what should be covered in the clinics, and how to set them up and advertise them to clients. As the article shows, carrying out adolescent nurse clinics can be very rewarding and positive for the practice.     

Care of guinea pigs

ABSTRACT:

This article covers all aspects of husbandry and nutrition, enabling the veterinary nurse to feel confident in advising owners about the correct care of guinea pigs. It describes signs of health, allowing the nurse to conduct an examination in a nurse's clinic and be able to recognise the first signs of disease. The last section covers nursing of the sick guinea pig, enabling nurses to care for guinea pigs in the clinic, and give advice to owners about how to nurse their pets at home.     

Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: Descriptive comparative study

ObjectiveComparison of nurse involvement in end of life decision making in European countries participating in ETHICUS I- 1999 and ETHICUS II- 2015.MethodologyThis was a prospective observational study of 22 European ICUs included in the ETHICUS-II and I. Data were collected as per the ETHICUS-I and ETHICUS-II protocols. Four questions within the ETHICUS protocols related to nurse involvement in end of life decision making were analyzed. This is a comparison of changes in nurse involvement in end of life decisions from 1999 to 2015.SettingInternational e-based questionnaire completed by an intensive care clinician when an end of life decision was performed on any patient.SubjectsIntensive care physicians and nurses, no interventions were performed.MeasurementsA 20 question survey was used to describe the decision making process, on what basis was the decision made, who was involved in the decision making process, and what precise decisions were made.ResultsA total of 4592 cases from 22 centres are included. While there was more agreement between nurses and physicians in ETHICUS-I compared to ETHICUS-I, fewer discussions with nurses occurred in ETHICUS-II. The frequency of end of life decisions that were discussed with nurses decreased in all three regions between ETHICUS-I and ETHICUS-II.ConclusionBased on the results of the current study, nurses should be further encouraged to increase their involvement in end of life decision-making, especially those in southern Europe.     

Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy

AimTo present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan.BackgroundGlobally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership.DesignA multi-method research study using theoretical and empirical literature 1974–2015, a focus group, expert opinion and a national on-line survey.DiscussionA conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined.ConclusionImplementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated.     

Not for resuscitation instructions: the law for adult patients in the UK

Case Scenario: Marion, aged 55 years, has suffered from multiple sclerosis for 10 years and had reached the stage where she was wheelchair bound and had become extremely depressed. She was admitted to hospital for review of her medication and treatment plan. She discussed with a nurse what should happen in the event of her suffering a cardiac arrest and stated that she would not wish to be resuscitated. She had not discussed this with her relatives, nor had she put the instructions in writing. Two days later, when her daughter was visiting her, she had a cardiac arrest. Her daughter was anxious every effort should be made to resuscitate her and asked the nurse to call the arrest team. However, the nurse said that Marion had told her that she did not want to be resuscitated and that was therefore binding upon her. The daughter disagreed. What is the law?     

Closing the Gap: The Role of Discharge Nurses in an Emergency Department

IntroductionPatients discharged from the emergency department may require a follow-up appointment with an outpatient specialty clinic. Referral processes vary by clinic, some requiring faxed referrals, some providing appointments immediately, and others contacting the patients directly. The frequency with which patients are successfully connected with outpatient follow-up services is largely unknown.MethodsThe ED discharge nurse role was developed to facilitate the navigation of patient follow-up and confirm that patients successfully connect with specialty outpatient clinics. Eight emergency nurses were recruited into this position to study the problem using a quality improvement approach. The ED discharge nurses reviewed referrals, contacted clinics and patients discharged from the emergency department, and intervened when barriers to transition occurred.ResultsThe ED discharge nurses were able to determine specific causes and themes of missed appointments experienced by patients. Systemic problems identified include lost faxes, illegible contact information, incomplete referrals, and referral refusals by the clinics without patient notification. Considering the variability of clinic processes outside the emergency department’s control, the ED discharge nurse role became crucial in minimizing the risk of lost/unsuccessful follow-up for patients discharged from the emergency department.DiscussionImplementing the ED discharge nurse role created a contact for outpatient clinic referrals, patient inquiry, and a process to track errors and data to better understand the frequency of missed follow-up. In this quality improvement initiative, the role of the ED discharge nurse addressed the risk of patients falling through the cracks of a complex system.     

