Collette Clifford

English nursing and medical students' attitudes towards organ donation

English nursing and medical students’ attitudes towards organ donation The purpose of the study reported in this paper was to examine nursing and medical students’ attitudes towards organ and corneal donation. A sample of 72 nursing and medical degree students from a British University, completed a 61-item self-administered quantitative questionnaire, adapted by Kent and Owens (1995) from an original tool devised by Parisi and Katz (1986). The findings revealed that all but one of the respondents had an overall positive attitude towards organ donation; a significant relationship was found to exist between the extent of this positive attitude held by each student and their personal willingness to donate organs. In total, 74% of the student nurses had already signed a donor card, compared to only 43% of the medical students, and the difference in the two groups’ personal commitment towards donation was significant (P=0·005). However, this disparity between the nursing and medical students was not evident when students were questioned about personally accepting organs, for survival. Most respondents agreed that they would take some form of transplanted organ or tissue into their body, if it was needed to maintain life. Overall, the study revealed that although this group of student nurses seem to be in favour of organ donation, with many willing to sign a donor card, doubts still exist in the medical student group. Further work is required to understand this phenomena. A comparison of the data with an earlier study completed by Kent and Owens (1995) indicate that student nurses may have a more positive orientation to donation than qualified staff.

An evaluation of the implementation of a programme to improve end-of-life care in nursing homes

The Gold Standards Framework in Care Homes programme aims to improve the quality of end-of-life care for residents. The impact of introducing phase 2 of the programme to homes in England was evaluated. A pre–post survey design was adopted, focusing on indicators identified as markers of good end-of-life care. The 95 homes in phase 2 of the programme were invited to participate in the evaluation. Homes completed a baseline survey of care provision and an audit of the five most recent resident deaths. The survey and audit were repeated post programme completion. Forty-nine homes returned completed pre- and post-surveys, 44 returned pre- and post-data on deaths. Although some staff found completion of the programme challenging, homes that returned pre- and post-data demonstrated improvements in aspects of end-of-life care. There were statistically significant increases in the proportion of residents who died in the care homes and those who had an advanced care plan. Crisis admissions to hospital were significantly reduced. This evaluation indicates that appropriately funded structured programmes have the potential to assist nursing homes improve the provision of end-of-life care to older adults, in line with government health policy.

The role of the nurse teacher

This paper reports on selected findings of a small exploratory study of the role of the nurse teacher. A questionnaire was circulated to teaching staff in one college of nursing. Quantitative data collected included a range of biographical detail, an outline of career patterns, professional qualifications and specific preparation undertaken for the teaching role. Qualitative data gathered in the study was transcribed and categorised into themes. The areas that are reported here include the identification of the factors that influenced decisions to work in nurse education, educators views on preparation for the teaching role and areas of satisfaction and dissatisfaction in their work. Issues related to classroom teaching role, clinical teaching role, management and research are discussed.

The role of the nurseteachers: concerns, conflicts and challenges

As part of an ongoing study into the role of the nurse teacher a series of questionnaires was designed and administered to explore nurse teachers perception of different facets of their role. Reasons for entering nurse education as a career, preparation for that career, positive and negative aspects of working in nurse education and specific aspects of the role in classroom teaching, clinical practice, research and management were all explored. An exploratory study was undertaken in one college of nursing. Following this the questionnaire was refined and administered to four colleges of nursing in England to determine if the findings identified in the exploratory study were typical of the nurse teacher group as a whole. This paper reports some of the concerns and conflicts identified by nurse teachers in this study. As a result of this work some of the challenges facing nurse teachers, particularly in relation to a clinical role, are discussed.

Quality of life after liver transplantation for hepatitis C infection

IntroductionTransplantation is a life-saving option for patients with liver disease. However, recovery is variable. Impairments in physical health, emotional wellbeing and quality of life are reported. Quality of life may be worse after transplantation for hepatitis C virus (HCV) infection.ObjectiveTo identify factors that could impact on quality of life after liver transplantation for HCV infection.MethodsA qualitative design was used. Data were collected by in-depth interview. Colaizzi’s framework for data analysis was used.ResultsVarying levels of physical and psychological disability persist for many years after liver transplantation. Participants described living productive and meaningful lives. Many reported a more positive outlook on life since transplantation. Many felt stigmatised by the association of liver disease with alcohol/drug misuse. Participants described the uncertainty of life after transplantation. While all expressed gratitude to the donor, emotional responses to the donation varied.ConclusionsTransplant recipients exchange one health state for another. Pre-transplant preparation should encourage realistic expectations of life after transplantation. Before transplantation, potential recipients should be given an opportunity to discuss the donation process. This may reduce the burden of emotional debt experienced by some recipients. Feelings of stigma and future uncertainty may be worse for transplant recipients with HCV. A qualitative approach can provide deeper insight into issues affecting quality of life after transplantation for HCV, and explain some of the ambiguous and contradictory findings of previous quantitative studies.

