A clinical trial of a bead bed system for the prevention of pressure sores in elderly orthopaedic patients

This paper summarizes the results of the trial of the Beaufort Bead Bed system designed to reduce the incidence and severity of pressure sores. Elderly orthopaedic admissions were allocated alternately to the Beaufort system and to the usual trolley, table and bed surfaces, and followed from admission to hospital until separation. The incidence of pressure sores was 15-6% in the 32 'trial' patients, which was significantly less than the 48-8% in the 43 'control' patients, as was the mean maximum diameter of the pressure sores incurred: 6-4 mm for the 'trials' as against 29-5 mm for the 'controls'. In particular the trial group were free from pressure lesions to the heel, which affected 32-6% of the control group. The groups were well matched on a variety of criteria on admission, and we conclude that the Beaufort system successfully reduces the incidence and severity of pressure sores for elderly orthopaedic patients. The system – renamed recently the 'Neumark-Macclesfield Support System'– is now in regular and satisfactory use.     

The serious import of humour in health visiting

Using a typical example this paper illustrates how health visitors use humour in child health clinics to introduce subjects on which health visitor and client may have different views.     

Recovery from anaesthesia in children

There are no published comprehensive surveys of paediatric recovery room experience and the incidence of complications. A prospective survey was made of 16,700 consecutive admissions to the recovery room at the Royal Manchester Children's Hospital during the years 1985-1988. The incidence of respiratory complications was low, with laryngospasm 0.85%. The incidence of hypotension was higher than that in adult studies; over 50% of children recorded a decrease in blood pressure in the recovery room of more than 20%, compared to values before operation. The incidence of vomiting in the recovery room was also lower than in comparable adult studies. Certain aspects of recovery room practice changed during the 4 years of the study; these included routine oxygen administration, parents in the recovery room, and our approach to postoperative analgesia. The implications of these changes are discussed.     

The Marie Curie/St Luke''s Relative Support Scheme: a home care service for relatives of the terminally ill

A hospice-based scheme for the support of relatives of dying patients is described. The majority of carers were females and almost a third of them elderly. Most patients were suffering from malignancy. Relatives reported a high level of satisfaction with the help they received from the scheme, but late referral was a common source of dissatisfaction. A large proportion of patients subsequently died at home but it is suggested that the intervention of the relative support scheme was not the only contributory factor. The perceptions of nurses working for the scheme and the susceptibility of volunteers to stress are highlighted.     

Paid Work Increases and State Benefit Claims Decrease after Bariatric Surgery

Background Bariatric surgery is a clinically effective treatment for obesity and has been shown to be costeffective. The impact of bariatric surgery on the subsequent ability to work and the uptake of state-funded benefits is not well documented. Methods A consecutive series of 79 patients who had undergone laparoscopic Roux-en-Y gastric bypass (LRYGBP) or laparoscopic adjustable gastric banding (LAGB) were surveyed to assess changes in their ability to work and the number and type of state benefits claimed after surgery. Results 59 patients (75%) responded, median age 45, median follow-up 14 months. There was a 32% increase in the number of respondents in paid work after surgery (P < 0.05).The mean weekly hours worked increased from 30.1 to 35.8 hours (P < 0.01). Respondents also reported a decrease in obesityrelated physical and emotional constraints on their ability to do work (P < 0.01). Fewer patients claimed state benefits postoperatively (P < 0.01). Conclusion More patients perform paid work after LRYGBP and LAGB than beforehand, and the number of weekly hours they work increases. After surgery, patients claim fewer state benefits.     

The effectiveness of continuing training for traditional birth attendants on their reproductive health-care knowledge and performance

Objective

to evaluate the effectiveness of continuing training for traditional birth attendants (TBAs) on their reproductive knowledge and performance.

Setting

Mzuzu Central Hospital in the northern region of Malawi.

