Allyson Lipp

Developing the Reflexive Dimension of Reflection: A Framework for Debate

Abstract Reflexivity is defined and then explored as a meta-methodology for research as well as a means to stimulate professional development using reflection as a platform. Reflexivity is argued to be a deeper and broader dimension of reflection. A model of reflection, based on critical theory, is introduced to assist with the transition from reflection to reflexivity as the categories of the reflective model provide the foundation for the transition. Solutions are then outlined for the various challenges to reflexivity. A preliminary framework for undertaking reflexivity is introduced in an effort to guide novices in this ever-more necessary adjunct to research and professional development.

A systematic review of prophylactic antimicrobials in PEG placement.

AIM To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. BACKGROUND Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. DESIGN Systematic review. METHODS We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. RESULTS Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0.31, 95% CI 0.22-0.44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5.8 patients to prevent one infection - NNT. CONCLUSIONS Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. RELEVANCE TO CLINICAL PRACTICE The nurses role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement.

A Guide to Developing a Systematic Review

Systematic reviews are used to gather information from a variety of sources and distill information based on best evidence synthesis, while also excluding poor quality studies via explicit validity checks. This article provides a roadmap to conducting a systematic review with the Cochrane Collaboration and uses an example of a completed systematic review. The literature is drawn upon to provide rationale for the processes undertaken. The aim of the sample systematic review was to identify and review all randomized controlled trials evaluating disposable surgical face masks worn by surgical team members during clean surgery to prevent postoperative surgical wound infection.

Stigma in Abortion Care: Application to a Grounded Theory Study

Abstract A recent research study found that being more directly involved in medical abortion places greater demands on the nurses. The demands required by nurses working in abortion care may be increased by the stigma attached to such an antisocial action. This paper presents an application of stigma theory, as espoused by Goffman, based on a qualitative research study on abortion. It is argued that women attending for abortion are stigmatised and nurses, although ‘wise’, have an affiliate stigma through their close association with the procedure. It is proposed that the situation can be ameliorated by addressing stigma at policy, local and personal levels. Examples from other areas of practice are outlined for possible application to practice.

Conceding and concealing judgement in termination of pregnancy; a grounded theory study

This study aimed to elicit some of the affective attributes in nurses and midwives involved in caring for those undergoing abortion and explore how they may affect the care given. Nurses and midwives face challenges in caring for women during abortion. Recent advances have resulted in more nursing/midwifery input into abortions. Impending legislation is also likely to increase nursing involvement and yet little is known of the likely impact on those involved. Twelve nurses and midwives working in termination of pregnancy services throughout Wales were interviewed using a grounded theory approach. An early affective attribute was being non-judgemental, but the core category derived from comparative analysis revealed that nurses and midwives conceded judging the women, but then concealed their judgements. To help them conceal their judgements maxims were used such as ‘there but for the grace of God go I’. Goffman’s work on stigma was used to challenge and integrate the grounded theory into the literature. As being non-judgemental is an aspiration, acknowledging that judgement occurs may be more appropriate for clinical nurses in order for them to devise strategies to conceal judgements in a considered manner.

A Woman Centred Service in Termination of Pregnancy: A Grounded Theory Study

The issue of abortion is contentious. It challenges those involved emotionally and ethically and, although in the UK it is set within legal parameters, it remains controversial. The involvement of nurses and midwives in abortion care has not been explored to any great depth. In the UK, there has been a sustained increase in the number of medical compared to surgical terminations over the last decade. Nurses/midwives are at the forefront of this procedure and, because of the current political climate, their involvement is likely to increase in the future. This grounded theory study aimed to explore how nurses and midwives perceive their role with women undergoing termination of pregnancy and how they cope with their increased involvement with these women.

Setting up a mental health service user research group: a process paper

It is claimed that the involvement of mental health service users in research remains fragmented, and expertise in involving service users is still developing. This paper explains how a group of mental health service users and carers formed a Research Development Group in Wales. This is a process paper which describes how the group was established and funded as part of the United Kingdom Clinical Research Networks. It explores the rationale for a Mental Health Service User and Carer Partnership Research Development Group and the challenges experienced in setting up the group, including activities such as a current research project. This project involves collaboration between group members and nurses from a local National Health Service Trust, which is helping to build research capacity. This project is used to illustrate the issues raised, and we provide critical reflections of this process. The power balances that posed challenges to a group of this type are explored and ways to overcome them are suggested. The research group is still in its infancy but has aspirations to move from being a user involvement group to a user-led group incorporating the differing viewpoints and promoting an equal contribution from its members.

Cyanoacrylate as a microbial sealant: examining the evidence.

This article examines the evidence base for the use of microbial sealant as a skin preparation prior to surgery. Firstly, using the steps of evidence-based practice the use of cyanoacrylate as a microbial sealant was explored. Next the evidence regarding the use of cyanoacrylate based microbial sealant was sought and then critically appraised. Having found evidence to support its use to be lacking in rigour and quality, an argument is made for the omission of cyanoacrylate-based microbial sealants as part of current preoperative preparation.

An evaluation of preoperative skin antiseptics.

An underpinning tenet of evidence-based practice is that all routine practices should be open to scrutiny. Questioning practice should not be limited to new, experimental procedures, but should also include examination of ‘tried and trusted’ techniques. Taking this perspective, the author recently contributed to a systematic review evaluating the use of antiseptics preoperatively.

An exploration of Taylor's reflective framework.

Abstract Taylors reflective framework has been in place for several years and as far as can be ascertained there has been no review of its utility. The aim of this paper is to explore Taylors framework in an endeavour to encourage its critical use by nurses in both clinical and academic roles. In the spirit of critical theory, upon which Taylors framework is based, the use of it as an instrument for reflecting on practice will be scrutinised thoroughly.