Dinah Gould

What are scoping studies? A review of the nursing literature

BACKGROUND Scoping studies are increasingly undertaken as distinct activities. The interpretation, methodology and expectations of scoping are highly variable. This suggests that conceptually, scoping is a poorly defined ambiguous term. The distinction between scoping as an integral preliminary process in the development of a research proposal or a formative, methodologically rigorous activity in its own right has not been extensively examined. AIMS The aim of this review is to explore the nature and status of scoping studies within the nursing literature and develop a working definition to ensure consistency in the future use of scoping as a research related activity. DESIGN This paper follows an interpretative scoping review methodology. DATA SOURCES An explicit systematic search strategy included literary and web-based key word searches and advice from key researchers. Electronic sources included bibliographic and national research register databases and a general browser. RESULTS The scoping studies varied widely in terms of intent, procedural and methodological rigor. An atheoretical stance was common although explicit conceptual clarification and development of a topic was limited. Four different levels of inquiry ranging from preliminary descriptive surveys to more substantive conceptual approaches were conceptualised. These levels reflected differing dimensional distinctions in which some activities constitute research whereas in others the scoping activities appear to fall outside the remit of research. Reconnaissance emerges as a common synthesising construct to explain the purpose of scoping. CONCLUSIONS Scoping studies in relation to nursing are embryonic and continue to evolve. Its main strengths lie in its ability to extract the essence of a diverse body of evidence giving it meaning and significance that is both developmental and intellectually creative. As with other approaches to research and evidence synthesis a more standardized approach is required.

Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data

• Simulations are of particular advantage in research studies where large samples are necessary to achieve statistical power and the information must be collected under uniform conditions in order to aid interpretation. • In the study reported below, simulation was achieved through the use of medical photography accompanied by case studies of the same patients. All information was collected on the same day. The purpose of the study was to determine the validity of the three pressure ulcer risk assessment scales most commonly used in clinical nursing practice in the UK. • Each clinical nurse assessed the same four patients using three risk assessment scales and a visual analogue scale designed to capture their own clinical judgement. External validity was assessed by a panel of tissue viability experts who provided independent ratings. • Data were obtained from 236 clinical nurses, yielding 941 risk assessments. • Experience with this approach to data collection suggests that it requires careful planning. This should include measures to ensure that the simulated information is valid and that all data collectors have been adequately trained and are able to motivate the nurses participating in the study. Providing consideration is given to these issues, the use of simulation can help to collect data that would be difficult to obtain by more conventional means. It is also important to recognize that clinical decisions are de-contextualized in simulations because they are reduced to verbal and visual summaries. The decision to use simulations should thus be taken only if this is acknowledged.

Disagreement and aggression in the operating theatre

AIM This paper is a report of a study to determine the national spread of incidents of disagreement within and between professional groups in operating departments and the frequency of perceived aggressive behaviour demonstrated by operating department personnel. BACKGROUND There is both anecdotal and empirical evidence supporting the idea of the operating team as the ultimate example of teamworking in health care. At the same time, international concern is expressed over the level of interprofessional conflict and aggression reported in operating departments. Such reports do not sit well with notions of excellence in teamwork as conceptualized by theorists. METHOD A questionnaire survey was designed, and sent to a random sample of National Health Service operating departments in England (n = 62) in 2002. Usable survey questionnaires were returned from 37 departments (response rate 59.6) and yielded 391 individual responses. Respondents included nurses (58%, n = 227), surgeons (9.7%, n = 38), anaesthetists (14.32%, n = 56) and operating department practitioners (17.9%, n = 70) of all grades. FINDINGS Half of the respondents reported experiencing aggressive behaviour from consultant surgeons (53.4%, n = 209). Daily disagreements between nurses and consultants about list management were reported. Perceptions of lack of understanding of roles and shared goals for patient care between the professional groups were also reported. Similar reports were received from all geographical locations in the sample. CONCLUSION Further research is needed to conceptualize the complex nature of interprofessional working in operating theatres before steps can be taken to develop a less stressful and more efficient working environment.

Patients and the public: knowledge, sources of information and perceptions about healthcare-associated infection

Statutory bodies provide information about healthcare-associated infection (HCAI) in the UK. Information is also available on National Health Service trust websites. Opinion polls demonstrate that fear of developing HCAI, especially methicillin-resistant Staphylococcus aureus, is the single greatest concern of people contemplating healthcare. We undertook a literature review to determine lay knowledge of HCAI, sources of information and perceptions of the risks. Twenty-two studies met the inclusion criteria. Of these, nine explored knowledge and perceptions as the primary research aim. The remainder consisted of a heterogeneous assortment of works comparing the knowledge and perceptions of different groups, their experiences of being infected or colonised and/or isolated. In all accounts, lay people expressed anxiety about the risks and consequences of HCAI. The most frequently reported source was the media, which has been blamed for sensationalist and inaccurate accounts. Lay people do not appear to access credible sources of information, or, if they do access them, are unable to understand their messages. Organisations that provide patient-focused information about HCAI are generic in scope, so that obtaining specific information may take time and effort to locate. Research is necessary to explore the acceptability, comprehensibility and accessibility of lay sources of information about HCAI and to find ways of readjusting risk perceptions to realistic levels in order to provide sensible levels of reassurance to those about to undergo healthcare.

