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Evidence-Based Nursing current issue



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Nursing and midwifery council registration for overseas childrens nurses: a perfect storm?

2017-09-25T06:25:38-07:00

In the UK, and particularly in London, we rely on recruiting nurses trained in other countries to maintain adequate staffing levels.1 This is likely to continue for several years due to poor workforce planning.2 It is difficult to predict what impact the changes to the funding arrangements for preregistration nurses in England this September, outlined in a recent study,3 will have on overall numbers of student nurses. Early suggestions are that despite the Government’s indicating their aim was to increase student numbers by 10 000 that there may be an overall drop in numbers of students starting courses in September 2017.4 5

Alongside the changes to funding for preregistration nursing courses, Health Education England (HEE) is experiencing economic pressures and the money available to support continuing professional development (CPD) has been significantly reduced.6 Consequently, the cost of CPD...




Ethnography: challenges and opportunities

2017-09-25T06:25:38-07:00

Introduction

Collectively qualitative research is a group of methodologies, with each approach offering a different lens though which to explore, understand, interpret or explain phenomena in real word contexts and settings. This article will provide an overview of one of the many qualitative approaches, ethnography, and its relevance to healthcare. We will use an exemplar based on a study that used participant-as-observer observation and follow-up interviews to explore how occupational therapists embed spirituality into everyday practice, and offer insights into the future directions of ethnography in response to increased globalisation and technological advances.

What is ethnography?

Qualitative research methodologies are inductive and focus on meaning; approaches are diverse with different purposes, reflecting differing ontological and epistemological underpinnings.1 With roots in sociology and anthropology, ethnography is one of the early qualitative approaches and is concerned with learning about people, in contrast to studying people, through...




Critical care nursing: caring for patients who are agitated

2017-09-25T06:25:38-07:00

EBN engages readers through a range of Online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates.




Adult Nursing

2017-09-25T06:25:38-07:00

EBN Perspectives bring together key issues from the commentaries in one of our nursing topic themes.




Inactivated influenza vaccination in first trimester does not appear to increase risk of birth defects

2017-09-25T06:25:38-07:00

Commentary on: Kharbanda EO, Vazquez-Benitez G, Romitti PA, et al. First trimester influenza vaccination and risks for major structural birth defects in offspring. J Pediatr 2017;187:234–239.e4.

Implications for practice and research

  • In this cohort study, inactivated influenza vaccination in first trimester did not increase risk of birth defects, which should reassure pregnant women of the safety of influenza vaccination in early pregnancy.

  • Despite evidence supporting the safety of antenatal vaccination, additional research investigating early pregnancy outcomes (ie, miscarriage) would be beneficial.

  • Context

    Pregnant women and their infants are at higher risk of severe outcomes from influenza compared with other groups.1 Vaccination against influenza annually can prevent these severe infections. Despite the health benefits offered by vaccination during pregnancy, uptake of influenza vaccine during pregnancy, particularly early pregnancy, is poor.2 One of the most consistently cited reasons for vaccine refusal among...




    Individualised assessment is required to establish the most appropriate anticoagulation option for patients

    2017-09-25T06:25:38-07:00

    Commentary on: Ferguson C, Inglis SC, Newton PJ, et al. Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives. J Clin Nurs 2017: [Epub ahead of print: 8 Feb 2017].

    Implications for practice and research

  • Healthcare professionals need to be aware that age and falls risk are not in themselves barriers to anticoagulation therapy. Anticoagulation therapy should not be withheld based on these factors alone.

  • Future research should focus on establishing enablers to anticoagulation therapy with the aim of improving compliance.

  • Context

    Atrial fibrillation (AF) currently affects approximately 2% of the population of the Western countries.1 The prevalence of AF rises with concomitant cardiovascular disease, and up to one-third of people with heart failure will also suffer from AF.2 These figures are set to rise further with the continuing ageing population. It is estimated...




    Mobile phone messaging delivering encouragement, reminders and education increases patient compliance with recommended exercise and results in positive short-term health behaviours

    2017-09-25T06:25:38-07:00

    Commentary on: Chen H, Chuang T, Lin P, et al. Effects of messages delivered by mobile phone on increasing compliance with shoulder exercises among patients with a frozen shoulder.J of Nursing Scholarship 2017;49:429–37.

