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    ABSTRACT: In this paper the authors explore the centrality of both patient safety and person centred care when preparing student nurses for their role. By examining these two goals against the understanding of human factors, the concept of risk and the interpersonal elements of patient centred, compassionate care, the authors identify the challenges that nurse educators must recognise in preparing the nurses of the future who must achieve both. The authors introduce the notion of human factors and their role in promoting safe environments. Thereafter the authors explore the development of the student nurse in coming to understand that optimal patient care must primarily be safe but must also have the wishes of individual patients at its core. Finally the authors raise the challenge for nurse educators of supporting students’ growing understanding of safety, risk and how these must be balanced with individual needs and wishes.
    Nurse education today 01/2014; DOI:10.1016/j.nedt.2014.01.008
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    ABSTRACT: To examine Nepali migrant nurses' professional life in the UK. In the late 1990s the UK experienced an acute nursing shortage. Within a decade over 1000 Nepali nurses migrated to the UK. A multi-sited ethnographic approach was chosen for this study. Between 2006 and 2009, 21 in-depth interviews with Nepali nurses were conducted in the UK using snowballing sampling. Nepali migrant nurses are highly qualified and experienced in specialised areas such as critical care, management and education. However, these nurses end up working in the long-term care sector, providing personal care for elderly people - an area commonly described by migrant nurses as British Bottom Care (BBC). This means that migrant nurses lack career choices and professional development opportunities, causing them frustration and lack of job satisfaction. International nurse migration is an inevitable part of globalisation in health. Nurse managers and policy makers need to explore ways to make better use of the talents of the migrant workforce. We offer a management strategy to bring policies for the migrant workforce into line with the wider workforce plans by supporting nurses in finding jobs relevant to their expertise and providing career pathways.
    Journal of Nursing Management 09/2013; 23(3). DOI:10.1111/jonm.12141
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    ABSTRACT: To compare how intensive care nurses in the UK and Australia (AU) perceive families in intensive care units (ICUs). International healthcare research and practice is often based on an underlying assumption of a person- or family-centred ideology. While nurses in ICUs acknowledge the importance of patients' families, a true integration of families as units of care is often not realised. Data from ICU nurses from two international studies: (1) a constructivist grounded theory study in the UK and (2) a quasi-experimental non-equivalent clinical study in AU. Data were collected in tertiary adult ICUs in the UK and AU. Nurse-to-patient ratio for high-acuity patients was 1:1 in both units. Twenty ICU nurses in five focus groups (UK study) and 197 surveys were sent out to ICU nurses in AU (response rate 26%). Evidence from both studies makes visible the contribution of family care in adult ICUs. Nurses remaining in control and initiating family member care involvement are less likely to perceive families as a burden. The AU study indicated that when nurses partner with families to deliver care, there was a minimal effect on their workload. The nurses concluded that inviting family members to be a part of the patient's care should be usual practice in ICUs. Nurses should promote, facilitate and invite the integration of families in care in today's healthcare system. This is mandatory as families are the caring resource for these patients during an often prolonged recovery trajectory. Families are more likely to be successfully integrated into a more active involvement with ICU patients when they are not perceived as a burden. Inviting and supporting family members is not necessarily time-consuming and starts the journey of supporting ICU survivors' recovery journey.
    Journal of Clinical Nursing 07/2013; 23(5-6). DOI:10.1111/jocn.12195
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    ABSTRACT: To establish what patients' expectations of postoperative pain were when undergoing open surgical repair of abdominal aortic aneurysm. A review of the relevant literature highlighted the fact that there had been no such studies conducted within a similar such homogenous group. Therefore, this study aimed to explore pain expectations prospectively and then compare these with the patients' actual experiences. It has long been established that high levels of satisfaction with pain management are very often reported in patients despite suffering from severe to moderate levels of pain. The reasons for these high satisfaction levels are not always as clear, although it is suggested that patients have an expectation of postoperative pain. The study set out to establish what expectations of pain patients had and the factors that might influence them within the abdominal aortic aneurysm subject group. A mixed methods approach was used. Pain expectations were gathered preoperatively using a Likert scale of pain scoring. These were then compared with the recorded postoperative pain scores. This was followed by a semi-structured interview. The study illustrated that patients expected to have postoperative pain as a natural consequence of their operations. Patients appeared to draw upon their previous experiences. Pain expectation levels were statistically significant, 60% of patients expected to have pain postoperatively. This study demonstrated that patients expect to have postoperative pain. Such expectations might influence the individual's relationship and experience of their postoperative management. The study highlights the need for nurses to evaluate the preoperative information given to patients and to listen to expectations they voice. Patient expectations of pain are sometimes that they expect to have pain, and it is the management of this pain that makes a difference to them.
    Journal of Clinical Nursing 07/2013; 23(3-4). DOI:10.1111/jocn.12268
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    ABSTRACT: Research into the patient's perspective on their care is being given increasing importance within health and nurse education policy, predicated upon the idea that the findings represent the patient experience. Researchers have power to silence the voices of research participants through the process of authorship. Exploring the arts as a means of presenting findings offers the opportunity problematize issues of power and authorship, and examine ways of decentring the researcher's voice. Re/presentation of patient experience in poetic form encourages readers to engage with that experience as they have to actively interpret the meaning of the poem. Researchers interested in examining and conveying the experience of others should be encouraged to problematize issues of authorship and consider the impact of their authority on the re/presentation of the experience of the other. The study aimed to understand the experience of being a patient on an acute psychiatric inpatient ward. A further aim was to open up spaces for the voices of participants to be heard. Contemporary government policy places patient experience at the centre of healthcare policy and service development. Despite this, those who occupy marginalized discourses struggle to be heard within the dominant discourse of health care. A qualitative approach was used, and narrative was conceptualized as representing experience. Sociolinguistic theories informed the development of the analytic framework treating meaning as contextual and arising from both content and structure of narratives. Concepts of representation, voice and authorship were problematized. Thirteen people who had been inpatients on an acute psychiatric inpatient ward participated. Narrative data were gathered using unstructured interviews. The data were analysed holistically using a method that attended to both the structure and content of the narrative. The product of these holistic narratives was the development of a poem representing each participant's experience. This paper focuses on the development of these poems as a method of decentring the authorial voice and opening up spaces for the voices of the participants to be heard.