A multimorbidity nurse practitioner-led clinic: Evaluation of health outcomes

BackgroundHealthcare services for people living with multiple chronic diseases have traditionally been organised around each condition, an approach which is neither resource-efficient nor convenient or effective for patients. The integrated nurse practitioner service reported here was developed to optimise patient experience and outcomes within a chronic disease self-management framework.AimTo evaluate patient outcomes following attendance at an integrated chronic disease nurse practitioner clinic for multimorbidity.MethodsA prospective service evaluation of adults with any combination of chronic kidney disease, diabetes and/or heart failure between June 2014 and December 2017. Demographic and clinical outcomes at entry and after 12 months of clinic attendance were collected from health records of all patients (n = 162); a subgroup also completed health-related quality of life and self-efficacy measures at entry and 12 months follow-up (n = 106).FindingsPatients attending the clinic had complex needs and poor health-related quality of life. Despite the complexity of their health problems, as a cohort blood pressure was well-controlled and self-efficacy for chronic disease management was relatively high. Over the first 12 months of integrated nurse practitioner care, there were large improvements in physical aspects of health-related quality of life and many patients achieved reductions in body mass index. Use of hospital inpatient and emergency services also decreased.DiscussionNurse practitioner-led services have the potential to reduce treatment burden and deliver integrated chronic disease management.ConclusionsThe multimorbidity clinic has improved health outcomes in this patient cohort and offers a model for enhanced primary care.     

The importance of nutrition in the post-operative recovery of cats and dogs

Abstract

Providing nutrition to patients following surgery is often within the remit of the veterinary nurse, and it is important to understand the role of nutrition as well as when and what to feed. A patient’s cardiovascular system should be stable and any pain must be controlled, after which nutrition must be addressed, as this plays an important part in the recovery process. Particular attention should be paid to nutritional assessment and the creation of a tailored feeding plan. Regular monitoring allows for adaptations to be made to ensure that the patient receives optimal nutrition, not only during hospitalisation, but also once discharged.     

The health promoting nurse

? This paper suggests that (i) the dominance of an individualistic philosophy of nursing, (ii) nurses' own perceptions of their role and (iii) the hospital:community divide are all obstacles to health promotion being well integrated into nursing practice. ? It explores how these obstacles need to be overcome in order for the new health promoting nurse to emerge in practice. ? This is an attempt to clearly demonstrate ‘who’ the health promoting nurse is, ‘what’ she/he does, ‘how’ she/he works and ‘where’ she/he works.     

Expectations of the child health nurse in Sweden: two perspectives

BACKGROUND: the child health service exists to support and stimulate parents in order to reduce stress and to encourage an advantageous development of the preschool child. AIM: To explore and describe similarities and differences in expectations of the child health nurse, from the perspective of the recently delivered first-time mother, as compared to an expression of what the child health nurse believed mothers of infants expected of them. The data consisted of 15 interviews with child health nurses and 20 interviews with first-time mothers. Thematic content analysis resulted in seven categories of expectations. The child health nurse was expected to be someone to approach, who could assess the child's development and give immunizations and to be a supporter, counsellor, safety provider and a parent group organizer with knowledge. Similarities between the mothers' and the nurses' statements occurred more frequently than differences, which is suggested to depend on the Swedish tradition among new mothers of visiting the child health clinic. The mothers expected participation in parent groups to a higher degree than the nurses thought they did. Child health nurses who fulfil the mothers' expectations appear to require a good relationship with the mother in order to find out what she desires, which the allocation of sufficient time for regular meetings, will facilitate. Moreover, the nurse requires knowledge about children's requirements and the transition to motherhood as well as the father's important role.     

eHealth for neonatal nurse education despite Covid-19

AimThe aim of this contemporary issue paper is to challenge the premise that the term “eHealth” is relatable to patient or service users only. It will be critically explored if the term can be broadened to include neonatal nurse education interventions.DesignA review of current literature will form the basis for the critical discussion of the term eHealth, and why it can be associated with neonatal nurse education.MethodsThe critical discussion will identify and review past and current literature relating to eHealth and its origins. It will portray the viability of the term eHealth as more than just a patient associated intervention, and why it should also be encompassed as a neonatal nurse education option.ConclusioneHealth is traditionally identifiable as a service user intervention or source of information. The term should be broadened to encompass neonatal nurse education and used as a resource that is easily accessible and user friendly. This will in turn encourage the personal and professional development of neonatal nurses and should ultimately contribute to evidence based best practices in the clinical environment, despite the current global pandemic.     

