Lecturer practitioners in UK nursing and midwifery: what is the evidence? A systematic review of the research literature

Background. Lecturer practitioner roles have been widely established in the UK, and are seen as having the ability to overcome the theory–practice gap in nursing, as well as offering other benefits including functioning as a link between education and practice. Aims and objectives. This article systematically reviews the research literature on UK lecturer practitioner roles in nursing and midwifery, in order to construct a picture of the themes that emerge from their national implementation. Conclusions. Only eight published research studies meeting the inclusion criteria were identified in journals, and five more included from the ‘grey literature’, totalling 13 suitable research reports. Of these 13 papers, six involved nurses and midwives. Key themes from the literature are outlined and discussed. There is an overwhelming preference for qualitative methodologies, although there is a strong argument for quantitative work in mixed‐methods studies. Relevance to clinical practice. Lecturer practitioner roles can make an important contribution to nursing and midwifery education, but this is problematic. It is essential that managers clarify the purpose, responsibilities, support and review of lecturer practitioner roles if they are to be successful.     

DNA methylation biomarkers in asthma and rhinitis: Are we there yet?

The study of epigenetics has improved our understanding of mechanisms underpinning gene‐environment interactions and is providing new insights in the pathophysiology of respiratory allergic diseases. We reviewed the literature on DNA methylation patterns across different tissues in asthma and/or rhinitis and attempted to elucidate differentially methylated loci that could be used to characterize asthma or rhinitis. Although nasal and bronchial epithelia are similar in their histological structure and cellular composition, genetic and epigenetic regulation may differ across tissues. Advanced methods have enabled comprehensive, high‐throughput methylation profiling of different tissues (bronchial or nasal epithelial cells, whole blood or isolated mononuclear cells), in subjects with respiratory conditions, aiming to elucidate gene regulation mechanisms and identify new biomarkers. Several genes and CpGs have been suggested as asthma biomarkers, though research on allergic rhinitis is still lacking. The most common differentially methylated loci presented in both blood and nasal samples are ACOT7, EPX, KCNH2, SIGLEC8, TNIK, FOXP1, ATPAF2, ZNF862, ADORA3, ARID3A, IL5RA, METRNL and ZFPM1. Overall, there is substantial variation among studies, (i.e. sample sizes, age groups and disease phenotype). Greater variability of analysis method detailed phenotypic characterization and age stratification should be taken into account in future studies.     

Dexmedetomidine use in the ICU: Are we there yet?

Expanded abstract

Citation

Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J; Dexmedeto midine for Long-Term Sedation Investigators: Dexmedetomidine vesus midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012, 307:1151-1160.

Background

Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an alpha-2 agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.

Methods

Objective

The objective was to determine the efficacy of dexmedetomidine versus midazolam or propofol (preferred usual care) in maintaining sedation, reducing duration of mechanical ventilation, and improving patients'' interaction with nursing care.

Design

Two phase 3 multicenter, randomized, double-blind trials were conducted.

Setting

The MIDEX (Midazolam vs. Dexmedetomidine) trial compared midazolam with dexmedetomidine in ICUs of 44 centers in nine European countries. The PRODEX (Propofol vs. Dexmedetomidine) trial compared propofol with dexmedetomidine in 31 centers in six European countries and two centers in Russia.

Subjects

The subjects were adult ICU patients who were receiving mechanical ventilation and who needed light to moderate sedation for more than 24 hours.

Intervention

After enrollment, 251 and 249 subjects were randomly assigned midazolam and dexmedetomidine, respectively, in the MIDEX trial, and 247 and 251 subjects were randomly assigned propofol and dexmedetomidine, respectively, in the PRODEX trial. Sedation with dexmedetomidine, midazolam, or propofol; daily sedation stops; and spontaneous breathing trials were employed.

Outcomes

For each trial, investigators tested whether dexmedetomidine was noninferior to control with respect to proportion of time at target sedation level (measured by Richmond Agitation Sedation Scale) and superior to control with respect to duration of mechanical ventilation. Secondary end points were the ability of the patient to communicate pain (measured by using a visual analogue scale [VAS]) and length of ICU stay. Time at target sedation was analyzed in per-protocol (midazolam, n = 233, versus dexmedetomidine, n = 227; propofol, n = 214, versus dexmedetomidine, n = 223) population.

Results

Dexmedetomidine/midazolam ratio in time at target sedation was 1.07 (95% confidence interval (CI) 0.97 to 1.18), and dexmedetomidine/propofol ratio in time at target sedation was 1.00 (95% CI 0.92 to 1.08). Median duration of mechanical ventilation appeared shorter with dexmedetomidine (123 hours, interquartile range (IQR) 67 to 337) versus midazolam (164 hours, IQR 92 to 380; P = 0.03) but not with dexmedetomidine (97 hours, IQR 45 to 257) versus propofol (118 hours, IQR 48 to 327; P = 0.24). Patient interaction (measured by using VAS) was improved with dexmedetomidine (estimated score difference versus midazolam 19.7, 95% CI 15.2 to 24.2; P <0.001; and versus propofol 11.2, 95% CI 6.4 to 15.9; P <0.001). Lengths of ICU and hospital stays and mortality rates were similar. Dexmedetomidine versus midazolam patients had more hypotension (51/247 [20.6%] versus 29/250 [11.6%]; P = 0.007) and bradycardia (35/247 [14.2%] versus 13/250 [5.2%]; P <0.001).