The critical care nurse's role in End‐of‐Life care: issues and challenges

AIM The purpose of this article is to discuss the challenges critical care nurses face when looking after patients needing End-of-Life (EoL) care in critical care environments. BACKGROUND Critical care nurses frequently provide care to patients who fail to respond to treatments offered to support and prolong life. The dying phase for individuals in critical care settings, commonly after withholding/withdrawing treatment, is very short posing great demands on critical care nurses to provide physical and emotional support to both patients and their families. Despite the existence of recognized care planning frameworks that may help nurses in providing EoL care, these are not used by all units and many nurses rely on experience to inform practice. A number of aspects such as communication, patient/family-centred decision-making, continuity of care, emotional/spiritual support and support for health professionals have been indicated as contributing factors towards the provision of effective EoL care. These are considered from the perspective of critical care nursing. CONCLUSION Skills development in key aspects of care provision may improve the provision of EoL care for critical care patients and their families. RELEVANCE TO CLINICAL PRACTICE Critical care nurses have an essential role in the provision of effective EoL care; however, this dimension of their role needs further exploration. It is noted that educational opportunities need to be provided for critical care nurses to increase the knowledge on planning and delivering EoL care. To inform this evaluation of current EoL care provision in critical care is necessary to address a knowledge deficit of the needs of nurses who seek to support patients and their families at a critical time.

Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study.

Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study The Delphi technique enables the structuring of group opinion and discussion using a survey approach, maintaining the anonymity of panel members and preventing contamination of individual responses through peer pressure. The Delphi technique was used by the authors to form an expert opinion regarding the needs of a critically ill child. The abstract and evaluative nature of need was a key issue to arise during early pilot work and stimulated the first author to undertake a concept analysis of the term ‘need’. The defining attributes arising from the concept analysis were used to construct two hypothetical case studies for the modified Delphi; these were used as part of the questionnaire for all three rounds. In the first round, the panel was asked to identify the needs of the child in the two case studies; in subsequent rounds the panel activity involved modifying these need statements and indicating the importance, frequency and maximum acceptable delay in meeting each need. Extensive pilot work was required for each round of the modified Delphi. This article evaluates the use of this technique to identify needs, discusses key features arising from the results and examines the difficulties experienced by the respondents in completing the time scales.

Cancer genetic predisposition: information needs of patients irrespective of risk level

Increased insight into the information needs of people about cancer genetic predisposition could allow materials to be developed to improve decision-making for those at high risk, whilst those at lower risk could have their anxiety reduced without the need for referral to genetics services. This study aimed to identify information needs of patients concerned about a genetic predisposition to cancer, and explore how this varied according to risk perception, cancer worry, personal motivation and demographics. Stage 1 used semi-structured telephone interviews pre and post participants’ genetic risk assessment. The findings informed stage two, a structured questionnaire survey of 1,112 patients, pre and post their genetic risk assessment. Participants were stratified by risk level and included those concerned about an inherited predisposition to breast, ovarian or colorectal cancer. About 512 (46%) responded with equal proportions of responders and non-responders across the risk categories. Findings indicated that irrespective of a person’s actual or perceived level of risk, cancer worry, demographic background or personal motivation; priorities in the type of information required were similar. Greatest emphasis focused on information provision about how risk was assessed. Least important was acquiring an understanding about genes and inheritance patterns. Most participants reported difficulties accessing or finding information. Peoples’ information needs are consistent irrespective of their risk level and therefore generalised information packages could be developed for anyone requesting cancer genetic risk assessment. Better information is likely to assist patients’ understanding and ultimately increase concordance with recommended screening and preventative measures.

Caring for families with a family history of cancer: Why concerns about genetic predisposition are missing from the palliative agenda

Care of the family is integral to palliative care, but little attention has been paid to the way nurses, or other healthcare professionals, are responding to the needs of families who are concerned about whether their family history of cancer is associated with an inherited genetic predisposition. This paper discusses how palliative care nurses perceive the care needs of patients with a family history of cancer. Data were collected through recorded, semi-structured interviews with 10 nurses who had worked in specialist palliative care. The findings show that there are cogent arguments and concerns about raising the issue of an inherited genetic predisposition at the end of life (especially when the patient is close to death and there is a lack of knowledge about genetics). Nevertheless, exemplar cases are used to illustrate the reasons why it is important that nurses working in specialist palliative care settings are aware of the needs of this patient group. The paper highlights that nurses not only need an appropriate knowledge base but also an insight of what can be achieved when supporting patients with a family history of cancer.

A literature review of the impact of a diagnosis of cancer of the vulva and surgical treatment

AIMS AND OBJECTIVES This paper examines the evidence available regarding the physical, psychological and sexual consequences for women following a diagnosis and treatment for cancer of the vulva. BACKGROUND Cancer of the vulva is a rare condition affecting approximately 1000 women in the UK each year. However, little is known about the impact of the condition as there is a limited research base to inform clinical practice. DESIGN Review. METHOD This paper critiques the 15 studies identified in the English language literature relating to carcinoma of the vulva from 1983 to the present. Collectively these involved less than 400 women with this condition. RESULTS The review highlighted a paucity of published studies on this patient group. There are weaknesses in the design and analytical methods of the studies and a lack of clarity in the analysis of the published data. However, the review has enabled a picture to be built up of the challenges these women face postoperatively. The lack of recent evidence to support care practices offers limited help in contemporary health care today. CONCLUSION There is a clear need for further research to explore the issues for women facing treatment for carcinoma vulva. RELEVANCE TO CLINICAL PRACTICE An awareness of the issues facing women following a diagnosis and subsequent treatment, usually surgery, for cancer of the vulva will allow nurses and other health care professionals to have a greater understanding of the needs of these women and thus impact on care planning.