Robin Lewis

The anatomy lesson of Dr Nicolaes Tulp: what can it teach us today?

We report on the use of a high fidelity patient simulator (SimMan) within a clinical lab setting to teach learning disability nursing students about epilepsy management. We had previously prepped the students with verbal discussions on epilepsy management and, when the simulator began to undergo a seizure, small groups of students managed the unfolding scenario. We received written feedback from the students on the experience, and with reference to this and to the wider literature we consider the benefits of this approach to patient care. We surmise that lessons learned here will be applicable to trainee professionals from other parts of the register and in other fields allied to healthcare. We anticipate that this will improve care for people with intellectual disability in line with recommendations in Health Care for All (2008).

The introduction of “Safety Science” into an undergraduate nursing programme at a large university in the United Kingdom

Abstract Implementing safety science {a term adopted by the authors which incorporates both patient safety and human factors (Sherwood, G. (2011). Integrating quality and safety science in nursing education and practice. Journal of Research in Nursing, 16(3), 226–240. doi: 10.1177/1744987111400960)} into healthcare programmes is a major challenge facing healthcare educators worldwide (National Advisory Group on the Safety of Patients in England, 2013; World Health Organisation, 2009). Patient safety concerns relating to human factors have been well-documented over the years, and the root cause(s) of as many as 65–80 % of these events are linked to human error (Dunn et al., 2007; Reason, 2005). This paper will describe how safety science education was embedded into a pre-registration nursing programme at a large UK university. The authors argue that the processes described in this paper, may be successfully applied to other pre-registration healthcare programmes in addition to nursing.

Dr Tulp attends the soft machine: Patient simulators, user involvement and intellectual disability

Simulation as a way to teach clinical skills attracts much critical attention. Its benefits, however, might be significantly reduced when the simulation model used relies exclusively on patient simulators. This is particularly true if the intended patient population for students taught is characterized by intellectual disability. Learning to care for people with intellectual disability might be better supplemented when the simulation model used incorporates input from ‘real’ people. If these people themselves have intellectual disabilities then the verisimilitude of the simulation will be higher and the outcomes for learners and potential patients will also be improved.

Changing hearts and minds: examining student nurses’ experiences and perceptions of a general practice placement through a ‘community of practice’ lens

BackgroundThe recent UK Government paper ‘Five year forward view’ describes the need to move much patient management from secondary to primary care, and this will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no clear recruitment strategy to address this. There have however been a number of proposed solutions to address the impending GPN recruitment crisis and to increase the numbers of new GPNs in post. General Practitioners (GPs) working in the Advanced Training Practice Scheme (ATPS) have been commissioned by Health Education England to provide placements for student nurses. This paper reports upon the findings of a study evaluating the South Yorkshire ATPS network in relation to nursing students’ perceptions of general practice as a placement and a potential career option post-graduation.MethodsData were collected using semi-structured interviews with 18 nursing students. Qualitative data analysis used a framework approach and themes were cross-checked within the team. The research had ethical approval and anonymity and confidentiality were maintained throughout.ResultsUsing the Communities of Practice (CoP) framework as a theoretical lens, two main themes emerged from the data: ‘Myths and misunderstandings’ outlined some of the misconceptions that abounded in the absence of an established CoP in general practice. These included perceptions of what constitutes a ‘good’ placement, an apparent lack of relevant content in the curriculum, and the widespread use of social media by students as a means of information gathering. ‘Changing hearts and minds’ referred to the need to positively influence the culture within general practice by addressing some of the longstanding myths. Through the fledgling CoP, the students’ perceptions of the GPN role in particular were positively revised, as was the prospect of a career in general practice upon graduation.ConclusionsThe CoP that is emerging through the ATPS placements appear to be gradually changing the socio-cultural landscape within general practice by enabling student nurses to experience the reality of life in general practice nursing, and to view the GPN role as a viable career option upon graduation.

GP/GPN partner* perspectives on clinical placements for student nurses in general practice: can a community of practice help to change the prevailing culture within general practice?

