Sue Dyson

A systematic review of electrical stimulation for pressure ulcer prevention and treatment in people with spinal cord injuries

Abstract Context Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited. Objectives To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI. Method Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments. Results Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant). Conclusion The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.

The politics of health services research: health professionals as hired hands in a commissioned research project in England

Previous health services research has failed to account for the role played by clinical staff in the collection of data. In this paper we use the work of Roth on hired hand research to examine the politics of evidence production within health services research. Sociologies of work predict lack of engagement in the research tasks by subordinated groups of workers. We examine the role of midwives in researching ante-natal screening for sickle cell and thalassaemia in England, and construct three ideal types: repairers, refractors, and resisters to account for the variable engagement of health staff with research. We find some features of the hired hand phenomenon predicted by Roth to be in evidence, and suggest that the context of our project is similar to much health services research. We conclude that without concerted attempts (1) to change the social relations of research production; (2) to mitigate hired hand effects; (3) to assess the impact of the hired hand effect on the validity and reliability of findings, and (4) to report on these limitations, that health services research involving large teams of subordinated clinical staff as data collectors will be prone to produce evidence that is of limited trustworthiness.

An exploration of the experiences of South Asian students on Pre-registration nursing programmes in a UK university

Abstract There is a lack of focused research on the educational experience of minority ethnic nursing students in the United Kingdom. This small scale mixed–method study has shown that in one institution, South Asian students entered training at a younger age than White students but had broadly similar levels of attainment and completion. Qualitative data suggest that although South Asian and White students share many common experiences, the cultural background of South Asian students may have a considerable effect on their academic life, sometimes creating particular tensions and difficulties. Several themes are explored, including choosing nursing, negotiating marriage, responding to family obligations, relating to fellow students and accessing support. Students expressed the importance of peer group and personal tutor support to their academic success. Understanding the student experience is important and should help institutions to develop culturally sensitive support systems.

Preparing Nurses for Contemporary Nursing Practice

This concluding chapter considers what nurse educators can do to design and deliver a nursing curriculum fit for the purpose of preparing nurses for the challenge of contemporary nursing practice. The chapter acknowledges while the challenges facing nurse educators are multifactorial and complex, consideration of alternative pedagogies is an educational imperative for nursing. To this end a model for contemporary nurse education is described, which draws together the key arguments in this book, that is, critical pedagogy as a transformative agent and structured opportunities for volunteering as a means of engaging the nursing curriculum in the co-creation imperative. The case is remade for a mindful consideration of alternative pedagogical approaches as a way forward for nurse education.

Nursing, Nurse Education and the National Health Service: A Tripartite Relationship

This chapter provides the basis for a detailed discussion of pedagogy in nurse education in the United Kingdom. Factors impacting the design and delivery of nursing programmes are examined, including key relationships between the Nursing and Midwifery Council and the Approved Education Institution. The chapter suggests the need for innovative and transformative pedagogies for nurse education, in response to reported failings in care at Mid Staffordshire NHS Foundation Trust. The current context of healthcare services is argued to severely impact the capacity for nurses to think creatively, and to arrive at solutions to problems of finite resources, staff shortages and rising public expectation in terms of diagnosis, treatment, and acute and long-term care.

Global Health and Global Nurse Education

This chapter discusses global health services and ways in which nurse education has developed to meet local needs. The chapter argues that increasing longevity coupled with exponential increases in long-term, complex health conditions is a global phenomenon, causing governments worldwide to rethink how healthcare is conceptualised and subsequently funded. The chapter makes connections between demographic changes, population growth, global health needs and the impact on migration of the nursing workforce. The chapter draws on recent evidence around the experience of the overseas nursing workforce in the UK and the implications for practice and education.

Co-creation in Nurse Education

This chapter considers the concept of co-creation within nurse education. Nursing students invariably accrue practice experience, which is both more contextual and more current than that of the nurse educators who are teaching them. Despite this, nursing students are rarely, if ever, consulted about their educational experiences, which is often more current and contextualised than that of nurse teachers. While many nurse educators engage in co-creation this is usually confined to activities at the level of the classroom, and as such is limited to learning and teaching methods, with the result that co-creation does not permeate curriculum development in any meaningful sense. The chapter discusses the pragmatics of the co-created nursing curriculum.

Transforming Nurse Education

This chapter builds on the principles of co-production discussed in Chap. 2 by considering ways in which transformative pedagogy can be incorporated into contemporary nursing curricula through co-productive approaches to education. The chapter suggests the ‘hidden curriculum’ effectively contributes to a persistent theory-practice gap, whereby students’ report what is taught in theory is often not enacted in practice. The chapter argues for a nursing curriculum, which draws on different types of nursing knowledge, to ensure aspects of professionalism, traditionally hidden within the curriculum are made explicit and subject to critical examination. Transformative pedagogy is argued to empower students through appropriate teaching methods to effect change and to enable them to make sense of contemporary nursing practice.

Pedagogy in Nurse Education

This chapter argues for nurse education to incorporate critical pedagogy, as a means of preparing students for contemporary nursing work. The work of Paulo Freire and Henry Giroux is considered of particular relevance for nurse education, as both offer insight into ways of thinking about present-day, modern nursing, which takes account of the social, political and technological context of healthcare. Critical thinking is considered fundamental to contemporary nursing work and key to development of knowledgeable, competent, caring and compassionate practice. The chapter considers ways in which key components of critical thinking—critical reading, critical writing, critical listening and critical speaking—can be incorporated into the nursing curriculum. Jack Mezirow’s work on adult learning provides a critical lens through which to view the role of the nursing curriculum in the development of sustainable positive nursing practice.

Post-registration interprofessional learning: a literature review and consideration of research methods

This review explores the literature with regards to interprofessional learning (IPL) for qualified nurses and other health care workers. Three research studies were found. These showed that IPL can promote interprofessional trust, knowledge and skills. There is as yet no evidence that patient outcomes are changed, and taken as a whole, the evidence is not strong. There is also evidence that the providers of IPL for post-registration health care workers also tend to be the researchers. This is not ideal; it raises the possibility of the inclusion of bias and, using the values of evidence based practice, weakens the evidence. It is suggested that workers who comment on their own IPL initiatives should make explicit the measures they have taken to minimise bias. Comparison of findings from the literature is made with pre-registration IPL and a tabulated summary of much of the published evidence is included, which may be a useful source for future authors in this field.