Pam Moule

Checking the carotid pulse: diagnostic accuracy in students of the healthcare professions

This study evaluated the competence of students of the healthcare professions to locate the carotid pulse using a computerised manikin, within 10 s. A sample of 105 students from physiotherapy, radiography, midwifery and nursing participated in measuring diagnostic accuracy in a single attempt at pulse check using a computerised manikin, timed to an accuracy of +/-1 s. All had received basic life support instruction, and one group had advanced life support skills. The mode and median diagnostic delays were calculated for each group. Comparisons of mean rank values for the groups were determined, and comparisons of previous training and accuracy in diagnosis were calculated. Forty (38%) students were able to give an accurate diagnosis within 10 s. The results identified significant differences between the performance of the groups (chi(2) 16.74, P<0.01), with the advanced life support course students demonstrating most competence. Previous training did not affect performance in the skill (chi(2) 0.29, P=0.58). Carotid pulse check skills should be emphasised and tested as part of cardiopulmonary resuscitation instruction.

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.

Issues with e-learning in nursing and health education in the UK: are new technologies being embraced in the teaching and learning environments?

In this paper we present aspects of a study that scoped e-learning implementation in nursing and health science disciplines throughout the UK and explored the factors affecting use. Data related to the use of technologies are presented here. While there are many drivers for the use of e-learning, the current scope of engagement in nursing and health science disciplines is unknown and variations in adoption have not been explored. A postal questionnaire sent to a purposive sample of 93 Higher Education Institutions (HEIs) obtained data from 25 universities (response rate of 28%) related to their uptake and development of e-learning. Questionnaire data was analysed using descriptive statistics. From this, nine HEIs were identified, reflecting a range of levels of engagement in e-learning. Data was collected through 35 staff interviews across the sites. Qualitative data from the interviews was transcribed to allow thematic analysis. Though e-learning adoption and use vary across the sector, the predominant learning and teaching engagement is instructivist and managed through a virtual learning environment. There is limited experimentation with e-learning and teaching use, linked to key centres of excellence and the efforts of ‘champions’. It is suggested that a more systematic approach to development and funding is required to achieve enhanced use of e-learning.

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.

Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates

BACKGROUND Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation after endotracheal intubation. The role of chlorhexidine and tooth-brushing has been considered as a clinical intervention to reduce infection rates, however, evidence to inform this needs appraising. AIM This paper presents a critical review on the effect of chlorhexidine gluconate (CHX) and tooth-brushing in decreasing rates of VAP in mechanically ventilated adult patients cared for in intensive care settings. METHODS A literature search was conducted using a number of bibliographic databases (n = 6). A number of parameters were used to exclude irrelevant papers. A total n = 17 papers were located and accessed, which were directly related to the field. Eight studies that met the criteria and addressed the study aims were reviewed. FINDINGS CHX was successful in reducing the rate of VAP and using a combination of CHX and colistine resulted in better oropharyngeal decontamination which reduced and delayed VAP. Chlorhexidine was also effective in reducing dental plaque in patients cared for in intensive care and had the potential to reduce nosocomial infections. Results of studies investigating the use of tooth-brushing in reducing VAP incidence proved inconsistent, although all recommend tooth-brushing as important in maintaining good oral hygiene. CONCLUSIONS The use of chlorhexidine has been proven to be of some value in reducing VAP, although may be more effective when used with a solution which targets gram-negative bacteria. Tooth-brushing is recommended in providing a higher standard of oral care to mechanically ventilated patients and reducing VAP when used with chlorhexidine. However, limitations in study design and inconsistency in results suggest that further research is required into the effects of tooth-brushing.

ICT: a social justice approach to exploring user issues?

Amidst the current imperatives to embrace technology as a teaching and learning medium within higher education, this paper considers the introduction of information and communication technology (ICT) within an undergraduate nursing programme from a social justice perspective, assuming ethical principles in accessing, constructing and developing knowledge. An interpretive paradigm position was taken to access the student voice, using open interviewing with a sample of six undergraduate nurses.A process of data reduction and display identified four themes. First, students described a stage of initial intimidation in the process of using the computer for learning. Second, students needed motivation to learn, demonstrating a lack of time and inclination to experiment with computers. Third, computer ownership was seen as crucial to developing ICT skills and also overcame problems with use of the university system. Finally, students felt they had had limited access to computer use in clinical practice, though they were enthusiastic to learn more about their clinical application. Recommendations identified the need to support students in developing ICT skills throughout the undergraduate programme, requiring curriculum development and a cultural shift. There is an additional need to consider strategies for increasing the flexibility and reliability of computer provision.

An evaluation of a basic life support CD-ROM

The faculty has developed a basic life support (BLS) CD-ROM as part of a staff development project across the UK’s south west region’s universities. The introduction of the BLS CD-ROM to the faculty represents a paradigm shift, from the former method of delivering an acetate-based BLS lecture to groups of students across the professional disciplines. It is the intention that all students and staff requiring BLS instruction, should access the CD-ROM to gain and test essential theoretical knowledge, and have an opportunity to observe best practice through video demonstrations. The production of the BLS CD-ROM meets many of the current National Health Service and Higher Education agendas, with the potential for learning to take place in clinical environments and for developing key transferable skills. The tool can also be used to achieve the requirements for multi-professional education. This presentation introduces the evaluative testing by questionnaire of the beta version of the CD-ROM, using a convenient sample of 26 Diploma nursing students, adult branch. The results identify changes needed before implementation of the CD-ROM as a learning tool across all pre- and post-qualified professional groups. The students particularly valued the opportunity to learn at their own pace, and the use of critical thinking scenarios, which enhanced their learning. A small number of technical and presentational errors were identified for correction. Students also made suggestions for other improvements and further developments of multimedia learning materials. While this enthusiastic appraisal is acknowledged, the current paucity of research demands that the faculty continues to evaluate the use of the CD-ROM when fully implemented. This research will be used to inform further developments of multi-media learning materials.

Using the Plan-Do-Study-Act model: Pacesetters experiences

PURPOSE This article aims to analytically review the Plan-Do-Study-Act (PDSA) model used in the Pacesetters national programme evaluation. DESIGN/METHODOLOGY/APPROACH The evaluation teams two-fold role is outlined: supporting project teams to develop PDSA plans and collect evaluation data. Four case studies are used to show the PDSA models application and effect in a participatory action learning approach. Despite limitations, it is clear that all four case studies illustrate the PDSA models potential benefits in a participatory evaluation approach, which involves public and patients. FINDINGS The models effectiveness is premised on several enabling factors such as: teams appreciating the model; a climate that values all learning and open to re-planning; engaging any external evaluators whose role is clearly communicated to all project stakeholders in a timely fashion. PRACTICAL IMPLICATIONS There are clear intentions to promote evidence-based commissioning in the UK that values patient and public involvement. The PDSA model has the potential to test and implement changes in real work-place settings and to involve the public in evaluation. ORIGINALITY/VALUE Case study analysis identifies new reflections on the PDSA models use to support innovative NHS practice development with public involvement in a participatory approach.

Virtual patients: development in cancer nursing education.

BACKGROUND The number of men diagnosed with prostate cancer is increasing and internationally there are high incidence rates. It is important that nurses and healthcare professionals are enabled to provide appropriate care to those men affected by prostate cancer and their families. Despite this need, there is recognition that many professionals feel ill prepared and lack knowledge in a number of areas. This paper presents the development of a Virtual Patient (VP) online resource to support practitioner learning. AIM To develop five online VP simulation scenarios to meet the learning needs of nurses and health-care professionals caring for men with prostate cancer. METHOD Topic areas for the VPs were taken from previous work exploring the needs of health care professionals working with men with prostate cancer. An initial scoping exercise involving nursing practitioners, students and a prostate cancer charity confirmed the focus of the case study scenarios. Service users and specialist practitioners reviewed an outline of each case study to ensure fidelity of the simulations scenarios. Cases were entered into UChoose, a web based interactive VP player and authoring tool. The final case studies were reviewed by a sample of both registered and non-registered nurses and nursing students. RESULTS The majority of respondents reported an increase in knowledge and suggested that they would recommend the resource to others. A number of positive aspects of the resource were highlighted. Respondents also commented about areas of weakness, a number of which have been addressed subsequently. CONCLUSIONS The VP case studies provided an opportunity to develop knowledge and confidence in caring for men with prostate cancer. The mode of delivery and the content was acceptable for less experienced and knowledgeable staff.

Rescheduling nursing shifts: scoping the challenge and examining the potential of mathematical model based tools.

AIM To review research in the literature on nursing shift scheduling / rescheduling, and to report key issues identified in a consultation exercise with managers in four English National Health Service trusts to inform the development of mathematical tools for rescheduling decision-making. BACKGROUND Shift rescheduling is unrecognised as an everyday time-consuming management task with different imperatives from scheduling. Poor rescheduling decisions can have quality, cost and morale implications. EVALUATION A systematic critical literature review identified rescheduling issues and existing mathematic modelling tools. A consultation exercise with nursing managers examined the complex challenges associated with rescheduling. KEY ISSUES Minimal research exists on rescheduling compared with scheduling. Poor rescheduling can result in greater disruption to planned nursing shifts and may impact negatively on the quality and cost of patient care, and nurse morale and retention. Very little research examines management challenges or mathematical modelling for rescheduling. CONCLUSION Shift rescheduling is a complex and frequent management activity that is more challenging than scheduling. Mathematical modelling may have potential as a tool to support managers to minimise rescheduling disruption. IMPLICATIONS FOR NURSING MANAGEMENT The lack of specific methodological support for rescheduling that takes into account its complexity, increases the likelihood of harm for patients and stress for nursing staff and managers.