    Implications for practice and research

  • The use of messaging platforms by clinics and hospitals to deliver encouragement, reminders and education increases patient compliance with recommended exercise and results in positive short-term health behaviours.

  • With short-term health behaviour change clearly identified, further research should consider how to use mobile devices to promote sustained change.

  • Technology and its uptake is expanding, and continued research on best approaches for health messaging and reminders is needed.

  • Context

    Mobile phone communication is growing rapidly across the globe with 7.6 billion subscriptions reported worldwide in 2017.1 There is quality evidence supporting the use of mobile phone communication by healthcare providers to enhance regular healthcare and provide informational support...




    Patient self-testing and self-management of anticoagulation is safe and patients are satisfied with these programmes

    2017-09-25T06:25:38-07:00

    Commentary on: Grogan A, Coughlan M, Prizeman G, et al. The patients’ perspective of international normalized ratio self-testing, remote communication of test results and confidence to move to self-management. J Clin Nurs 2017. doi: 10.1111/jocn.13767. [Epub ahead of print: 23 Feb 2017].

    Implications for practice and research

  • Patient self-testing and self-management programmes that augment education and telehealth approaches present a safe, sustainable and acceptable model of care for individuals with routine anticoagulation monitoring and management needs.

  • There is need for further research of patient self-testing and self-management programmes that addresses patient selection and building patient confidence.

  • Context

    Warfarin remains a key agent for thromboprophylaxis. However, it is not without complications. A narrow therapeutic range translates to a fine balance between thrombosis and bleeding. Given warfarin’s sometimes unpredictable nature, achieving quality anticoagulation can be challenging. Regular monitoring and careful titration of therapy are required...




    Father-infant skin-to-skin contact appears to be beneficial, however paternal experiences of this need to be explored

    2017-09-25T06:25:38-07:00

    Commentary on: Shorey S, He HG, Morelius E, et al. Skin-to-skin contact by fathers and the impact on infant and paternal outcomes: an integrative review. Midwifery 2016;40:207–17.

    Implications for practice and research

  • Fathers and infants benefit from fathers practising skin-to-skin contact. Thus, there is evidence for implementing this in practice. However, the prevailing culture, a family centred perspective, including the father’s own will, must be taken into account.

  • Further studies are warranted, including standardised protocols and paternal experiences from different settings.

  • Context

    Skin-to skin contact within neonatal intensive care has its origin in Columbia, due to a history of lack of incubators and mothers abandoning their fragile premature and/or sick infants. Today, skin-to-skin contact is part of ordinary care also within high-tech neonatal intensive care units. The evidence is strong that skin-to-skin care has many beneficial outcomes for infants and for mothers,1...




    Skin-to-skin care is an effective and safe intervention to reduce procedural pain in neonates

    2017-09-25T06:25:38-07:00

    Commentary on: Johnston C, Campbell-Yeo M, Fernandes A, et al. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2014:CD008435.

    Implications for practice and research

  • Skin-to-skin contact/care (SSC) is an effective and safe intervention for reducing procedural pain as measured by physiological and behavioural indicators and can be used in routine neonatal practice.

  • Further studies are needed to examine similar and clearly defined pain outcomes, taking into account SSC duration, age and comparison with other interventions.

  • Context

    Unrelieved pain caused by invasive procedures in early life is associated with detrimental outcomes in all major organ systems and has lasting implications for impairment of biobehavioural and neurodevelopment outcomes in neonatal period and later life.1 2 However, 40%–90% of infants still do not receive effective pain-relieving interventions.3 4 Non-pharmacological interventions, especially those incorporating parental involvement, that is,...




    Parenting concerns, parental identity and functional status influence medical treatment decisions of patients with advanced cancer

    2017-09-25T06:25:38-07:00

    Commentary on: Park EM, Check DK, Song MK, et al. Parenting while living with advanced cancer: A qualitative study. Palliat Med 2017;31:231–8.

    Implications for practice and research

  • Parents with advanced cancer would benefit from having clinicians engage in explicit discussions regarding their needs, concerns and plans pertaining to parenting as end-of-life gets nearer.

  • Future research also should explore some of the positive aspects that may come with parenting while experiencing advanced stages of cancer (eg, concepts of gratitude, emotional closeness and closure, and post-traumatic growth).

