The development of occupational standards in the practice of diagnostic ultrasound: Part 1, background

This, the first of two papers considers the development of occupational standards in the practice of diagnostic ultrasound, giving an overview of the background to the project which was commissioned by the NHS Executive South and West and the College of Radiographers. The paper provides a review of the literature related to occupational standards with key themes, such as the role of professional bodies in monitoring practice and practitioners and the derivation and definition of occupational standards. Other models and projects which have developed methods of standards design in areas of radiography and diagnostic ultrasound (such as the development of competency based standards for medical radiation science professions) are also considered. The paper concludes with a reflection on the need for continual evaluation of occupational standards and their use in practice.     

Placebo Analgesia: Clinical considerations

Pain is the predominant symptom that prompts patients to seek medical advice and treatment from physiotherapists. Various treatment modalities such as heat and cold, electrical stimulation (Cheing and Hui-Chan, 1999), ultrasound, manipulative techniques, massage and laser treatment have been demonstrated in varying degrees to be clinically effective for managing pain of different pathologies. However, all these treatments could be assumed to have some placebo elements (French, 1994).

From a research design perspective, the presence of placebo response is undesirable and must be controlled as it complicates the demonstration of ‘real' treatment effect. From a clinical perspective, it is intriguing to note that the condition of patients in the placebo control groups did improve considerably in many of these validation studies, although in the majority the improvement was not so marked as in the treatment groups. Conspicuously, some neuro-physiological and psychological aspects of the placebo effects may have clinical use in enhancing the effect of pain treatments and their outcomes.

Unfortunately, although placebo response has been a subject of continuing interest among some physiotherapy researchers and clinicians, information about placebo analgesia and its clinical utility is seldom discussed. The purpose of this paper is to provide clinicians with an overview of the construct and research related to placebo analgesia as well as a discussion of the potential clinical use of certain components of placebo analgesia to enhance pain rehabilitation outcomes in physiotherapy practice.     

Care of the critically ill patient: the impact of stress on the use of touch in intensive therapy units

The literature suggests that stress is a major factor for nurses personally 'disengaging' from patients who are critically ill. This research aimed to investigate if nurses in a general intensive therapy unit (ITU) disengage from their patients by using touches that are mainly task orientated, rather than caring/social touches. This study sought to establish whether there was a relationship between categories of touch deployed by nurses and the individual characteristics of the nurses. The patient's prognosis (as perceived by the nurse) was also explored in relation to the touch types used. The nurses were observed and the observations were categorized with the use of an adapted taxonomy (Estabrooks 1989). This study also sought to identify potential stressors for nurses in ITU through a semi-structured interview. The analysis of the observational data indicated that there was no significant relationship between touch type and a patient's prognosis. However, there was a significant relationship between caringlsocial touch and a nurse's length of service (r^s=−0.54, P < 0.01). The interview data discovered that the stressors were related to the organizational pressures of the environment in which care was delivered, rather than the involvement of caring for critically ill patients. This apparent contradiction of the literature contributes a further dimension in considering the impact of management changes and organizational structures upon nurses' stress, which has further implications for the delivery of care in ITUs.     

Towards a model of the expert practice educator – interpreting multi-professional perspectives in the literature

The health and social care professions all rely on the use of practice placements for a substantial element of their pre-qualifying professional education, and these practice-based professions have roles for existing practitioners to oversee the education and training of students when they are on practice placements. Practice educators play a vital role in the development of new practitioners and also in the development and perpetuation of professional values and standards. In this paper, we argue that the practice educator role is thus fundamentally an ethical function, requiring moral commitment from the practice educator but also playing a critical role in maintaining the ethical values of the profession.     

An introduction to chaos theory and some haematological applications

The concept of Chaos theory is introduced in simple terms and discussed in regard to health and disease. Health is regarded as chaotic, such a system has innate variability imparting the ability to respond to pertubations. In contrast disease is interpreted as a loss of flexibility whereby the physiological system is less able to adapt and respond to external stimuli. Chaos theory is developed in relation to haematology whereby the healthy bone marrow is perceived as a chaotic system. Periodicity demonstrating a disease state is highlighted in such conditions as cyclic neutropenia, malignancy and periodic thrombocytopenia. This review serves as a brief introduction to the relatively new theory of chaos. The in-depth mathematical treatment of chaos is beyond the scope of this article, interested parties are directed to the bibliography section for more detailed information.