Children who require long-term ventilation: staff education and training.

Children who live with conditions that were previously considered incompatible with long-term survival are often highly dependent on medical technology, interventions and equipment. This includes an increasing number of children who require long-term assisted ventilation. It is generally accepted that the social, psychological, emotional and developmental needs of children are best met at home, rather than in a hospital environment, and this applies equally to children who have long-term health problems. However, one of the many factors that can impede the discharge from hospital of children requiring long-term assisted ventilation is a lack of staff who can provide care and support for them and their families. Increasing the number of staff who are able to provide such support may therefore assist in improving the provision of appropriate care for this group. This paper reports on a study of the perceived education and training needs of staff who care for children with complex needs, including assisted ventilation, and their families.     

Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions

ObjectiveThis retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification.Material and methodsCT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the “defect body” method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis.ResultsA total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures – W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm² to 6.09 cm² for orbital floor and from 0.29 cm² to 5.43 cm² for medial wall fractures.The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm², W2(i) = 1.64 cm², W1(i)2(i) = 3.10 cm², W1(m) = 1.36 cm², W2(m) = 1.65 cm², W1(m)2(m) = 2.98 cm², W1 (im) = 3.35 cm², W1 (im) 2(i) = 4.63 cm², W1 (im)2(m) = 4.06 cm² and W1 (im)2 (im) = 7.16 cm².ConclusionThe AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.     

Reviewing evidence.

This paper summarises how evidence based practice is defined, and what can be considered to constitute evidence. It describes the steps which should be undertaken in a systematic review of evidence and some of the issues involved in implementing the findings from such reviews in practice. This includes identifying the types of evidence which should inform decisions about practice and how these should be integrated with clinical expertise and client choice in order to achieve best practice.     

Evidence for practice.

This paper identifies the documentary sources that can be included in the evidence base that informs practice, including the relative merits of research based and non-research based sources. It goes on to debate the issues involved in using research findings from both qualitative and quantitative paradigms in a review of the current best evidence. Finally, it discusses the place of clinical expertise and patient choice in evidence based practice, and how this can be combined with documentary evidence to provide optimum and individualised patient care.     

Challenging the balance of power: patient empowerment

Empowering patients is a central element of nursing care, according to the RCN (2003). This article discusses the reality of changing the balance of power in health care, awareness of types of knowledge and the ways in which power may consciously or subconsciously be used. It also includes awareness of the financial and political aspects of health care and how these affect patient choice.     

Use of constant comparative analysis in qualitative research

This article describes the application of constant comparative analysis, which is one method that can be used to analyse qualitative data. The need for data analysis to be congruent with the overall research design is highlighted.     

The nurse's role in supporting young people with complex health needs

An increasing number of young people have complex and continuing health needs. Their needs, the attitudes which individuals have towards them, and the way in which their needs are catered for by society can mean that it is more difficult for them to develop peer relationships, engage in leisure activities, take risks and develop sexual relationships than it is for other young people. Accessing further education and gaining employment may also be more problematic for them than it is for their peers. This may make it harder for them to develop independence and a positive self-esteem. Nurses who work with this group should be aware of the barriers which they may face, and plan support with them and their families so as to overcome these as far as possible, and to make them feel valued and respected.     

Learning to Support Children With Complex and Continuing Health Needs and Their Families

PURPOSE: This paper reports on the evaluation of a pilot placement for preregistration child health nursing students focused on supporting children with complex needs in their homes. CONCLUSIONS: This type of placement can be beneficial in enabling students to develop practical skills, attitudes, and values that will assist them to provide appropriate support for this client group. The pilot placement clarified some of the major organizational and practical issues that must be considered. PRACTICE IMPLICATIONS: Developing opportunities for preregistration nursing students to learn to support children with complex needs and their families is possible and potentially beneficial.     

From expert to tasks,expert nursing practice redefined?

Aim. The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. Background. Expert nursing practice can be argued to be central to high quality, holistic, individualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the ‘expert nurse’ to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. Method. The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. Conclusion. Nursing expertise which focuses on the provision of individualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision‐making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. Relevance to clinical practice. The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise.