Pamela Kirkpatrick

Factors influencing adherence to antiretroviral treatment in Asian developing countries: a systematic review

Objective  To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries.

Exploring clinical wisdom in nursing education

The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to ‘clinical wisdom’ itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice.

Lost in Translation: Reflecting on a Model to Reduce Translation and Interpretation Bias

Aim: This paper reflects on the language and translation challenges faced and interventions used whilst undertaking cross-cultural public health research in Nepal using translators. Background: The growth in cross-cultural studies and international research highlights the use of translators and the associated challenges for researchers with regard to cultural and linguistic issues when collecting data in one language and analysing and reporting in another. The specific challenges when using translators are frequently overlooked in the research literature and translators and the interpretation processes omitted from the research methodology and/or discussion. Methods: The experiences and challenges for an English-speaking nurse researcher working with a team of translators in a cross-cultural study on the sexual and reproductive health (SRH) of young people in Nepal, in 2006, is explored in this paper. The paper employs a case study approach. The Study: Data were collected over four weeks observing the settings, and the SRH knowledge and practices of participants in two villages in Kathmandu Valley were identified using a questionnaire, which was administered as a structured interview, and from the nurse researcher’s field notes. This provided information on the translation and interpretation events. Stages in the research process where error could occur are identified in the researchers model and the interventions taken to minimise these are discussed which clarify perspectives and opinions when researching in the field. Findings and Conclusion: Reflecting on translation and interpretation challenges during the data collection process in a language which the nurse researcher does not speak, can help reduce (or avoid) potential mistakes and error. The paper reflects on a model of translation processes which emerged during fieldwork which helps understand what events happened and what actions were taken to obtain the most accurate data. Using a model such as this for cross cultural fieldwork may be useful for both novice and established researchers.

Supporting Breastfeeding Establishment among Socially Disadvantaged Women: A Meta-Synthesis.

BACKGROUND Many women from socially disadvantaged groups discontinue breastfeeding in the early postnatal period before lactation is fully established. This suggests that existing health service practices do not adequately meet the breastfeeding support needs of this population. The aim of this meta-synthesis is to review the literature exploring how women from socioeconomically deprived backgrounds experience breastfeeding establishment and to identify factors associated with supportive practice. METHODS The meta-synthesis includes qualitative studies exploring the perception of women from disadvantaged groups of in-hospital and professionally led interventions to support the establishment of breastfeeding. Searches were conducted for studies published between 1992 and 2013; after critical appraisal, eight studies were retained. RESULTS Three overarching themes of the influences on maternal perception of the efficacy of breastfeeding support were identified. These included practical skill and knowledge of the breastfeeding process, the influence of psychological factors on perceived breastfeeding ability, and the provision of a person-centered approach to infant feeding support. CONCLUSIONS The findings illustrate that the factors associated with supportive breastfeeding practice are extensive, complex, and interrelated. Strategies which enable mothers to gain confidence in their ability to successfully breastfeed by acquiring technical expertise, which offer positive encouragement, and which are culturally specific are more likely to be perceived as supportive by women from socially disadvantaged groups.

the effectiveness and maternal satisfaction of breast-feeding support for women from disadvantaged groups: a comprehensive systematic review

