Four years experience of a nurse-led elective cardioversion service within a district general hospital setting.

AIMS: External direct current cardioversion is an effective method of restoring sinus rhythm (SR) in patients with persistent atrial arrhythmias. Increasing demand for hospital beds, together with a reduction in junior doctors' hours, has adversely affected cardioversion provision. A regular nurse-led cardioversion service conducted in a dedicated hospital day-unit was introduced to resolve these constraints. There are limited data on the safety or efficacy of such a service. METHODS AND RESULTS: All cardioversions between October 2000 and October 2004 were performed by an appropriately trained specialist nurse, under general anaesthesia. Patients attended a pre-assessment clinic. Energy requirements for initial and subsequent defibrillations were guided by a local protocol in accordance with the guidelines from American Heart Association, American College of Cardiology, and the European Society of Cardiology. Rectilinear biphasic defibrillation was introduced in January 2004 with an appropriate protocol amendment. In the absence of complications, the aim was to discharge patients the same day. A total of 578 cardioversions (475 monophasic; 103 biphasic) were performed on 464 patients [72.1% male, mean (+/- SD) age 67.8 +/- 9.4 years] with atrial fibrillation (AF) (89.7%) and atrial flutter (10.3%). SR was restored in 84.0 and 100% of patients with AF and atrial flutter, respectively, which increased to 90.2 and 100% following the introduction of biphasic defibrillation. Biphasic shocks cardioverted AF with less energy (163 +/- 22 vs. 289 +/- 81 J) and less cumulative energy (230 +/- 139 vs. 455+/-255 J) than monophasic (P < 0.001 for both), despite no difference in the duration of AF (P = 0.26) or patient age (P = 0.78). Two patients required hospital admission due to transient bradycardia; both were discharged within 72 h, without the need for permanent pacing. A total of 99.6% of patients was discharged home the same day; there were no deaths. CONCLUSION: The provision of a nurse-led elective cardioversion service is feasible and effective, without compromising safety.     

Assessing palliative care outcomes for people with motor neurone disease living at home

A number of palliative care outcome measures are used to facilitate the provision of palliative care. This short article reports the use of one palliative care outcome measure, the Palliative care Outcome Scale, with people with motor neurone disease (MND) living at home. The outcome measure was generally viewed positively by those involved. However, problems with this scale itself point to the need for a specialized instrument to assess palliative care outcomes for people living with MND.     

Language translation of outcome measurement tools: views of health professionals

Assessing the outcome and effectiveness of treatment is extremely important in nursing practice and it is vital that outcome measures are available to non-English speakers. We investigated health professionals' views on translating outcome measures for use in nursing practice. Semi-structured interviews were conducted with a purposive sample of 10 health professionals. Content analysis of data identified the following two broad themes: meeting need and cultural consideration. Specific palliative care issues were also identified. Low literacy levels among ethnically diverse communities and the need to ensure cultural equivalence were perceived as major challenges for palliative nursing practitioners when translating outcome measures. Given increasing cultural diversity within the UK, health professionals considered clinical tool translation worthwhile because it helps to address inequalities in health-care provision for ethnically diverse communities. A consideration of the cultural context is needed when interpreting responses on translated outcome measure. However, translations into appropriate languages can help overcome communicant barriers and minimize the need for family members to act as interpreters for patients with palliative care needs.     

Safety in nursing social research

Background. Researcher safety is an important consideration in all areas of nursing social research. Risks to researchers’ safety are multidimensional and manifest differently, contingent on the context of the research encounters.

Aim. To review researcher safety issues in social research with special attention to nursing.

Review focus. A small number of studies are used in this article, as examples, to demonstrate the range of researcher safety issues in nursing. Some preliminary suggestions to help ensure researcher safety are outlined: organisational culture, resources, a researcher safety lead, systems and procedures, education and training and insurance.

Conclusions. There is a need to raise the profile of researcher safety issues in nursing for all involved, including researchers, students, funders and review committees. The article highlights the importance of nursing researchers writing reflexively about their safety. There is also a need for new nursing research to assess the nature and extent of safety issues. Taken together, these issues represent the starting point for establishing researcher safety guidelines and identifying good practice for the nursing research community.     

‘It’s like having half a sugar when you were used to three’ — drug injectors’ views and experiences of substitute drug prescribing inside English prisons

The prescribing of substitute drugs to dependent drug users is an important harm-reduction strategy. This article explores drug injectors’ views and experiences of substitute prescribing inside prison. Data was generated from in-depth interviews and small group discussions. Qualitative analysis revealed five categories of response: diverse experiences of substitute prescribing; people not receiving substitute drugs; the provision of sedatives, painkillers and anti-depressants; detoxification courses with methadone and lofexidine; and, finally, inconsistencies in drug prescribing. The concluding discussion considers drug injectors’ views and experiences, which point to the need for consistent drug policies inside and outside prison.     

An audit of theatre scrubrooms in a district general hospital.

While much has been written on surgical theatre design, little can be found on the design of theatre scrubrooms. An audit of theatres at a modern district general hospital (DGH) revealed that only one scrubroom had the minimum free floor space required and none complied with other baseline parameters. A survey of surgeons revealed that 60% had to re-scrub because their hands had desterilised through insufficient scrubroom space. The implications for hygiene hazards are clear. We review the literature and outline the basic dimensions which should be incorporated in the design of modern theatre scrubrooms.     

Clinical practice in a computer world: considering the issues

BACKGROUND: In an era when information technology developments are being harnessed by governments to improve patient care, it is important to consider the issues raised by the use of computers in health care practice and policy. AIM: The aim of this paper is to provide an appraisal of considerations raised by the use of computers in health care. REVIEW FOCUS: Drawing on a range of studies in the social and medical sciences, the paper reviews the considerations. The introduction to the paper maps out the policy context, which is followed by three substantive sections: first, computer hardware and software considerations; second, issues around confidentiality; and third, personal, social and cultural considerations. CONCLUSION: This paper demonstrates that information technology developments must be allied with government or state direction and should be informed by evidence. Whilst the issues discussed are of primary relevance to the United Kingdom National Health Service, they have wider relevance to health care systems internationally.     

What is the potential for the use of clinical outcome measures to be computerised? Findings from a qualitative research study

Clinical outcome measures are used in clinical audit to monitor the quality of care provided to patients. As information technology (IT) is increasingly being integrated into the delivery of health care, computerising the use of clinical outcome measures has been proposed. However, little is known about the attitudes of health professionals towards this. Aims to understand professionals' views on adapting one clinical outcome measure--the palliative care outcome scale (POS)--for use on hand-held computers. Concludes that these results reinforce existing research on clinical outcome measures and IT in health care; identify special palliative care issues when considering the use of computerised clinical outcome measures with patients; and highlight the need for further research.     

Competencies: Reservations, Risks and Developments - A Response to Chris Whyte

I write in response to the 'Personal View' published in the British Journal of Psychotherapy by Chris Whyte (1994). He writes of his fears about the current attempts by the UKCP to develop a competency-based assessment to qualify psychotherapists under the Government's National Vocational Qualifications scheme. I write to support his reservations and to add to his views in order to begin to explore some of the complexities of the current political/professional situation. I then want to explore some of the risks involved and to propose some first thoughts on what competencies in Psychoanalytic Psychotherapy already look like, as I believe they can be seen in current training practice, if often unarticulated.