Conclusions

Among ICU patients receiving prolonged mechanical ventilation, dexmedetomidine was not inferior to midazolam and propofol in maintaining light to moderate sedation. Dexmedetomidine reduced duration of mechanical ventilation compared with midazolam and improved the ability of patients to communicate pain compared with midazolam and propofol. Greater numbers of adverse effects were associated with dexmedetomidine.     

Is there a place for ontological hermeneutics in mental-health nursing research? A review of a hermeneutic study

A lot of research carried out within the context of mental-health nursing using qualitative data collection tools claims that it is hermeneutical, with usually just a short section describing the hermeneutical methodology as though it is a very broad philosophical approach. Criticisms of the latter approach more often than not concentrate on the level of the data collection tools without getting to grips with the underlying hermeneutical philosophy. This paper examines the difference between methodological and ontological hermeneutics and then gives an example of a piece of research using the latter approach. It is then argued that criticisms of the hermeneutical approach usually only concentrate on methodological hermeneutics with the consequence that they seriously misapply their criticisms if the research is using ontological hermeneutics.     

Best practice in clinical simulation education − are we there yet? A cross-sectional survey of simulation in Australian and New Zealand pre-registration nursing education

Background

Simulation is potentially a means of increasing clinical education capacity. Significant investments have been made in simulation but the extent to which this has improved uptake, quality and diversity of simulation use is unclear.

How is cultural safety understood and translated into midwifery practice? A scoping review and thematic analysis

AimTo identify and understand the scope of the literature published since January 2008 that explored Australian midwives understanding of cultural safety and how this is translated into their practice when caring for First Nations women and families.BackgroundRecognition and understanding of First Nations peoples history and culture and the impact this has on the health and wellbeing of women and their families is essential if the midwife is to promote culturally safe and respectful maternity care. The role and responsibilities of the midwife in ensuring that their practice is culturally safe are now reflected in the Australian professional midwifery codes and standards. Whilst midwifery academics’ awareness of cultural safety and how it is taught within midwifery education programs have previously been explored, at present, little is known about midwives’ understanding of cultural safety, and how this translates into their clinical practice.MethodsA Scoping Review was undertaken following Arksey and O’Malley’s five step process. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses – Scoping Review extension checklist. Twelve studies met the criteria for inclusion. Thematic analysis was used to analyse the data and organise the results.ResultsThematic analysis, guided by two predetermined review questions led to the identification of six overarching themes: ‘Awareness of deficiencies’, ‘The importance of meeting women’s diverse needs’, ‘Understanding relationships as a foundation for culturally safe care’, ‘Working in partnership with others’, ‘Providing individualised care’ and ‘Fostering effective relationships and communication’. One sub-theme of the first theme was identified, this was named ‘Seeking an understanding of culture’.ConclusionAustralian midwives’ level of understanding of cultural safety and how it is translated into their midwifery practice when caring for First Nations women and their families differ widely. Midwives across Australia require increased and equitable access to appropriate opportunities to improve their knowledge and understanding of cultural safety. Whilst theoretical learning on cultural safety has a place in all midwives annual mandatory training requirements, this should ideally be supplemented, where possible, with opportunities for immersive practice in communities. Immersion was considered the optimal way to gain rich knowledge and understanding to strengthen culturally safe midwifery practice. Continuity models of midwifery care which incorporate the principles of cultural safety should be consistently implemented across Australia. These models enable midwives, women, families, communities, and Aboriginal Support Workers to work in collaboration towards achieving optimal outcomes for mothers and babies.Study registrationN/A     

Are we there yet? Graduate readiness for practice,assessment and final examinations

Background

This paper reports on one aspect of a larger doctoral project which investigated the perceptions of qualified nurses on the abilities of newly registered nursing graduates.

Are nurses prepared to curb the tobacco epidemic in China? A questionnaire survey of schools of nursing

BACKGROUND: Smoking prevalence among Chinese males is the highest in the world and its morbidity and mortality is growing. Previous studies suggested nurses are inadequately prepared to treat tobacco use and dependence. OBJECTIVES: To examine the inclusion and organization of tobacco control content in the undergraduate nursing curriculum of Hong Kong and Mainland China; and the smoking status of faculty and students. DESIGN: Cross-sectional survey. METHODS: Deans of 32 nursing schools in Hong Kong and China with an undergraduate programme (representing over 12000 students) completed a self-administered questionnaire. RESULTS: Most schools included the health hazards of tobacco (56.3-100%), but few covered tobacco cessation theory (31.3-62.5%), or behavioural (9.4-56.3%) and pharmacological (3.1-34.4%) interventions in the curriculum. Most curricula covered less than 1h of tobacco content per year of study. Nearly all schools (93.1%) reported smoking among faculty but only half reported access to smoking cessation programmes. CONCLUSIONS: This is the first known study to examine the extent of tobacco control education in the nursing curriculum in China. Results suggested deficiencies in the coverage and clinical practice in smoking and smoking cessation, and recommendations were made to strengthen the curriculum.