  • Context

    The extant literature suggests that parents with advanced cancer with dependent children are prone to higher psychological distress than those without. Past studies have mainly focused on parents with early-stage cancer communicating information about their diagnosis to underage children.1 2 Few have explored the realities of raising children while coping with advanced cancer and its effect...




    Cognitively impaired patients with heart failure may not perceive weight gain as a risk for decompensation

    2017-09-25T06:25:38-07:00

    Commentary on: Dolansky MA, Hawkins MA, Schaefer JT, et al. Cognitive function predicts risk for clinically significant weight gain in adults with heart failure. J Cardiovasc Nurs 2016. doi: 10.1097/JCN.0000000000000376. [Epub ahead of print: 2 Nov 2016].

    Implications for practice and research

  • Healthcare practitioners should be aware that many patients with heart failure (HF) do not fully recognise the link between weight gain and HF decompensation.

  • Self-care confidence has been found to influence self-care behaviours (including daily weighing in HF) much more than cognition, so future studies should determine whether interventions focused on self-care confidence can also improve patients’ ability to manage weight gain.

  • Context

    HF has a prevalence between 0.5% and 2% in the general population and is associated with poor quality of life, increased hospitalisations and high care costs.1 To counteract the impact of HF, patients need to perform self-care, including daily weighing, as...




    Risk of injury higher in older adults with dementia than in those without

    2017-09-25T06:25:38-07:00

    Commentary on: Meuleners LB, Hobday MB. A population-based study examining injury in older adults with and without dementia. J Am Geriatr Soc 2017;65:520–5.

    Implications for practice and research

  • Nurses should assess older adults for dementia and anticipate potential safety risks. Caregivers and older adults need education on interventions such as fall prevention, home safety measures and supervision of those with dementia.

  • Additional rigorous studies are needed to test fall and injury prevention interventions in dementia populations.

  • Context

    People with Alzheimer’s disease often develop impairments in executive function, resulting in poor judgement and unsafe behaviours.1 These problems put them at risk of accidents and injuries, particularly in the home environment. Coupled with ageing changes and disease processes, the person with dementia may develop functional decline that can lead to accidents and injuries. A number of interventions have been studied to address these problems in...




    Pain-related palliative care challenges in people with advanced dementia call for education and practice development in all care settings

    2017-09-25T06:25:38-07:00

    Commentary on: De Witt Jansen B, Brazil K, Passmore P, et al. Nurses’ experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study. J Clin Nurs 2017;26:1234–44.

    Implications for practice and research

  • Patient-related challenges in pain management were universal across settings, indicating a need for education and practice development at all care settings.

  • Nurse-related and organisational factors influencing pain management vary across different care settings, implying a need for different approaches to improve nurse–physician relations and learning opportunities.

  • Patient-related challenges imply a need for research on administration of medications among persons with dementia to ensure pain relief in end stage.

  • Context

    The increasing life expectancy in Europe and in developed countries worldwide indicates improved health and social conditions. However, it also means that people are older when they receive end-of-life care and are at increased risk of suffering from dementia. There...




    Frailty significantly increases the risk of fractures among middle-aged and older people

    2017-09-25T06:25:38-07:00

    Commentary on: Chen KW, Chang SF, Lin PL. Frailty as a predictor of future fracture in older adults: a systematic review and meta-analysis. Worldviews Evid Based Nurs 2017;14:282–93.

    Implications for practice and research

  • All healthcare providers including professional nurses who take care of older people should be aware of, and prepared for, increased risks of fractures according to frailty.

  • Future research should be focused on developing evidence-based interventions to reduce fracture risks in frail older people.

  • Context

    Older people are a heterogeneous population that often has multiple medical problems, disabilities and comorbidities with different patterns and severity. It is therefore challenging to provide optimal care for older patients and meet their healthcare needs. The term ‘frailty’ has gained increasing attention and interest from healthcare providers and researchers. It has emerged as a significant concept to assess overall health status of older people. Because frailty...