Background Breast‐feeding is considered the optimum method of infant nutrition conveying health and psychological benefits for mother and baby. Women from disadvantaged groups are less likely to initiate or successfully establish breast‐feeding and with the current emphasis on addressing health inequalities there is an identified need to tailor breast‐feeding strategies towards this population. Objectives To appraise and synthesize the best available evidence on effectiveness and maternal satisfaction of interventions supporting the establishment of breast‐feeding in the early postnatal period, up to seven days following delivery, for women from disadvantaged groups. Inclusion criteria Types of participants Women from disadvantaged groups, defined as those from socio‐economically deprived areas; low income; under 20 years or substance dependent. Types of intervention(s)/phenomena of interest Any study exploring practical, motivational, informative and/or educational interventions supporting disadvantaged women to establish breast‐feeding. Types of studies Quantitative and qualitative studies. Types of outcomes The establishment of breast‐feeding/lactation within the postnatal period; perceived usefulness and acceptability of the intervention to support breast‐feeding establishment in the postnatal period. Search strategy Searches were conducted for any published or unpublished material, in the English language, between 1992 and March 2013. A three‐step search of databases including ASSIA; Campbell Collaboration; CINAHL, Cochrane Database; EBSCO; EThOS; Journals @OVID; Medline and SAGE journals was conducted. Methodological quality Each paper was assessed by two independent reviewers for methodological quality using the appropriate critical appraisal instrument from Joanna Briggs Institute. Data collection Data was collected using standardized extraction tools developed by Joanna Briggs Institute. Data synthesis Data was synthesized according to their methodological approach using instruments from the Joanna Briggs Institute. Where this was not possible, findings are presented in a narrative form. Results A total of 10 studies were included in the review. Two were quantitative studies (prospective cohort studies) and eight were qualitative studies (qualitative components of a mixed methodology study and seven qualitative studies). Forty‐five findings were extracted from the qualitative components of the studies. Findings were synthesized into 12 categories. Categories were synthesized into three findings. The quantitative review demonstrated that technical assistance and information provision resulted in greater awareness of breast‐feeding physiology, increased rates and a longer duration of breast‐feeding. The qualitative synthesized findings suggested that maternal satisfaction was enhanced when proactive practical assistance was given within the confines of a collaborative relationship. Professional support offering positive encouragement and delivering socio‐culturally appropriate strategies were considered by mothers as helping to meet their breast‐feeding objectives. Disempowering practices included inaccessible information, conflicting advice and judgmental attitudes from health care providers. Conclusions The review identified interventions aimed at enhancing technical skill and knowledge as clinically effective in establishing successful breast‐feeding. Disadvantaged women considered support strategies offering culturally relevant advice and specific to their individualized needs as the most acceptable and effective in meeting their breast‐feeding intentions. Implications for practice The evidence suggests that health care interventions facilitating both maternal awareness of the physiology of breast‐feeding and the acquisition of technical skill assists establishment of breast‐feeding. Proactive, professional support complementing practical advice with positive encouragement and tailored to the mothers specific needs appears to be both useful and acceptable for disadvantaged women establishing breast‐feeding. Implications for research Future studies should evaluate how health care professionals promote the establishment of breast‐feeding for women from disadvantaged groups specifically in relation to the additional socio‐cultural barriers experienced by these groups.

Absolute clinical skill decay in the medical, nursing and allied health professions: a scoping review protocol

Review questions/objectives: The objective of this scoping review is to examine and map absolute clinical skill decay in the medical, nursing and allied health professions and to map the range of approaches used to address decay of clinical skills in these professions. Specifically, the review questions are: which clinical skills, performed by which professional groups, are reported to be most susceptible to absolute clinical skill decay, and what approaches have been reported for addressing absolute clinical skill decay in the medical, nursing and allied health professions? In addressing the review questions, the following sub-questions will also be addressed:Which healthcare settings have been investigated in relation to addressing absolute clinical skill decay?What are the characteristics of the approaches used to address absolute clinical skill decay in the medical, nursing and allied health professions?Which outcomes have been utilized when investigating approaches to addressing absolute clinical skill decay? It is anticipated that this scoping review will inform further systematic review/s on the topic of addressing clinical skill decay in the medical, nursing and allied health professions, as well as identify gaps in the research knowledge base that will inform further primary research.

Competencies for the multi-disciplinary team caring for severely obese patients undergoing bariatric surgery: a systematic review.