    Journal of Psychiatric and Mental Health Nursing 07/2013; 21(5). DOI:10.1111/jpm.12094
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    ABSTRACT: BACKGROUND: High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries. OBJECTIVES: A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes. DESIGN: A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices. SETTINGS: All universities in Scotland providing pre-registration nursing and/or midwifery programmes. PARTICIPANTS: All 10 identified universities agreed to take part and a total of 18 interviews were conducted. METHODS: Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis. FINDINGS: Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement. CONCLUSIONS: Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings.
    Nurse education today 04/2013; 33(11). DOI:10.1016/j.nedt.2013.02.024
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    ABSTRACT: The UK National Health Service has a long history of recruiting overseas nurses to meet nursing shortages in the UK. However, recruitment patterns regularly fluctuate in response to political and economic changes. Typically, the UK government gives little consideration of how these unstable recruitment practices affect overseas nurses. In this article, we present findings from two independent research studies from Malawi and Nepal, which aimed to examine how overseas nurses encountered and overcame the challenges linked to recent recruitment and migration restrictions. We show how current UK immigration policy has had a negative impact on overseas nurses' lives. It has led them to explore alternative entry routes into the UK, affecting both the quality of their working lives and their future decisions about whether to stay or return to their home country. We conclude that the shifting forces of nursing workforce demand and supply, leading to abrupt policy changes, have significant implications on overseas nurses' lives, and can leave nurses 'trapped' in the UK. We make recommendations for UK policy-makers to work with key stakeholders in nurse-sending countries to minimize the negative consequences of unstable nurse recruitment, and we highlight the benefits of promoting circular migration.
    Health Policy and Planning 03/2013; DOI:10.1093/heapol/czt010
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    ABSTRACT: Aims and objectives.  To examine the relationship between patient satisfaction and the incidence of severe and enduring pain through a health board wide hospital satisfaction questionnaire. Background.  The incidence and management of acute postoperative pain and its relationship to patient satisfaction have been of great interest to clinicians over the last 20 years. Evidence suggests that despite many moves to address this problem with the advent of acute pain nurse specialists and dedicated pain teams, severe and enduring pain continues to be a problem. However, patients appear to report high satisfaction levels. Design.  The study design was a postal questionnaire the results of which were analysed statistically. Methods.  The postal questionnaire was sent to patients who had been discharged from acute hospitals in one health board in the previous two weeks. A total of three large acute hospitals were included. The data were analysed to produce descriptive statistics for all patients on the pain questions and then for patients with severe and enduring pain on the variables of age, gender, ethnic group, responses to pain questions and type of admission. Results.  Twenty-six percent of patients reported having pain all or most of the time. Patients suffering from severe and enduring pain were younger females. Conclusion.  Acute postoperative pain continues to be a problem, although patients continue reporting moderate satisfaction levels. Relevance to clinical practice.  Acute postoperative pain is an ongoing issue for postsurgical patients. It is crucial to understand and recognise issues that can adversely contribute to increased pain severity.
    Journal of Clinical Nursing 09/2012; 21(23-24). DOI:10.1111/j.1365-2702.2012.04253.x
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    ABSTRACT: Purpose Functional electrical stimulation (FES), for dropped foot, has been shown to have positive benefits in chronic stroke. It has been suggested that similar benefits may be seen earlier after stroke. The aim of this feasibility study was to evaluate the trial methodology of undertaking a randomized controlled trial (RCT) of FES in sub-acute stroke. Method: This was a randomized feasibility study with non-blinded outcomes at 6 and 12 weeks. Sixteen sub-acute stroke in-patients with dropped foot were randomized into two groups (control, n =  7; intervention, n  =  9). Both groups received routine gait re-education and an orthotic device, the control group used an ankle foot orthosis and the intervention group used FES. Outcome measures included gait velocity and cadence, Functional Ambulation Classification, Visual Analogue Scale of perception of walking, and the Stroke Impact Scale. Results: Eligibility criteria developed for inclusion of participants in the trial were appropriate. Set-up of FES during sub-acute stroke was feasible but more challenging than with chronic patients. Outcome measures were suitable and have informed the choice of measures for future work. Conclusions: It is feasible to undertake a trial evaluating FES during the sub-acute phase of recovery after stroke. A larger RCT is required.
    Physiotherapy Theory and Practice 04/2012; DOI:10.3109/09593985.2012.674087
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    ABSTRACT: History taking is a key component of patient assessment, enabling the delivery of high-quality care. Understanding the complexity and processes involved in history taking allows nurses to gain a better understanding of patients' problems. Care priorities can be identified and the most appropriate interventions commenced to optimise patient outcomes.
    Nursing standard: official newspaper of the Royal College of Nursing 02/2012; 26(24):41-6; quiz 48. DOI:10.7748/ns2012.02.26.24.41.c8946
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