Cardiopulmonary resuscitation standards for clinical practice and training in the UK

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.     

The context, measures and outcomes of psychosocial care interventions in long-term health care for older people

This paper examines the psychosocial dimensions of long-term care with reference to the new International Classification of Functioning, Disability and Handicap (ICIDH 2) and to research conducted in Hong Kong. It also draws on selected international literature about older people. It discusses the different ways in which information can be gained about the personal, social and emotional processes of rehabilitation that influence outcomes and raises methodological questions about the study of interventions. Outcomes that are sensitive to psychosocial interventions and that take account of the elderly person's own perspective are identified as important challenges for nurses and other professionals in the multidisciplinary team, in order to respond to an individualized approach to long-term care. It is concluded that gaining a better understanding of the psychosocial dimensions of long-term care will enhance professional practice and benefit older people and their carers.     

Cefotaxime Treatment of Pelvic Inflammatory Disease

We studied cefotaxime in the treatment of gonococcal and nongonococcal pelvic inflammatory disease. Cefotaxime was uniformly effective against gonococcal pelvic inflammatory disease. However, 4 of 11 patients with nongonococcal pelvic inflammatory disease had a suboptimal response.     

Information needs of myocardial infarction patients.

The main objectives of this study were to assess the perceptions of patients immediately after their first myocardial infarction of their needs in a cardiac education programme and to compare these with their perceptions 6 weeks after the event and also with their nurse educators. The data were collected by a questionnaire, the cardiac patients' learning needs inventory which was administered to both patients and nurses. It comprised 37 "needs" items grouped into seven categories, each item to be scored into one of five levels of importance. There were 27 patients interviewed on the first occasion, of whom 18 responded to a postal questionnaire on the second occasion. A census of three groups of nurses was taken in the study, namely all nurses employed in one coronary care unit and in a cardiac ward at a large Dublin Hospital and all nurses employed as cardiac rehabilitation nurses/officers in Ireland at the time of commencement of the study. Sixty-eight nurses responded, a response rate of 80%. A key finding was that the responses were highly skewed, with two-thirds in the top grade ("very important") and less than 1% in the two lowest grades ("not important" and "somewhat important"). The overall response score distribution of the patients differed somewhat from that of the nurses, but this difference was accounted for by mainly three items, all in the "physical activity" category, namely "when to resume driving", "when to resume sexual activity", and "when to resume work", which the nurses scored high and the patients low. Both patients and nurses gave the highest mean scores to four items, namely "what to do when in chest pain", "what are the symptoms of a heart attack", "when to call a doctor", and "what to do to reduce the chance of another heart attack". The first three of these are in the "symptom management" category. These findings support previous studies on the topic. The findings also support the need for individualised nurse/patient negotiated cardiac teaching programmes that can be tailored to suit each patient's needs.     

Palliative medicine teaching program at the University of Cape Town: integrating palliative care principles into practice

The article describes the development of the postgraduate palliative medicine programs at the University of Cape Town (UCT) through collaboration with the Palliative Medicine Division from the University of Wales College of Medicine in Cardiff, United Kingdom. The course is presented as a distance-learning program supported by web-based learning with three face-to-face teaching sessions during the course. UCT recognized the urgent need to assist African doctors in developing the medical skills required to care for an ever-increasing population of patients and their families who are faced with terminal illness and the physical, emotional, psychosocial, and spiritual distress associated with end-of-life issues. Since 2001, 139 postgraduate students have registered for the course, 10% of whom are from African countries other than South Africa. Using the experience from UCT in distance-learning programs, the Hospice Palliative Care Association developed an interdisciplinary course, "Introduction to Palliative Care." This course recognizes that, although improvement in patient care and palliative care will come as undergraduate training in palliative care is established, it is essential that previously qualified health care professionals are able to enhance their palliative care knowledge, skills, and attitudes. Trainers provide support to participants over a six-month period and assist in the transference of knowledge and skills into the workplace.     

The convergent validity of the Manchester Pain Scale.

OBJECTIVE: To test the convergent validity of the Manchester pain scale when compared to the current 'gold standard' in children's pain assessment, the Oucher pain scale. METHOD: One hundred and fifty two children presenting to the emergency department had pain scale assessments using both the Manchester and Oucher pain scales. The order of presentation of the scales was randomised. The degree of convergence between the scales was assessed using Spearman's rank correlation as well as Bland and Altman plots. RESULTS: One hundred and thirteen children used numerical scales; the correlation coefficient for these was 0.802. Thirty nine children used pictorial scales; the correlation coefficient was 0.820. CONCLUSION: There is strong convergent validity between the scales as demonstrated by a high degree of correlation between the numerical and pictorial scores generated by the Manchester and Oucher pain scales. The Manchester pain scale can be used to assess pain in children presenting to emergency departments.     

Selected predictors of registered nurses' intent to stay

This paper reports initial findings from a longitudinal study of autonomy, willingness to risk, exit/voice (E/V) and managerial environment (ME) as predictors of registered nurses' intent to stay (ITS) that is being conducted at eight Midwestern hospitals in the USA In this two-stage study, initial findings are based on responses from 524 staff nurses Due to the nature of the ITS variable, two logistic regression analyses were computed to test the predictive relationships of the independent variables In the first, subjects with neutral ITS scores were grouped with subjects who had no intent to stay Both ME and E/V were predictive of ITS In the second analysis, the subjects with neutral ITS scores were grouped with subjects who intended to stay In this case, only ME was predictive While the per cent variance accounted for by these variables is not as high as some other variables reported in previous research, these variables are amenable to managerial interventions     

District nurses' referrals to home-based palliative nursing services

This study investigated district nurses' considerations of the Marie Curie Nursing Service. Most saw the primary service as respite care and referred patients to it during late stages of illness rather than palliative phases. The MCNS is valued, but confusion exists about appropriate referral times and the services provided. Improvement in communication and education is needed. The provision of this home palliative nursing service helps to promote the principle of palliative care in optimising the quality of life of patients who have life-limiting diseases and their families.     

Professionals' views and experiences of using outcome measures in palliative care

In palliative care, outcome measures are increasingly used to aid clinical practice, conduct audit and research. The objective of this study was to elicit professionals' views and experiences of using outcome measures, paying special attention to the Palliative care Outcome Scale (POS). This article presents the results of a qualitative study of 26 professionals, experienced in using the POS, who were invited to participate in semi-structured telephone interviews. Of those invited, 22 people took part. Participants' comments were noted verbatim through the interviews and data subjected to content analysis. Analysis of data identified a number of key themes surrounding outcome measures, notably their reasons for use, application in clinical settings and a range of professionals' attitudes. The article concludes that understanding the process of outcome measures is important for improving their implementation. When undertaking further research, attention should be paid to the wider social, cultural and structural contexts, as factors that can influence the implementation of outcome measures. As the drive towards outcome measures continues, it is essential that measures are not developed in a vacuum. Instead they should always be informed by the needs and experiences of individuals and services.