Frank Milligan

In defence ofandragogy

Abstract This paper supports the continued use ofthe term andragogy in Project 2000 nurse education programmes. It is argued that the theory of andragogy, and its supporting philosophy, methods, and research, are consistent with both the means and ends of contemporary nurse education. Some of the recent pressure felt in relation to use of alternative terms, such as critical pedagogy, are linked to wider socio-political influences and it is argued that it is essentially a sign of the times that andragogy has now come under threat. The call, from some, for a return to pedagogy is also seen as an attempt to reassert an increased degree of control over the student by those educationalists. This article is also a response to the article by Philip Darbyshire (1993) which questions the viability and relevance of the term andragogy.

Diabetes medication patient safety incident reports to the National Reporting and Learning Service: the care home setting.

Diabet. Med. 28, 1537–1540 (2011)

The use of criteria-basedgrading profiles in formative and summative assessment

This article outlines the development and use of criteria based grading profiles for formative and summative assessment. The profiles were developed in 1991 in an attempt to improve assessment validity, inter-marker and inter-course reliability and student feedback within the Faculty of Health Care and Social Studies. Important underlying aspects of assessment theory are examined and it is argued that assessment should be conceptualised as an ethical activity requiring clarification for students of expectations through specification of criteria. It is concluded that the profiles have proved useful in guiding both lecturers and students in the completion and marking of assessed work and that further study and debate needs to take place in relation to the effectiveness and potential disadvantages of such profiles.

Going beyond blame: reporting NHS medication errors in nursing home residents with diabetes

It is widely accepted in literature on patient safety that an open culture — one that seeks to understand the multiple reasons for error — is required to promote incident reporting and maximise learning for system improvement.1 In the attempt to deliver the research described here we encountered a culture of blame. Such a culture leads to low levels of medication error reporting with regard to NHS systems supplying the nursing home setting. This article explores the problem of this low level of reporting being detrimental to future learning on NHS medication errors.2 The study we undertook, ‘Root causes of medication errors in nursing home residents with diabetes: enhancing safety in NHS medicines management’, was funded by the Research for Patient Benefit (RfPB) programme. It focused on residents with diabetes in nursing homes, as defined by the Care Quality Commission (CQC),3 and involved consenting homes in Bedfordshire and Hertfordshire. Nursing homes were selected because medication delivery processes are slightly different from residential care home provision, although the incident reporting systems are similar. The aim of the study was to gather data on NHS errors, and report on and analyse them for learning purposes and solution development. The comments made here relate to the data collection process. The final research findings will be summarised in future publications. Patient safety is defined by the World Health Organization as the absence of preventable harm to a patient during the process of health care and involves coordinated efforts to prevent such harms.4 In part, the positive progress seen in patient safety in the NHS has been attributable to the creation of the National Reporting …

Limiting Harm in Health Care: A Nursing Perspective: Milligan/Limiting

Maps, medicine, nurses and health care defining medicine, nursing and the nature of iatrogenesis health professions, power, knowledge and expertise shifting boundaries in current nursing practice the hidden harm of drug therapy drugging family therapy - shifts in the care of hyperactive children talking harm - the medicalization of mental health practice disabling professions - the lay perspective lessons on managing risk - the medical experience nurse diagnosed myocardial infarction - hidden nurse work and iatrogenic risk talking death, talking harm NHS Direct - the impact of information technology and shifting nurse roles repercussions and possible future trends - limiting iatrogenic harm.

An audit of acute coronary syndrome assessment (TIMI scoring) and treatment

Purpose – The purpose of this paper is to report the findings of an audit undertaken on the use of the Thrombolysis in Myocardial Infarction (TIMI) scoring system, and adherence to agreed treatment protocols, in the triage of patients with cardiac chest pain.Design/methodology/approach – A retrospective review of case notes. Sixty eight patients were audited on the use of TIMI score and 64 of these were further audited on the management commenced in the emergency department.Findings – Only nine of the 68 patients with cardiac chest pain had a TIMI score documented. Of the 64 patients, 31 analysed for treatment commenced were managed correctly, 33 patients (n=64) were either under or over treated.Practical implications – Adherence to clinical guidelines should be subject to audit review to assess impact on patient outcomes. Over‐treatment included administration of unnecessary anticoagulants raising patient safety and cost issues. Under‐treatment left patients vulnerable to further cardiac events.Originali...

“Supporting nursing, midwifery and allied health professional students to raise concerns with the quality of care: A review of the research literature”

BACKGROUND This article reports aspects of a systematic literature review commissioned by the UK Council of Deans of Health. The review collated and analysed UK and international literature on pre-registration healthcare students raising concerns with poor quality care. The research found in that review is summarised here. OBJECTIVE To review research on healthcare students raising concerns with regard to the quality of practice published from 2009 to the present. DATA SOURCES In addition to grey literature and Google Scholar a search was completed of the CINAHL, Medline, ERIC, BEI, ASSIA, PsychInfo, British Nursing Index, Education Research Complete databases. REVIEW METHOD Sandelowski and Barrosos (2007) method of metasynthesis was used to screen and analyse the research literature. The review covered students from nursing, midwifery, health visiting, paramedic science, operating department practice, physiotherapy, chiropody, podiatry, speech and language therapy, orthoptist, occupational therapy, orthotist, prosthetist, radiography, dietitian, and music and art therapy. RESULTS Twenty three research studies were analysed. Most of the research relates to nursing students with physiotherapy being the next most studied group. Students often express a desire to report concerns, but factors such as the potential negative impact on assessment of their practice hinders reporting. There was a lack of evidence on how, when and to whom students should report. The most commonly used research approach found utilised vignettes asking students to anticipate how they would report. CONCLUSIONS Raising a concern with the quality of practice carries an emotional burden for the student as it may lead to sanctions from staff. Further research is required into the experiences of students to further understand the mechanisms that would enhance reporting and support them in the reporting process.