J. Albarran

Evidence-based practice in health and social care: where are we now?

This paper explores evidence-based practice (EBP) in health and social care in the UK from the individual perspectives of professionals in physiotherapy, midwifery, nursing and social care. The present interest in EBP emerges as a natural derivative of contemporary economic, social and political trends and concerns. There is optimism and broad acceptance of the overall philosophy of EBP and each profession demonstrates a concerted organisational attempt to bridge the research--practice divide. This includes the interpretation of research outcomes in the form of practice guidelines, protocols and standards. However, adherence to these is poor and resistance to EBP is growing. This is attributed to practical and philosophical tensions common to all of the professions. These include the continued dominance of randomised controlled trials (RCTs) in the hierarchy of evidence. RCTs often fail to capture the multi-faceted individualistic nature of health and social care interactions or the development of qualitative methodologies within the professions. Concern is expressed that professional autonomy and the art of practice will be eroded by the enforcement of guidelines and protocols. EBP is currently located within individual professions rather than the broader context of interprofessional practice. The future of EBP is dependent, at least in part, on educational initiatives, organisational commitment and support, patient/client involvement and the development of a broader interprofessional perspective.

Exploring the patient's experiences of learning to live with an implantable cardioverter defibrillator (ICD) from one UK centre: a qualitative study.

BACKGROUND: International expansion of indications for implantable cardioverter defibrillator (ICD) implant means increasing numbers of patients with devices worldwide. However, smaller numbers of patients with ICDs in the UK has meant that clinical expertise available to care for this specialized group is limited. Whilst North American patients’ experiences of living with an ICD are well documented, European perspectives remain underrepresented. AIM: The aim of this study was to explore and describe patients experiences around the time of their ICD device implant and after they returned home from one UK centre. METHODS AND RESULTS: Eligible patients were recruited from one regional cardiothoracic centre and interviewed in their own homes using semi-structured schedules. Analysis of data elicited three themes; non-individualised nature of information, adjustments to living with the device and future outlook. Unique findings identified were; (a) concealment of concerns and symptoms; (b) funding issues; and (c) unavailability of appropriate support and advice during and after time in hospital. CONCLUSION: Individualized care and support for these ICD patients appeared lacking according to respondents. Opportunities to discuss concerns appeared non-existent, which may indicate that UK patients are disadvantaged in the domain of psychological support compared with their European and North American counterparts. Findings remain tentative until explored with a larger, more representative and international sample.

The Presence of Family Members During Cardiopulmonary Resuscitation: European Federation of Critical Care Nursing Associations, European Society of Paediatric and Neonatal Intensive Care and European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement

This paper presents the European federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement on The Presence of Family Members During Cardiopulmonary Resuscitation. Copyright of this position statement is jointly owned by the European Federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, the Council on Cardiovascular Nursing and Applied Professions, and Connect Healthcare Publishing Ltd.

Research priorities of adult intensive care nurses in 20 European countries: a Delphi study.

AIMS This paper is a report of a three round Delphi study of intensive care nursing research priorities in Europe (October 2006-April 2009). BACKGROUND Internationally, priorities for research in intensive care nursing have received some attention focusing on healthcare interventions and patient needs. Studies as early as the 1980s identified priorities in the United States, United Kingdom, Hong Kong and Australia. Research priorities of intensive care nurses across the European Union are unknown. METHODS The participants, invited in 2006, included 110 intensive care nurses, managers, educators and researchers from 20 European Critical Care Nursing Associations. Delphi round one was an emailed questionnaire inviting participants to list important areas for research. The list was content analysed and developed into an online questionnaire for rounds two and three. In round two, participants ranked the topics on a scale of 1-6 (not important to extremely important). Mean scores of round two were added to the questionnaire of round three and participants ranked the topics again. RESULTS There were 52 research topics in 12 domains. There was a dominance of priorities in five main areas: patient safety; impact of evidence based practice on outcomes; impact of workforce on outcomes; wellbeing of patients and relatives; and impact of end-of-life care on staff and practice. CONCLUSIONS The results reflect worldwide healthcare concerns and objectives and highlight topics that nurses view as fundamental to the care of critically ill patients. These topics provide a platform for future research efforts to improve clinical practice and care of patients in intensive care.

A non-randomized comparison of e-learning and classroom delivery of basic life support with automated external defibrillator use: a pilot study.

This pilot study investigated whether computer-based learning package followed by practical instruction and traditional classroom methods were comparable in developing knowledge and skills in basic life support with automated external defibrillator. Eighty-three mental health care professionals were allocated to one of two groups. Twenty-eight completed an e-learning package, and the remaining 55 received delivery of content in a classroom. Using standardized assessment methods, comparisons of participant knowledge gain and performance in resuscitation were made. Significant increases in knowledge followed training. No differences were found with basic resuscitation skills or in the time taken to the first shock; however, both groups were inaccurate with electrode pad placement. E-learners performed slightly better in 21 of the 30 observed skills. Overall group performance did not differ suggesting computer-based education has the potential to prepare learners in resuscitation knowledge and skills to comparable levels of classroom courses.