Participants and analysis

a total of 81 TBAs trained during 2004 and 2006 in Mzuzu, Malawi received continuing training courses. Their reproductive knowledge was assessed by a structured questionnaire during 2004 and 2007. A multivariate generalised estimating equation (GEE) model was constructed to determine the associations between their reproductive knowledge scores and age, years of education, time since the last training course, test frequency and number of babies delivered.

Findings

from July 2004 to June 2007, a total of 1984 pregnant women visited these trained TBAs. A total of 79 (4.0%) mothers were referred to health facilities before the birth due to first-born or difficult pregnancies. No maternal deaths occurred among the remaining mothers. There were 26 deaths among 1905 newborn babies, giving a perinatal mortality rate of 13.6 per 1000 live births. The GEE model demonstrated that knowledge scores of TBAs were significantly higher for TBAs under the age of 45 years, TBAs with more than five years of education, TBAs who had taken a training course within one year, and TBAs with a higher test frequency.

Conclusion and implications for practice

continuing training courses are effective to maintain the reproductive knowledge and performance of trained TBAs. It is recommended that continuing training should be offered regularly, at least annually.     

Mental health literacy survey of psychiatrically and generally trained nurses employed in a Singapore psychiatric hospital

Mental health literacy studies consider the capacity of respondents to recognize certain psychiatric disorders, judge the comparative utility of a range of interventions, and make estimates about outcome and prognostic issues. We report such a study involving a sample of nursing staff employed at a large psychiatric institution in Singapore, and who were provided with separate brief vignettes of mania, schizophrenia and depression. Subjects were highly accurate in 'diagnosing' schizophrenia, less accurate for depression and even less accurate in diagnosing mania. Depression was alternately diagnosed as stress, mania was most commonly misdiagnosed as schizophrenia, and for both psychotic conditions, a percentage returned non-psychotic diagnoses. In terms of treatment options, staff distinctly favoured a 'medical model' and viewed traditional and alternative healing options as distinctly harmful. Analyses contrasted psychiatrically trained and generally trained nurses, but identified few significant differences. Such information has the potential to shape the education and training of mental health professional staff, as well as provide important insights about how nurses may diagnose, view and favour alternative treatments and strategies to assist those with common psychiatric disorders.     

Control beliefs of orthopaedic nurses in relation to knowledge and prevalence of pressure ulcers

Data are reported from a larger study of perceptions of locus of control and value of pressure ulcer prevention to show the position of orthopaedic nurse control beliefs, their departmental knowledge level, and their value of pressure ulcer prevention relative to that of staff in other specialties. The survey population consisted of trained and assistant nursing staff in both hospital and community settings of a rural Health Service Trust. Overall results showed that key personnel, such as sisters, were significantly associated with prevalence, in that the more they believed they controlled pressure sore prevention, rather than the patient, the higher the prevalence. This has been explained using locus of control typology. The more it was thought that fate controls pressure sore prevention, the lower the departmental prevalence. Further, beliefs about specific conditions (e.g. pressure ulcer prevention) may be less important than generalized beliefs about control in terms of reducing prevalence.It is suggested that the study is replicated and refined, and that the value of pressure sore prevention needs raising. Certain types of attitudes amongst staff may be unhelpful in a broader range of conditions and outcomes. There may be a need to change control expectations of groups of personnel in order to protect patients.     

Verbal communication: what do critical care nurses say to their unconscious or sedated patients?

The importance of using verbal communication in the care of critically ill patients has long been known. Both qualitative and quantitative studies have presented evidence of the benefits of effective communication. This non-participant observational study aimed to explore how much and what types of verbal communication critical care nurses use when caring for unconscious or sedated patients. Sixteen critical care nurses were observed in 4-hour episodes and their verbal communication was transcribed and timed at source. Seven categories of verbal communication and a 'core concept' emerged on analysis of the raw data. Medical investigations/interventions performed on the patients increased the amount of communication used. The participants in this study were found to use a greater variety and amount of verbal communication than participants in other studies. The findings of this study highlight the need for formal support systems and continued education for nurses about the benefits of verbal communication.