Clifford Richardson

Nursing therapeutics: Teaching student nurses care, compassion and empathy

BACKGROUNDnDebate continues regarding whether humanitarian values such as care and compassion can be taught or are innate in individuals who wish to become nurses.nnnOBJECTIVESnTo undertake a discursive review of the literature on caring, compassion and empathy. To understand the teaching and learning issues associated with these concepts. To design and implement an Undergraduate Unit of study which addresses the development of caring, compassion and empathy in student nurses.nnnMETHODS/DATA SOURCESnMEDLINE, CINAHL, and a wide range of literature including books and governmental reports were used for a discursive narrative review.nnnRESULTSnCaring, compassion and empathy are ill-defined; however healthcare users are clear that they know when nurses use skills and attitudes associated with these concepts. Evidence is available to show that caring, compassion and empathy can be taught and there are tools available to measure them in neophytes through their training. Central to the androgogical embedding of these concepts into nursing curricula is the development of therapeutic relationships.nnnCONCLUSIONSnIt is possible to develop materials to enable student nurses to learn how to care using compassion and empathy. Nursing therapeutics is a term devised to describe how student nurses can exploit the therapeutic potential of any patient contact especially when related to specific and routine nursing interventions. Muetzels model for understanding therapeutic relationships is one framework that can be adopted to help student nurses to appreciate how to build patient relationships and encourage them to move towards therapeutic advantage using care, compassion and empathy.

Adherence to ocular hypotensive therapy: patient health education needs and views on group education

Background In this study the authors sought both to understand the health education needs of patients with glaucoma, with particular regard to adherence to glaucoma treatment, and to examine these patients’ views of group education. Methods Using a health promotion approach to health education, 27 qualitative interviews with new and established patients receiving glaucoma treatment were conducted. Health promotion is defined as a way of strengthening people’s capacities to control and optimize their own health. The interviews were transcribed and were then analyzed thematically Results Nine categories of health education needs were identified from the transcripts: (1) to understand glaucoma; (2) to understand their diagnosis or understand the difficulties in giving a diagnosis; (3) to understand the implications of eye drops, their side effects, and how to renew the eye drops; (4) to feel confident to put in eye drops; (5) to put the condition into perspective - to know how to manage their risk; (6) to be able to ask questions of clinicians; (7) to be able to navigate the health care system; (8) to understand and be able to manage own adherence behavior; and (9) to know where to access other sources of information. The majority of patients had something positive to say about group education, and about half of the patients said they would attend group education if they were offered the opportunity. Conclusion A health promotion approach identified a wide range of patient-centered health education needs regarding adherence to glaucoma treatment. Group education will be attractive to some patients. Clinicians could use the health education needs identified in this study to guide the development of either individual or group-based educational intervention to improve adherence to glaucoma treatment. However, clinicians need to be aware that when developing a group intervention, attention will need to be given to making the education relevant to the circumstances of each patient.

A Clinical Evaluation of Postamputation Phenomena Including Phantom Limb Pain after Lower Limb Amputation in Dysvascular Patients

To explore the effects of phantom phenomena on a group of dysvascular lower limb amputees. This was a cross-sectional study of dysvascular lower limb amputees. A modified version of the phantom phenomena questionnaire was used to measure the prevalence of phantom phenomena and the effects of those phenomena on daily life. Eighty-nine amputees were recruited. The majority were inpatients (72%) and male (72%). Most had pain before amputation (83%). Sixty-three percent had phantom limb pain. No associations were found between phantom limb pain and preamputation pain (p = .397). Phantom limb pain was present immediately on waking from amputation in 23%. Phantom limb pain is highly fluctuant. It is more likely that phantom limb pain was present with more time passed since amputation (p = .002). Outpatients with unhealed wounds were less likely to have phantom limb pain (p = .007). The effects of postamputation phenomena include sleep loss and social restrictions. These results challenge the belief that phantom limb pain reduces over time as more outpatients reported phantom limb pain than inpatients. Preamputation pain is not linked to the presence of phantom limb pain. The fluctuant nature of phantom limb pain makes its treatment complex. Some may wish intensity to reduce, whereas others may prefer to reduce the number of episodes or duration of each episode instead. More research is needed to clarify the needs of amputees in relation to the postamputation phenomena.

