Helen Aveyard

Core topics of health care ethics. The identification of core topics for interprofessional education.

Objectives: The aim of this project was to identify core topics of health care ethics that could be taught through an inter-professional approach to undergraduate education. Design: Five nominal group technique workshops. Setting and participants: Teaching staff from different professional disciplines in our university (nursing branches, occupational therapy and physiotherapy). Results: Seven core topics of health care ethics that are common across all disciplines were identified. However participants in all workshops identified the need for case studies used in teaching and learning to be specific to the clinical setting encountered by the student. Conclusion: Despite the identification of core topics that apply to all disciplines, caution should be taken when seeking to integrate these into an inter-professional undergraduate programme. There is evidence from other studies that students have difficulty in transferring knowledge from one context to another. In view of this, an inter-professional approach to health care ethics teaching to a group, members of which do not encounter shared clinical ethical problems may be inappropriate. It is suggested that inter-professional learning in undergraduate health care ethics should focus on facilitating learning in the clinical area with students who share similar ethical encounters, in which case the learning will be truly inter-professional.

Informed Consent Prior to Nursing Care Procedures

It is largely undisputed that nurses should obtain consent prior to nursing care procedures. This article reports on a qualitative study examining the way in which nurses obtain such informed consent. Data were collected through focus group discussion and by using a critical incident technique in order to explore the way in which nurses approach consent prior to nursing care procedures. Qualified nurses in two teaching hospitals in England participated in the study. An analysis of the data provides evidence that consent was often not obtained by those who participated in the study and that refusals of care were often ignored. In addition, participants were often uncertain how to proceed with care when the patient was unable to consent. Consent prior to nursing care procedures is an essential but undeveloped concept, for which a new ethos is required.

The patient who refuses nursing care

Objectives: The aim of this paper is to examine the way in which nurses manage patients who refuse nursing care procedures. Design: This paper reports on a qualitative study which was undertaken to explore the way in which nurses obtain consent prior to nursing care procedures. Focus groups were carried out to obtain background data concerning how consent is obtained. Critical incidents were collected through in depth interviews as a means of focusing on specific incidents in clinical practice. Setting: Two teaching hospitals in England. Participants: Purposive sample of qualified nurses. Results: When a patient refuses nursing care, nurses respond by giving information until the patient finally accedes to the procedure. Nurses will go to great lengths to achieve patients’ agreement to the procedure, but the extent to which the agreement remains voluntary cannot be ascertained by the data collected in this study. If the patient does not eventually agree to a procedure, there is evidence that nurses will administer the care in the absence of consent. Conclusions: Nurses are concerned to obtain the patient’s consent prior to the administration of nursing care but if this cannot be achieved do not regard obtaining consent as an absolute requirement. Consent is preferred, but not considered essential. Nurses have some understanding of the principles of informed consent but do not apply them to everyday clinical nursing practice.

The patient who is unable to consent to nursing care

The aim of this paper is to examine the way in which nurses manage patients who are unable to consent to nursing care procedures. This paper reports on a qualitative study using focus groups and critical incidents collected through in-depth interviews to explore the way in which nurses obtain consent prior to nursing care procedures. The finding indicate that nurses are uneasy about administering care to a patient who cannot consent. When complicating factors are present this unease is exacerbated and sometimes the appropriate delivery of care is withheld.

Student nurses’ competence in sexual health care: A literature review

AIMS AND OBJECTIVES To explore the way in which sexual health care is perceived and experienced by students in clinical practice. BACKGROUND Student nurses understand the need to learn about sexual health but report a variety of learning needs and experience challenges acquiring skills to deliver such care in part due to varied clinical experience. Furthermore, there is a paucity of data exploring clinical competence of sexual health care among student nurses. DESIGN AND METHODS A literature review of the published literature was conducted following a search of online databases. Articles were selected for analysis according to inclusion and exclusion criteria. Eight articles were critically appraised and thematically analysed. RESULTS The following themes were identified: student nurses report having a positive attitude towards sexual health care; however, many felt uncomfortable about addressing sexual health and are reluctant to initiate a conversation; many student nurses lack knowledge about sexual health; they also lack role models at university and on clinical placement. Student nurse caregiving in relation to sexual health was also noted. CONCLUSIONS It is encouraging that student nurses have some knowledge, but their knowledge assessed is narrow. Their attitude is generally positive although many feel uncomfortable discussing issues of sexual health and sexuality. Very few student nurses report delivering sexual health care. There is a lack of positive role models both on clinical placement and at university. RELEVANCE TO CLINICAL PRACTICE The reasons behind a lack of sexual health care delivery by student nurses should be understood. Student nurses should be supported to assess patient need and provide holistic care. Positive role models should be established in clinical and educational environments along with a focus on wider sexual health knowledge and skills.

What is the experience of being readmitted to hospital for people 65 years and over? A review of the literature

Aim: To explore the experience of readmissions to hospital from the perspective of older adults. Methods: A systematic review with an interpretative approach was conducted. CINAHL, Embase, and Medline were consulted in October 2016. Results: Six studies with data collection between 2004 and 2013 fit the relevant criteria and included a total of 68 older adults. Two overarching themes were developed with relevant subthemes: Experience during initial hospital stay distinguished by exclusion (Feeling powerless; Feeling disregarded; Perception of readiness for discharge); Patients experience uncertainty following discharge (Perception that community-based services are not available or adequate; Perception that hospital is the only safe place; Difficulty in adapting to a “new normal”). Conclusions: A cycle of exclusion exists during the initial hospital stay and beyond. The experience of being readmitted to hospital is challenging, mostly perceived as negative, and, existential, emotional and psychological well-being is not satisfactorily addressed by healthcare professionals.

Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review

AIM The aim of this integrative literature review was to explore the quality of the dying and death experience in the Emergency Department from the perspective of staff and carers. BACKGROUND Death in the Emergency Department is common. Understanding the quality of the death and dying experience of patients and their family members is crucial to building knowledge and improving care. DESIGN Systematic integrative literature review reported following the PRISMA guidelines. DATA SOURCES Pubmed, Cumulative Index to Nursing and Allied Health Literature, Magonline (internurse), and the Cochrane library. Articles used were published in English during 1990- 2017. REVIEW METHOD Appraisal and thematic analysis. RESULTS Sixteen articles are included. Eight themes emerged from the literature: care in the Emergency Department is about living not dying, staff perceive that death is a failure, staff feel underprepared to care for the dying patient and family in this environment, there is limited time for safe standards of care, staff stress and distress, staff use of distancing behaviours, the care of the dying role is devolved from medics to nurses at the end of life, and patients and staff perceive that the Emergency Department is not the preferred place of death CONCLUSION: There are areas of concern about end of life care in the Emergency Department. To improve practice and to ensure that a good death occurs, further research is needed. There is a need to understand more about the experience of caregivers when a relative or friend dies in the Emergency Department.