Nursing handovers: An integrative review of the different models and processes available

The aim of this study is to explore the different handover models and processes available and their efficacy in improving handover communication within nursing practice. The handover of information is a key nursing responsibility that ensures patient outcomes through continuity of care. This process is widely recognised as an opening for error that may comprise patient safety. This paper is an integrative literature review that employed an inductive exploratory design. A computerised database search was employed including CINAHL, PubMed and Science Direct and a manual citation search with included papers limited to papers published 2005–2016, in English with full text freely available. This included a systematic search strategy, a critical appraisal of the papers utilising the Critical Appraisal Skills Programme, an inductive data extraction and thematic analysis. Sixteen papers were included in this review. The results detailed that there are various handover models in use, yet there is no evidence that any one model displays superior efficacy. The iSoBAR model and its adaptations remain the only model employed across various specialties. More research is warranted to determine if any handover model displays superior efficacy or transferability.     

In vitro storage and in vivo survival studies of red cells from persons with the In(Lu) gene

Red cells (RBCs) of individuals with the In(Lu) gene are characterized by suppression of the Lutheran, P1, i, and other blood group antigens, acanthocytosis, and abnormal electrolyte metabolism. To determine the clinical significance of these abnormalities, the survival of autologous RBCs was determined by 51Cr in two siblings with the dominant Lu(a-b-) [In(Lu)] phenotype. Both subjects studied had normal hemoglobin, hematocrit, reticulocyte count, haptoglobin, and ferritin values. RBC indices were mildly hypochromic. Examination of the peripheral smear showed mild acanthocytosis in one individual. Analysis of RBC distribution on discontinuous density gradients showed a shift to lighter fractions than normal control RBCs. Storage of these Lu (a-b-) RBCs at 4 degrees C showed significant hemolysis within a few days; this was confirmed by increased autohemolysis, which was reduced by glucose and ATP. RBC cation content (sodium and potassium) was higher than that in control cells, which indicated increased cell hydration, which explains the lighter density and mild hypochromia of the Lu(a-b-) RBCs. 51Cr survival of autologous Lu(a-b-) RBCs was normal in both subjects studied. The data indicate that the morphologic and cation abnormalities of RBCs of persons with the In(Lu) gene are clinically insignificant, as these cells have normal in vivo survival. Such RBCs, however, are susceptible to increased hemolysis in vitro under standard blood banking storage conditions. Individuals of the Lu(a-b-) phenotype, associated with In(Lu), may not be suitable candidates for routine blood donation.     

Met-enkephalin and beta-endorphin are not involved in the analgesic action of transcutaneous vibratory stimulation.

Although the analgesic effects observed during the application of vibration may be attributable to neuronal inhibition of the pain pathways, this does not account for the fact that pain relief sometimes persists for a long time after the end of vibration treatment. Two experiments were carried out in order to determine whether pain relief might involve the release of endogenous opioids. In the first experiment, we studied the effects of injecting either a morphine antagonist, naloxone (0.4 mg), or a placebo, on the analgesia resulting from vibratory stimulation in 12 patients suffering from acute or chronic pain. In the second experiment, the Met-enkephalin and beta-endorphin levels were determined before and after 30 min vibratory stimulation in the cerebrospinal fluid of 8 patients suffering from chronic pain and 1 control subject, all of whom had been fitted with a ventriculo-peritoneal drain which made it possible to collect samples of cerebrospinal fluid painlessly. The results of these experiments show, on the one hand, that the effects of naloxone on the vibration-induced analgesia did not differ from those of the placebo and, on the other hand, that no increase in the Met-enkephalin or beta-endorphin levels occurred concomitantly with pain relief. It will therefore be necessary to investigate other mechanisms as possible means of explaining the post-vibratory analgesic effects.     

The social bases of discrepancies in health/illness perceptions

Health care professionals generally assume that their perceptions and assessments of their patients' health status are accurate and are congruent with those of the patient and other health care providers. However, despite the patient education process, there is evidence that discrepancies in perceptions persist. These discrepancies are of particular concern to nurses because they may interfere with the provision of quality patient care. Poor communication, non-compliance with the treatment regimen, inadequate or unnecessary treatment, and ethical problems could be outcomes of discrepancies in perceptions. In this paper, the literature pertaining to discrepancies in health/illness perceptions is reviewed. As well, several social factors that may affect perceptions are described. These include cultural background, gender, socioeconomic status, experience and role. The effect of occupational role on health/illness perceptions has not been examined systematically. Regarding differences in perceptions of physicians, nurses and patients, further research is required to clarify and explain the nature of discrepancies in health/illness perceptions.