Bariatric surgery is the only intervention leading to sustained weight reduction for severely obese individuals. However, there is variability across the UK in organisation of bariatric services, and perceptions of how to develop and deliver optimum care. This means lack of clarity on competencies and skills required for roles within the multidisciplinary bariatric surgical team. This systematic review was carried out to synthesise literature identifying the competencies required by members of the multidisciplinary team for provision of safe, meaningful and appropriate care for severely obese patients undergoing bariatric surgery. The databases CINAHL; Medline; ERIC; PsycINFO; IngentaConnect; The Knowledge Network, and Web of Knowledge were searched to identify key papers. Papers selected were independently appraised for methodological quality by two reviewers using Joanna Briggs Institute systems. Thirty-six papers were included in the review. The literature was poorly developed, largely consisting of text and opinion, and lacking evaluative content. Pooling of papers generated three synthesised findings: 1) Safe, meaningful and appropriate care may be delivered if staff in each role in the multidisciplinary team achieve a minimum set of competencies; 2) Safe, effective and meaningful care may require a minimum set of competencies for managing a bariatric surgery unit and the multidisciplinary team; 3) To achieve competencies for safe, effective and meaningful care certain approaches to education may be developed. Sensitive care, pre-operative psychological assessment, post-operative care and identification of complications, and team management may be areas in which educational interventions develop, but the conclusion remains tentative because of lack of empirical research in the area.

competencies and skills to enable effective care of severely obese patients undergoing bariatric surgery across a multi-disciplinary healthcare perspective: a systematic review

Background The incidence of severe and complex obesity with co‐morbidity and high risk of mortality is increasing globally. Bariatric surgery is the only intervention leading to sustained weight reduction, and the number of procedures carried out is increasing. There is variability across the UK in the provision of bariatric services and in perceptions of optimum care. A key factor believed to be integral is a multidisciplinary team (MDT) specifically skilled for the speciality. However, there is a lack of clarity on the competencies required for specific roles within the bariatric surgery team. Objectives This review synthesized literature on perceived competencies and skills required to provide safe, meaningful and appropriate care for severely obese patients undergoing bariatric surgery. Inclusion criteria Types of participants The review initially concentrated on four key roles: surgeon, nurse, dietitian, and psychologist. Where available, literature pertaining to other practitioners such as physiotherapists and anesthetists was included. Phenomenon of interest Competencies and skills required by MDT members to provide care for severely obese patients undergoing bariatric surgery. Types of studies The review included qualitative research studies, policy documents, standards for clinical care, guidelines, narratives, opinion pieces and discussion papers. Search strategy A search strategy was designed to access both published and unpublished materials in the following databases: CINAHL, Medline, ERIC, PsycINFO, IngentaConnect, The Knowledge Network, and Web of Knowledge. Grey literature was searched in British Library Ethos and National Institute for Social Care & Health Research (NISCHR). Methodological quality Papers selected were independently appraised for quality by two reviewers using the Joanna Briggs Institute Narrative, Opinion and Text Assessment and Review Instrument (JBI‐NOTARI). Data collection Data were extracted using JBI‐NOTARI data extraction tool. Extracted data included participant information, logic of argument, and author conclusions. Results Thirty‐six papers were screened, and 13 were excluded because they lacked information about competencies. Twenty‐three papers met the inclusion criteria and proceeded to quality assessment. The literature was poorly developed, consisting of text and opinion type articles. Papers were pooled using JBI‐NOTARI, involving the synthesis of publication conclusions into categories, which were then amalgamated in meta‐syntheses. Three overall synthesised findings emerged: • Safe, meaningful and appropriate care of severely obese patients undergoing bariatric surgery may be delivered if staff in each role achieve a minimum set of competencies. • Safe, effective and meaningful care for bariatric surgery patients may require a minimum set of competencies for managing a bariatric surgery unit and the MDT. • To achieve the competencies for safe, effective and meaningful care for bariatric surgery patients, certain approaches to education may be developed. Conclusions Reviewed articles gave some broad indication of areas in which to develop competencies. Consensus between practitioners is required to take forward strategies for competency development. Implications for practice Sensitive care, preoperative psychological assessment, postoperative care, including identification of complications and team management, are areas in which competencies in the MDT should be developed. Implications for research Mixed methods studies to establish best practice and required competencies. Evaluative component in all educational interventions. Comparison studies of methods of delivery of competency based education, and measurement of effectiveness. (498 words)