A review of the management of phantom limb pain: challenges and solutions

Background Phantom limb pain (PLP) occurs in 50% and 80% of amputees. Although it is often classified as a neuropathic pain, few of the large-scale trials of treatments for neuropathic pain included sufficient numbers of PLP sufferers to have confidence that they are effective in this condition. Many therapies have been administered to amputees with PLP over the years; however, as of yet, there appears to be no first-line treatment. Objectives To comprehensively review the literature on treatment modalities for PLP and to identify the challenges currently faced by clinicians dealing with this pain. Method MEDLINE, EMBASE, CINAHL, British Nursing Index, Cochrane and psycINFO databases were searched using “Phantom limb” initially as a MeSH term to identify treatments that had been tried. Then, a secondary search combining phantom limb with each treatment was performed to find papers specific to each therapy. Each paper was assessed for its research strength using the GRADE system. Results Thirty-eight therapies were identified. Overall, the quality of evidence was low. There was one high-quality study which used repetitive transcutaneous magnetic stimulation and found a statistical reduction in pain at day 15 but no difference at day 30. Significant results from single studies of moderate level quality were available for gabapentin, ketamine and morphine; however, there was a risk of bias in these papers. Mirror therapy and associated techniques were assessed through two systematic reviews, which conclude that there is insufficient evidence to support their use. Conclusion No decisions can be made for the first-line management of PLP, as the level of evidence is too low. Robust studies on homogeneous populations, an understanding of what amputees consider a meaningful reduction in PLP and agreement of whether pain intensity is the legitimate therapeutic target are urgently required.

The effect of Ringer's solution within a dressing to elicit pain relief.

Clinical studies suggest that dressings containing Ringers solution, such as the TenderWet and HydroClean families, provide relief from wound pain. This report reviews the available evidence and possible mechanisms for the relief of wound pain by these dressings. The ability of dressings containing Ringers solution to provide pain relief is likely to be through providing a moist environment that is favourable for wound healing; furthermore, the dressing augments the protective barrier function by having additional fluid under the dressing, which covers exposed nerve endings and protects against friction damage. Ringers solution will have a dilution effect and an influence on the pH of exudate. Diluting cytokines within the exudate would be expected to decrease inflammation in chronic wounds and reduce the influence of caustic components such as matrix metalloproteases (MMPs). Altering the pH of the wound bed could inactivate proteins and glycoproteins implicated in the pain response such as MMPs and sodium and calcium channels. The moist environment may also be better at recruiting leukocytes that release natural painkillers at areas of injury. These mechanisms are likely to act in combination to explain why dressings containing Ringers solution can have analgesic effects.

Therapeutic opportunities when using vapocoolants for cannulation in children

How nurses make a difference and influence outcome has been the subject of much debate over many years and is perhaps more relevant now owing to healthcare funding being a scarce commodity. Nurses need justification and validation of what they do. Nursing therapeutics is a relatively new term that can help nurses and others to appreciate the multifariousness, complexity and value of what they do. It encapsulates the means by which a nurse delivers care that is both evidence based and beneficial to his or her patients. This article highlights how nurses can make use of common nursing interventions to ensure that the full impact of their skills is embedded in their care-using the administration of vapocoolants as the focus of the discussion. It will be illustrated that through each patient contact, a nurse can establish therapeutic principles that can positively influence health outcomes.

Introducing nursing practice to student nurses: How can we promote care compassion and empathy

To the population nursing and caring are synonymous. Empathy and using therapeutic relationships are ways that nurses can utilise care and compassion in their practice. However health care delivery needs to be led by evidence and one way to ensure evidence-based care is delivered compassionately and with empathy is to utilise the principles of nursing therapeutics. Nursing therapeutics allows a nurse to understand how care should be delivered as well as why. This discussion paper explores the use of therapeutic relationship building, nursing therapeutics and compassionate nursing and how neophyte student nurses can be introduced into these concepts during their first practice exposure. Using clinical case-studies, role-play and reflective discussion, student nurses explore and re-evaluate assumptions, to apprise and consider their beliefs and their impulse to care. Educational dialogue encourages a connection with the patient, to the person and their humanity. The implementation of this approach is facilitated by the use of newly devised learning resources which have been formulated to frame the encounter and to enable the student to look at their interaction and develop their therapeutic approach.

Group-based patient education delivered by nurses to meet a clinical standard for glaucoma information provision: the G-TRAIN feasibility study

BackgroundGlobally, glaucoma is the leading cause of irreversible blindness. However, many patients with glaucoma do not understand their disease which reportedly impacts on their ability to manage their condition successfully. The aim of this feasibility study was to undertake research to inform a future randomised controlled trial of the effectiveness of group-based education for patients to improve adherence to glaucoma eyedrops.MethodsKey objectives were to understand current provision of information during routine nurse-led glaucoma consultations, to investigate if it is possible to deliver patient information in line with a clinical standard by training nurses to deliver group-based education in multiple hospital sites and to explore the acceptability of group-based education to nurses and patients compared with usual information provision in consultations. This study employed quantitative and qualitative research methods situated in a sequential design across three hospitals in England and Wales. Current provision of information given to 112 patients with glaucoma across the three hospitals was observed and compared to that recommended in a clinical standard. Then, six nurses were trained to deliver group-based education. Following which, the level of information was assessed again in line with the clinical standard as the group-based education programme was delivered in the three hospitals to 16 patients in total. All nurses and six patients were interviewed to explore experiences of the group-based education sessions.ResultsThe main area of information provided during routine nurse-led consultations concerned the management of glaucoma and that least covered was about prognosis of the disease and information about support services. Nurses were trained to implement group-based education for patients. Information was provided more often by the nurses about all the items of the clinical standardxa0when delivering group based education. However, patients’ motivation to attend were negatively impacted mainly by delays in delivering the education for the third phase and because the majority were established patients. Nurses and patients who participated found it useful and comprehensive.ConclusionThis feasibility study demonstrates that the proposed intervention for the randomised controlled trial, the group-based education, goes beyond current information provision, is in line with that articulated by a clinical standard and is implementable across several sites. This bodes well for a future randomised trial, but the following needs to be taken into account to ensure success: independent implementation of the research, training and delivery at each site, timely provision of the patient education, inclusion of new patients, and consistently delivered nurse training.Trial registrationInternational Standard Randomised Controlled Trial number, ISRCTN91188805

Multidisciplinary attitudes to people with dementia; training and environmental factors play a role in caring for people with dementia in a Cardiac Catheterisation Laboratory

Purpose n n n n nThe purpose of this paper is to explore multidisciplinary attitudes and environmental factors affecting dementia care in the Cardiac Catheter Laboratory (CCL). n n n n nDesign/methodology/approach n n n n nQuestionnaires (n=87) were distributed in a hospital CCL in the North of England. The authors utilised the Dementia Attitudes Scale which incorporates two subscales: Social Comfort and Dementia Knowledge. In addition, a newly devised questionnaire asking about perceptions of how the CCL environment affected care of patients with dementia was added. n n n n nFindings n n n n nThe response rate was 71 per cent (n=62). Years’ experience in the CCL was associated with lower Social Comfort scores (p=0.026). Dementia training was associated with higher mean Dementia Attitudes Scale and Social Comfort scores (p=0.021, p=0.007). Participants who had undertaken “Professional studies” had higher Dementia Attitudes Scale and Dementia Knowledge mean scores (p=0.038, p=0.046) but “On-the-job” training was perceived as most beneficial (32 per cent, n=20). Unit co-ordinators and nurses felt the CCL was an unfavourable environment for patients with dementia. Care was perceived to be impaired by environmental functionality, equipment and the presence of ionising radiation. n n n n nResearch limitations/implications n n n n nThe small sample limits generalisability. Although the Dementia Attitudes Scale is a validated questionnaire it has not been widely used so reliability of these results is unclear. n n n n nPractical implications n n n n nCaring for patients with dementia has unique challenges especially in areas like the CCL. These results suggest that practical experience and training can affect the perception of staff to patients with dementia hence there may be a need to assess what would be the most appropriate training to give health professionals in the future. n n n n nOriginality/value n n n n nThe authors believe this to be the first multi-professional research study into care of patients with dementia in a specialised acute unit. This was the most diverse sample known to have attitudes to dementia measured quantitatively in an acute hospital department and the results need to be replicated before practice should be changed.