Reflection-on-practice: enhancing student learning

The writing of a reflective diary is viewed as an effective tool for promoting reflection and learning in students, and for self-assessment and evaluation of a clinical learning experience This work is a study of 30 undergraduate nurses and then- use of reflective diaries during a period of community health care practice The theoretical basis of the study is based on Schon's work on reflection-in-action The research tool, developed for the study of nursing practice by Powell, is based on Mezirow's levels of reflectivity The findings are that, in the sample used, students do reflect on their practice according to Mezirow's levels of reflectivity, but that the highest number of reflections occur at the lower levels of reflectivity (94% of the total number of scores) However, although only 6% of the total number of scores were found at the higher levels of reflectivity, some 22 of the sample of 30 students did attain conceptual and theoretical reflectivity, the highest levels of reflectivity     

The challenge of change in nurse education: traditionally trained nurses' perceptions of Project 2000

Adapting to change can often be a difficult process. How traditionally trained nurses perceive the change brought about by Project 2000 is important, since this may affect how they view their own future, how they receive those who are qualifying via Project 2000 and how they work with Project 2000 diplomates in the future. It is, therefore, important that attempts are made to overcome any resistance to the changes brought about by Project 2000. The findings presented here are taken from the first questionnaire in a Department of Health-funded, longitudinal study into the careers of traditionally trained mental health nurses. Five hundred and fifty-six nurses were asked their views about the new training and how they thought it would affect them. Four hundred and forty-seven people returned the questionnaire: an 80% response rate. This study has revealed some positive views on Project 2000 as well as a variety of concerns.     

Comparison of two warming interventions in surgical patients with mild and moderate hypothermia

Two interventions: a forced warm-air device (Bair-Hugger series 500, Augustine Medical Inc., Eden Prairie, MN, USA), group 1; and a standardized approach to the use of warmed blankets (group 2) are compared with the aim of enhancing thermoregulation in surgical patients with mild and moderate hypothermia in the immediate recovery period. One hundred and twenty patients in a post-anaesthetic care unit were systematically allocated to group 1 or group 2 so each group consisted of 110 participants. No significant differences were found between the groups in gender, age, time in surgery, use of warmed intravenous fluids or muscle relaxants, or type of surgery. After exclusion of orthopaedic patients, significant differences in the mean rewarming rates were found, with more rapid rewarming occurring within group 1 (the group rewarmed with a forced warm-air device, t = 2.15, df = 92, P = 0.03) compared with group 2. No significant differences were found in the mean rewarming time, or heat gain between groups, and subsequent power estimates were less than 0.80. This study supports improved rewarming rates in select surgical patients (with mild or moderate hypothermia) using the Bair-Hugger^TM compared with a standardized blanket rewarming intervention and identifies the need for patient comfort and cost-benefit analysis to be considered in future studies.     

A survey of current practice in skeletal pin site management

The management of sites for external fixator pins and wires has been a matter of debate within orthopaedic and trauma nursing for decades. The literature outlining the conundrum goes as far back as the early 1980s. Sadly, none of this literature, to date, has resolved the question of how to most effectively prevent infection in these challenging wounds. This article reports on a UK survey that identifies current practice in pin and wire site wound management. It should help those planning to conduct research in this area to identify possible interventions, controls and variables that need to be taken into account when conducting randomised controlled studies.     

Developing nursing research

Following an information-giving workshop to senior nurses within the hospital by the Research Nurse Group, a research-practice gap was identified. To ascertain the extent of this, a survey with an explanatory letter was distributed to all qualified nurses within the Trust. Although initially the response rate was thought to be low, it compared favourably to other studies. Results showed that 45% of respondents did not feel confident to undertake a research project but more than 80% felt that research was a part of their clinical role and was relevant to nursing. Three-quarters of respondents also acknowledged that they had read a paper resulting in a change in their clinical practice. When asked about skills and resources, 29% did not know how to conduct a literature search and 39% were unable to critically appraise a paper. Furthermore, 62% did not know what resources were available when considering a research project of their own. It was concluded therefore, that the research-practice gap does exist and nurses need encouragement and support in the implementation of the research process. In view of these conclusions, an action plan was developed.     

Effectiveness of a prospective physician self-audit transfusion- monitoring system

BACKGROUND: The purpose of this study was to search for a more effective transfusion-monitoring system than the existing system of retrospective peer review. STUDY DESIGN AND METHODS: This research used a study-control, preintervention and postintervention design, to evaluate the effectiveness of a prospective physician self-audit transfusion-monitoring system that functioned without the direct involvement of transfusion service physicians. This research also evaluated the effectiveness of issuing to physicians a memo with transfusion guidelines. Three process indicators were used to assess physician behavior at various stages of the blood-ordering process: 1) the number of crossmatches ordered per admission, 2) the transfusion-to- crossmatch ratio, and 3) the number of blood units returned to the laboratory after physician self-auditing. The study used two outcome indicators to reflect overall blood utilization: 1) the percentage of patients who received red cell transfusions and 2) the number of blood units transfused per recipient each month. RESULTS: The prospective physician self-audit system implemented at the study hospital did not reverse physician transfusion decisions, and the process of issuing to physicians a memo with transfusion guidelines at the control hospital failed to reduce blood usage. However, a transient reduction in blood utilization was observed at the study hospital. CONCLUSION: The reduction was hypothesized to be due to a Hawthorne effect, in which observed behavior is affected by the subject's awareness of the research study.     

Sudden-onset Severe Acute Asthma: Clinical Features and Response to Therapy

Abstract. Objectives : To characterize patients with sudden onset of severe acute asthma (SAA) and to examine whether this presentation is associated with rapid recovery. Methods : Retrospective cohort study of ED visits to a teaching hospital. Subjects were aged 18–64 years, with SAA ( n = 225), denned as initial peak expiratory flow rate (PEFR) ≤40% of predicted. Visits for sudden-onset SAA (≤3 hours of symptoms) were characterized and multivariate logistic regression was used to examine the association between sudden onset and rapid recovery. Results : Patient visits for sudden-onset SAA had different triggers as compared with those for the slower-onset group (p = 0.006). The sudden-onset patients were less likely to report an upper-respiratory-tract infection (17% vs 40%) and more likely to have an unidentifiable trigger (40% vs 19%). In the multivariate logistic regression model, sudden onset was a strong independent predictor of rapid response [odds ratio (OR) 4.3, 95% confidence interval (CI) 1.6–11.6]. Sudden-onset visits were less likely to lead to admission (23% vs 43%, p = 0.03). Conclusions : These data suggest that different triggers may be involved in sudden-onset SAA and that sudden onset of symptoms is independently associated with rapid recovery. In their rapid deterioration and rapid response, these subjects share certain characteristics with "sudden asphyxic asthmatics" and may constitute a population suitable for further study of factors contributing to that condition. While these visits led to admission less frequently, prospective studies are necessary to provide information on duration of response and risk for relapse.