    High-dose monthly vitamin D3 can help to prevent acute respiratory infections in older long-term care residents, but may increase risk of falls

    2017-09-25T06:25:38-07:00

    Commentary on: Ginde AA, Blatchford P, Breese K, et al. High-dose monthly vitamin D for prevention of acute respiratory infection in older long-term care residents: a randomized clinical trial. J Am Geriatr Soc 2017;65:496–503.

    Implications for practice and research 

  • Vitamin D deficiency is rampant in institutionalised elderly individuals. Routine high-dose vitamin D3 appears to prevent acute respiratory infections in this population. This clear benefit must be weighed against a higher risk of falls with monthly vitamin D3 doses.

  • Future research should establish optimised vitamin D supplementation protocols and find the best benefit–risk strategy.

  • Context

    Vitamin D deficiency is common in elderly people, in those with sunlight deprivation, malnutrition and when comorbidities are present. One or all of these factors are often found in nursing home residents, making them one of the most populous risk groups for vitamin D deficiency. The beneficial effect of vitamin D for the prevention...




    Correction: Community-based exercise interventions during pregnancy are perceived as a satisfactory and motivating form of exercise engagement

    2017-09-25T06:25:38-07:00

    Ette L. Community-based exercise interventions during pregnancy are perceived as a satisfactory and motivating form of exercise engagement. Evid Based Nurs 2017;20:77–78. doi: 10.1136/eb-2017-102681

    The author correspondence details should read ‘Lizzie Ette’, not ‘Dr Lizzie Ette’.




    Simulation training appears to improve nurses ability to recognise and manage clinical deterioration

    2017-09-25T06:25:38-07:00

    Commentary on: Orique SB, Phillips LJ. The effectiveness of simulation on recognizing and managing clinical deterioration. West J Nurs Res 2017. doi: 10.1177/0193945917697224. [Epub ahead of print: 1 Mar 2017].

    Implications for practice and research

  • Evidence suggests that simulation training improves nurses’ clinical knowledge and performance in recognising and managing clinical deterioration in simulated environments.

  • More research is required to establish the most effective models of simulation training and the impact on patient outcomes in real clinical settings.

  • The development of a valid and reliable standardised evaluation tool could improve the comparability and consistency of simulation training in the recognition and management of clinical deterioration.

  • Context

    The importance of education has been highlighted to support nurses’ role in recognising and responding to clinical deterioration.1 Simulation is increasingly used as a teaching modality in both academic and clinical settings to improve nurses’ ability to recognise and...




    Healthcare providers need to address misconceptions young women have around IUDs and their fertility

    2017-09-25T06:25:38-07:00

    Commentary on: Payne JB, Sundstrom B, DeMaria AL, et al. A qualitative study of young women’s beliefs about intrauterine devices: fear of infertility. J Midwifery Womens Health 2016;61:482–8.

    Implications for practice and research

  • Healthcare providers should be aware that adolescent and young adult women may receive few positive messages about intrauterine device (IUD) use from their family and friends, and lean heavily on their healthcare provider for information about IUDs.

  • When counselling adolescents and young adults about contraceptive options, healthcare providers should communicate the safety of IUDs, reversibility of the method, and that menstrual changes after IUD placement are expected and do not threaten future fertility.

  • Context

    Most pregnancies among adolescent and unmarried young women in the USA are unintended. Intrauterine devices (IUDs) are safe and highly effective contraceptives, and recommended as first-line options for women, including adolescents.1 Although IUD use among American...




    Resources page

    2017-09-25T06:25:38-07:00

    Drug and Therapeutics Bulletin (DTB)

    dtb.bmj.com

    Vitamin supplementation in pregnancy

    Ensuring that a woman is well nourished, both before and during pregnancy, is crucial for the health of the woman and that of the unborn child. Maternal deficiency in key nutrients has been linked to pre-eclampsia, restricted fetal growth, neural tube defects, skeletal deformity and low birth weight. Many nutritional supplements containing vitamins, minerals and other micronutrients are heavily marketed to women for all stages of pregnancy. However, much of the evidence for vitamin supplementation in pregnancy comes from studies carried out in low-income countries, where women are more likely to be undernourished or malnourished than within the UK population. The challenges lie in knowing which supplements are beneficial and in improving uptake among those at most need. Here, we summarise current UK guidance for vitamin supplementation in pregnancy and review the evidence behind it. DTB 2016;54:81–4.

    ...