The relationship between continuing professional education and commitment to nursing

Nurses have a responsibility to undertake continuing professional development to enable them to keep abreast with changes in health care. Acquiring new knowledge and skills is essential for nurses to practice safely in new and extended roles. Opportunities for continuing professional development are thought to increase retention. The aim of this study was to explore the relationship between undertaking continuing professional development and commitment to the profession and the employing National Health Service trust and to explore any differences between nurses in standard and extended roles. A questionnaire survey was undertaken with 451 nurses employed in three contrasting trusts. The questionnaire incorporated a validated scale to measure organisational and professional commitment. Three hundred and eighteen (70.5%) of the nurses had undertaken continuing professional development over the previous 12 months. Ninety nine nurses (22%) had received only mandatory training over the same period. There was no evidence of a relationship between professional and organisational commitment and undertaking continuing professional development. There was no evidence that specialist nurses in extended roles had undertaken the developmental continuing professional development that would be expected in order for them to acquire new competencies and skills.

Universal precautions A review of knowledge, compliance and strategies to improve practice

The purpose of this literature review is to consider key themes from empirical research relating to the knowledge and compliance of universal precautions amongst healthcare practitioners. Utilising international studies, strategies to improve universal precautions are analysed. The review identifies areas of limited knowledge, synthesises existing research and suggests aspects of universal precautions that need to be studied further. A literature search of studies listed in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database was conducted from 1990–2003, using a number of key words. Review, analysis and synthesis of selected studies were performed. The findings of this review showed that universal precautions are considered an effective means of protecting patients and staff and controlling infection. The consensus from this body of evidence is that, globally, knowledge of universal precautions is inadequate and compliance low. Studies from many countries have shown that specific intervention strategies, such as education, are influential in improving knowledge and compliance. This review concludes that it is imperative that future research examines how the attitudes and beliefs of practitioners can be influenced and changed to reenforce adherence to universal precautions within the clinical practice setting. There remains a lack of evidence on the long-term benefits of practice interventions to improve compliance, and what specific barriers are influential in affecting how healthcare practitioners adopt universal precautions more effectively in their practice.

Endotracheal suctioning in adults with severe head injury: literature review

Endotracheal suctioning is a routine but potentially dangerous nursing procedure. The research literature documenting approaches to minimising the complications of endotracheal suctioning in adults with severe head injuries is reviewed. Hyperoxygenation, hyperventilation, hyperinflation, normal saline instillation and the effects of endotracheal suctioning on intracranial pressure and cerebral perfusion pressure are examined. Recommendations for an evidence-based endotracheal suctioning protocol are made.

Eyecare for the sedated patient undergoing mechanical ventilation: the use of evidence-based care.

There is a need to evaluate different nursing procedures to determine whether in todays cost-conscious climate of health care they genuinely benefit the patient. If such procedures are indeed found to be of value, ways must be explored of ensuring that the manner in which they are performed conforms to acceptable standards. In the study reported here eyecare for the ventilated, sedated patient was examined because variations in clinical practice had been observed and a preliminary examination of the literature indicated that this patient group was at particular risks of developing serious ocular complications. The study was conducted in two phases. Phase 1 took the form of a literature review which demonstrated that although many questions remained unanswered, sufficient information relating to eyecare existed to help develop protocols to guide care. Phase 2 consisted of non-participant observation with 15 nurses employed in an intensive care unit to examine the standard of eyecare actually delivered. The standard of eyecare fell short of the ideal and as in other studies designed to observe nursing procedures accurately and in detail, there was no demonstrable relationship between clinical practice, knowledge or clinical experience. From the study overall it was possible to conclude that patients would benefit from the implementation and audit of guidelines of eyecare but that before these innovations are undertaken barriers to good practice should be explored in intensive care units.

Impact of observing hand hygiene in practice and research: a methodological reconsideration

The purpose of hand hygiene is to break the chain of healthcare-associated infection. In many countries hand hygiene is regularly audited as part of quality assurance based on recommendations from the World Health Organization. Direct observation is the recommended audit method but is associated with disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is analogous with productivity improvement by increasing the frequency with which hand hygiene is undertaken. Unobtrusive and/or frequent observation to accustom staff to the presence of observers is considered an acceptable way of reducing the Hawthorne effect, but few publications have discussed how to implement these techniques or examine their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. In the presence of auditors, health workers might defer or avoid activities that require hand hygiene, but these issues are not addressed in guidelines for practice or research studies. This oversight has implications for the validity of hand hygiene audit findings. Measuring hand hygiene product use overcomes avoidance tactics. It is cheaper and generates data continuously to assess the compliance of all clinicians without disrupting patient care. Disadvantages are the risk of overestimating uptake through spillage, wastage, or use by visitors and non-clinical staff entering patient care areas. Electronic devices may overcome the Hawthorne and avoidance effects but are costly and are not widely used outside research studies.

Disciplinary processes and the management of poor performance among UK nurses: bad apple or systemic failure? A scoping study

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems.