Nurse managers’ narratives of organizational change in the English National Health Service

Aims To investigate nurse managers’ accounts of organizational change. Background While the importance of the ward manager role in delivering quality care is recognized, less is known about ward managers’ involvement in change. Methods Face to face qualitative narrative interviews were conducted. They were audio recorded, transcribed verbatim and analysed thematically. Results Managers were experiencing change that was occurring at an increasing rate. They reported that being effective communicators was central to their approach to managing change. The hybrid nature of the role informed their approach to change and enabled them to initiate and control it to a degree at ward/department level. They did not base their management approach on theory and focused activity more on the practical and contextual nature of change. Implications for nursing management Organizational change has attracted a great deal of attention in research terms; however, there are few studies that examine nurse managers’ experiences of change. The accumulated expertise and experience of this group of staff is an untapped resource in terms of mobilizing organizational change in hospitals in England. More attention to work-based learning and support would assist managers in their role.     

‘Who will do it if I don’t?’ Nurse anaesthetists’ experiences of working in the intensive care unit during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, the workload on the intensive care unit (ICU) increased nationally in Sweden as well as globally. Certified registered nurse anaesthetists (CRNAs) in Sweden were transferred at short notice to work with seriously ill patients with COVID-19 in the ICU, which is not part of the CRNAs' specialist area. However, limited research has shed light on healthcare professionals’ experiences of the pandemic.ObjectivesThis study illuminates CRNAs’ experiences of working in the ICU during the COVID-19 pandemic.MethodsThis study used a qualitative method with an inductive approach to interview nurse anaesthetists who worked in the ICU during the COVID-19 pandemic.FindingsThe participants experienced ambivalent feelings towards their work in the ICU. They also lacked information, which created feelings of uncertainty and resulted in expectations that did not correspond to the reality. They described that owing to an inadequate introduction, they could only provide “sufficient” care, which in many cases caused ethical stress. Not being able to get to know their new colleagues well enough to create effective cooperation created frustration. Even though the participants experienced the work in the ICU as demanding and challenging, overall, they enjoyed their time in the ICU and were treated well by their colleagues.ConclusionsAlthough CRNAs cannot replace intensive care nurses, they are a useful resource in the ICU in the care of patients with COVID-19. Healthcare workers who are allocated from their ordinary units to the ICU need adequate information and support from their work managers to be able to provide the best possible care and to stay healthy themselves.     

Staphylococcus lugdunensis: the coagulase-negative staphylococcus you don’t want to ignore

Staphylococcus lugdunensis is a virulent coagulase-negative staphylococcus (CoNS) that behaves like Staphylococcus aureus. Toxic shock syndrome, osteomyelitis, septic arthritis and postoperative endopthalmitis have been observed. Endocarditis complicated by heart failure, periannular abscess formation and embolic phenomenon have brought particular attention to this CoNS. Mortality rates for endocarditis appear higher when compared with other CoNS. Owing to the laboratory methods used, identification may be misleading. β-lactam antimicrobials are recommended pending sensitivities. Evaluation for endocarditis should be pursued in bacteremic patients due to its pathogenic potential.     

Nurse Practitioners’ and Nurse Practitioner Students’ LGBT Health Perceptions

Nurse practitioner (NP) and NP student perceptions of adult lesbian, gay, bisexual, and transgender (LGBT) health needs were qualitatively explored. One overreaching theme, “We need to do better. We have a lot to do,” and four key themes were identified: (1) same basic health needs as straight people; (2) a little more risk, a little more help, a little extra care; (3) breaking down that trusting, honest provider relationship; and (4) society sucks and social media and politics play a major role. Results support the need for future research exploring NP and NP student understanding of LGBT health needs.     

Why don’t intensive care nurses perform routine delirium assessment? A discussion of the literature

Delirium is a well recognised and serious problem in adult intensive care patients. With a reported incidence as high as 87%, it has been associated with increased length of stay, higher costs of care, ongoing cognitive impairment and increased mortality rates. The problem is so significant that routine, formal delirium assessment is recommended for all intensive care patients. However, there is evidence to suggest that few intensive care nurses are incorporating this screening into their daily practice. The aim of this paper is to discuss what is currently known about intensive care nurses' attitudes and beliefs in relation to caring for adults who are experiencing delirium, with a focus on identifying possible barriers to formal delirium assessment. It will be argued that intensive care nurses are well placed to perform regular delirium assessment and therefore have a responsibility to promote an improvement in delirium assessment practices.     

Why does diabetes increase atherosclerosis? I don’t know!

There is a wealth of clinical data showing the relationship between diabetes mellitus and atherosclerosis and its clinical complications. To dissect this relationship, investigators have attempted, usually unsuccessfully, to create a small-animal model in which diabetes accelerates vascular lesion development. This effort has often been complicated by development of hyperlipidemia leading to difficulty in differentiating the effects of hyperglycemia from those of lipid abnormalities. A study in the current issue of the JCI provides data on a new mouse model in which atherosclerosis initiation is accelerated in diabetic mice and is reduced by insulin therapy. Moreover, these animals have greater intra-arterial hemorrhage, which might be due to less stable plaques.