BackgroundThe UK Government document 5 year forward view describes the need to move chronic disease management from secondary to primary care, which will require a significant increase in the numbers of General Practice Nurses (GPNs). Until recently, there has been no specific recruitment strategy to address this increased need. In recent times, a number of solutions have been suggested to address this impending GPN recruitment crisis. For example, Health Education England (HEE) commission General Practitioners (GPs), who are members of the Advanced Training Practice Scheme (ATPS), to provide placements for student nurses within general practice.MethodsA descriptive qualitative study was undertaken, in which data were collected using semi-structured interviews with 16 GPs and 2 GPN partners*. Qualitative analysis used a framework approach and themes were cross-checked within the team and member checking was undertaken with a convenience sample of GPs. The research had ethical approval and anonymity and confidentiality were maintained.ResultsFrom the GP perspective, there were two key themes that emerged from the data. The first theme of ‘fishing in the same small pond’ included succession planning for the general practice workforce, the ‘merry go round’ of poaching staff from other practices, and the myths and misunderstandings that have grown up around general practice nursing. The second theme, ‘growing your own’, looked at the impact of the student nurse placements as a means to address the crisis in GPN recruitment. There was recognition of the need for cultural change in the way that GPNs are recruited, and that the ATPS was one way of helping to achieve that change. There were however a number of challenges to sustaining this cultural shift, such as the financial constrains placed upon the GP practice, and the need to function as a ‘small business’.ConclusionsDespite all the challenges, the evidence is that, through the Community of Practice (CoP), the ATPS scheme is beginning to ‘bear fruit’, and there is a subtle but discernible move by GPs from a ‘why would we?’ to ‘why wouldn’t we?’ invest in education and training for nurses in general practice.N.B. The term GPN partner* denotes a GPN who is a ‘full partner’ in the practice business, holding the same NHS contracts and the same status as a GP. For the purposes of the paper itself, the term GP will be used to denote both types of partner.

Help to spot deterioration.

Patient deterioration is not always detected, resulting in avoidable deaths.

Reducing harm from pressure ulcers.

Pressure ulcers are one of the main causes of avoidable harm in patients. A pressure ulcer is an area of damage to the skin and underlying tissues caused by prolonged pressure, usually over a bone such as the sacral area or elbow. Identifying patients at risk of developing pressure ulcers is an essential part of prevention. All patients should be assessed on admission to hospital. The most common risk assessment tools are the Waterlow and Norton tools. These tools include key risk factors such as body mass index, nutritional status and mobility. Each risk factor is scored and the overall score gives an indication of the patient’s risk of developing a pressure ulcer. If a patient is immobile and seated for too long, pressure on the sacral and pelvic tissues can cause an ulcer. Pressure restricts blood flow to the tissues underneath, causing hypoxia. be changed regularly, at least every two hours. When assessing the patient’s skin, a visible pink or red area over a bony area is an early indication that pressure damage is occurring. If the pressure is not relieved, discolouration becomes darker until it is purple or black. This means necrosis has occurred and a pressure ulcer will develop. Thin, papery skin, often found in older or malnourished patients, is easily damaged. Urinary incontinence and tissue oedema (swelling) will also decrease the skin’s ability to survive pressure damage NS Early identification of patients at risk of developing pressure ulcers is vital, says Robin Lewis

Measuring malnutrition: Poor nutrition can hinder a patient’s recovery. It is important to spot and monitor its signs, says Robin Lewis

Poor nutrition can hinder a patient’s recovery. It is important to spot and monitor its signs, says Robin Lewis.

Blood glucose checks.

Measuring blood glucose in patients with diabetes by taking a sample of capillary blood is a safe method. It is also good for detecting hypoglycaemia or hyperglycaemia, and managing complications of diabetes.

Addressing dehydration: Common sense and vigilance are vital to ensure patients’ optimum fluid levels are maintained, says Robin Lewis

Maintaining an adequate fluid intake is vital for health. Under normal circumstnces, humans require about 2.5 litres of fluid per day. Dehydration occurs when the body loses more fluid than it takes in, and can be the result of either inadequate fluid intake or excessive fluid loss.