Nurses leading male lower urinary tract symptom (LUTS) clinics: A scoping review

Nurse-led clinics are known to positively impact and benefit patients; however, there is little understanding of the role of the nurse in a nurse-led male Lower Urinary Tract Symptoms (LUTS) clinic. LUTS affect up to 30% of males over 65 in the United Kingdom and can significantly impact the quality of life of the person experiencing them. LUTS can be managed with conservative changes, as well as with medication and surgical intervention. The aim of this scoping review is to map what is known about the role of the nurse in a nurse-led male LUTS clinic and what research tells us regarding, the barriers and enablers in nurses leading a male LUTS clinic. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) checklist and the methodological guidelines set out by the Joanna Briggs institute. A literature search was carried out over three databases (CINAHL, Medline Ovid, ProQuest health and medical collection) and systematically searched from 2000 to 2021. Grey literature was also searched, and citation chaining was undertaken. Following a systematic review of the literature, four papers met the inclusion criteria for this scoping review. The emergent themes across the four papers consisted of structure, assessment and resources, and effectiveness of the nurse-led male LUTS clinic. There was clear agreement across the literature regarding the investigations and assessment the nurse should carry out. Ongoing practical, theoretical, and observational training and education is required to ensure the nurse is competent in running a male LUTS clinic. The papers reviewed showed the nurse provided a supportive role to the consultant. However, there is evidence indicating there is a move towards autonomous practice. There is a dearth of the current research relating to the role of the nurse in nurse-led male LUTS clinics and the enablers and barriers in nurses leading male LUTS clinics. Further research should be considered to gain a better understanding of where nurse-led male LUTS clinics currently take place, what the role of the nurse is in leading a LUTS clinic and what enablers and barriers exist.     

The development of self skills in an authentic learning environment: A qualitative study

BackgroundThe contemporary healthcare environment is an authentic, demanding, challenging and ever-changing environment that requires learners to possess good self skills when they need to engage in meaningful, critical discourse in order to solve authentic problems. However, nurse educators assume that learners already have well-developed self skills at the commencement of their nursing training and as a result do not explicitly teach and develop such skills in the learners.ObjectivesThe objectives of this research were to explore and describe nurse educators’ views on how learners’ self skills can be developed within an authentic learning (AL) environment, and to formulate recommendations based on the findings.MethodA qualitative and contextual research design was used to seek rich, in-depth data from 20 nurse educators who were purposively sampled. Semi-structured individual interviews were conducted, and the data were analysed using Miles, Huberman and Saldaña method.ResultsThe three themes that emerged were that nurse educators should (1) ensure an AL environment that promotes self skills, (2) engage learners in activities that will consciously evoke authentic self and (3) evaluate the developed self skills and metacognition.ConclusionBy developing good self skills, learners should be able to deliver quality patient care, find solutions to complex problems and handle cognitive complexity and authentic conditions whilst creating their own identity.     

体现整体护理理念内涵 避免形式模仿

整体护理开展以来,各级医院相互观摩学习,设计的各种病历、表格五花八门,护士却为面对一个具体的病人不知在哪一栏划勾而左右为难,为无法套上哪个护理诊断而犯愁,类似照搬模式使整体护理流于形式而缺乏内涵。如何使护理实践均以病人整体作为护理目标,“以病人为中心”的护理理念应深入每个护士心中,应体现在每个医院、每个病区、每个护士、每个班次、每次护理活动中。     

Contraception--a woman's dilemma

The case history of a 36-year-old West German woman--Elsa--who had an abortion is recounted along with information obtained from other members of staff involved with her care--a medical social worker, a family planning nurse, and a doctor. Conversation with Elsa revealed that she had ambivalent feelings about birth control. When Elsa learned she was pregnant, she seriously considered her subsequent decision to have an abortion. Actually, she would have preferred to have the baby if she could have depended on her boyfriend's encouragement and his commitment to being a father. At the clinic, Elsa was found to be in good physical condition. She informed the doctor that she had already had 2 terminations of pregnancy, 15 and 11 years ago. Following the birth of her son she had taken an oral contraceptive (OC) for 4 years, but had stopped taking it in 1976 because she thought she was too old for the pill and had been taking it too long. She had then used an IUD, but this had supposedly been removed 10 weeks before the abortion, after she had suffered from recurrent menorrhagia and heavy vaginal discharge. Elsa was then fitted with a diaphragm which she had been using when she became pregnant. After the abortion, Elsa continued to be undecided about what form of contraception to use in the future. She did not want to become pregnant again before she was in a position to have the baby. Elsa had good reason for concern about using OC, i.e. OCs containing estrogen and progestogen, at the age of 36. Along with discussion about the use of OC, Elsa sought more information about the diaphragm. Elsa finally decided to use OCs, but it is doubtful if she will ever be content with either this method or the diaphragm. Family planning nurses have an important role to play in educating people about contraceptives and their use, but they should never tell people that they should or should not be controlling their fertility.