Sedation practice in Nordic and non-Nordic ICUs: a European survey

BACKGROUND AND AIMS A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries. DESIGN AND METHODS A cross-sectional survey of ICU nurses attending the fourth European federation of Critical Care Nursing associations (EfCCNa) in Denmark, 2011. Data included use of protocols; sedation, pain and delirium assessment tools; collaborative decision-making; sedation and analgesic medications; and educational preparation related to sedation. RESULTS Response rate was 42% (n = 291) from 22 countries where 53% (n = 148) used sedation protocols. Nordic nurses reported greater use of sedation (91% versus 67%, p < 0·01) and pain (91% versus 69%, p < 0·01) assessment tools than non-Nordic nurses. Decision-making on sedation was more inter-professionally collaborative in Nordic ICUs (83% versus 61%, p < 0·01), units were smaller (10 versus 15 beds, p < 0·01) and nurse-patient ratio was higher (1:1, 75% versus 26%, p < 0·01). Nordic nurses reported greater consistency in maintaining circadian rhythm (66% versus 49%, p < 0·01), less use of physical restraints (14% versus 36%, p < 0·01), less use of neuromuscular blocking agents (3% versus 16%, p < 0·01), and received more sedation education (92% versus 76%, p < 0·01). Delirium assessment was not performed systematically in most settings. CONCLUSIONS Organizational and contextual factors, such as ICU size, staffing ratio and inter-professional collaboration, are contributing factors to sedation management in European ICUs. The Nordic context might be more germane to the goal of lighter sedation and better pain management. RELEVANCE TO CLINICAL PRACTICE Our study raises awareness of current sedation practice, paving the way towards optimized ICU sedation management.

Lesbian, gay and bisexual experiences within critical care nursing, 1988-1998: a survey of the literature

The aim of this paper is to provide an analysis of the extent to which gay, lesbian and bisexual service user experiences are represented within the critical care literature. A survey of five well established critical care journals, covering the period 1988-1998, was conducted in order to reveal the range of themes addressed within them. The findings suggest that these groups are invisible in this field of practice and consequently their particular concerns have remained marginalised. The implications of this absence are far reaching, potentially inhibiting nurses from establishing effective caring relationships with either lesbians, gays or bisexuals and from identifying and developing appropriate interventions for the care of these patients and their families.

Family witnessed resuscitation: the views and preferences of recently resuscitated hospital inpatients, compared to matched controls without the experience of resuscitation survival.

AIM OF THE STUDY To compare the preferences of patients who survived resuscitation with those admitted as emergency cases about whether family members should be present during resuscitation. METHODS We used a case control design and recruited, from four large hospitals, 21 survivors of resuscitation and 40 patients admitted as emergency cases without the experience of resuscitation (control group) who were matched by age and gender at a ratio of 1:2. Data collection involved face-to-face interviews using a standardised 22 item questionnaire. Data analysis sought to identify differences between the two groups. RESULTS Both groups were broadly supportive of the practice, however resuscitated patients were more likely to favour witnessing the resuscitation of a family member (72% versus 58%), preferred to have a relative present in the event they required resuscitation (67% versus 50%) and believed that relatives benefited from such an experience (67% versus 48%). Additionally, both groups indicated that staff should seek patient preferences about family witnessed resuscitation following hospital admission, and stated that they were unconcerned about confidential matters being discussed with family members present during resuscitation (91% and 75%, respectively). However none of these differences between the two groups achieved statistical significance. CONCLUSION Hospitalised patients report a favourable disposition towards family witnessed resuscitation, and this view appears to be strengthened by successfully surviving a resuscitation episode. Practitioners should strive to facilitate family witnessed resuscitation by establishing, documenting and enacting patient preferences. Research exploring the perceptions of the wider public would help further inform this debate.

Gender differences on chest pain perception associated with acute myocardial infarction in Chinese patients: A questionnaire survey

AIMS To investigate gender differences in chest pain perception among Chinese patients with acute myocardial infarction. BACKGROUND Thrombolytic therapy is beneficial to outcomes of acute myocardial infarction if administered within 12 hours from the onset of chest pain. However, cardiac symptom interpretation may impact time of presentation to hospital. Differences in cardiac symptom reports by gender partly explain misdiagnoses and delays in treatment, particularly among women. Whether, such trends apply to Chinese patients with myocardial infarction is unknown. DESIGN A descriptive prospective study. METHODS Using questionnaires, data on demographic variables, the number of patients reporting chest pain and other chest sensations at the onset of acute myocardial infarction and chest pain intensity, description, location and radiation across the chest were collected. RESULTS A total of 128 participants equally divided by gender were recruited. Chest pain was more prevalent among men than women (84.37% vs. 67.19%, p < 0.05). Although no statistical significance was found, Chinese men had higher mean chest pain intensity scores (7.54 SD 2.35 vs. 7.51 SD 2.25) and reported less atypical chest pain (0.00% vs. 9.3%) compared with women. Men had more upper right sided chest pain (40.74% vs. 20.93%, p = 0.038) whereas women experienced increased neck pain and pain to the upper central chest, middle central chest, upper central back, middle central back and middle right back regions. CONCLUSIONS Discreet gender differences in chest pain perceptions exist between Chinese men and women, with the latter group, who may be considered as a high-risk group for missed and delayed diagnosis from myocardial infarction, reporting more atypical presentations. RELEVANCE TO CLINICAL PRACTICE Irrespective of culture, women with myocardial infarction tend to present with atypical chest pain symptoms and therefore they should be aggressively investigated.

An analysis of professional, specialist and advanced nursing practice in critical care

A recent document, The Future of Professional Practice--Standards for Education and Practice Following Registration (United Kingdom Central Council (UKCC) 1994a), has laid down a structure for clinical practice, providing a pathway for nurses to progress from the professional level, through to specialist and advanced levels, according to clinical expertise and educational preparation. The purpose of this article thus sets out to analyse critically these distinct levels in relation to critical care nursing. In particular, the paper discusses the development of advanced practice and how the proposed levels may be integrated within critical care.