Warren P. Gillibrand

An Exploration of Culture, Diabetes, and Nursing in the South Asian Community A Metasynthesis of Qualitative Studies

South Asian people are often perceived as a homogenous group whose culture is prescriptive and constraining. A metasynthesis of how culture influences diabetes self-management in the context of a South Asian population was undertaken. Theory explication was used to deconstruct and reconceptualize the findings of the studies. Eleven publications reported themes of health beliefs, individuality, context, and shared experiences. The results indicate that culture does not influence diabetes self-management in a rigid and prescriptive way; instead, individuals negotiate and interpret culture in a shifting and diverse context. An individualized approach to delivering culturally appropriate nursing care should be taken.

A pilot study exploring quality of life experienced by patients undergoing negative-pressure wound therapy as part of their wound care treatment compared to patients receiving standard wound care

The use of negative pressure wound therapy (NPWT) has been widely documented as a technique to help heal complex wounds. This article presents the findings of a preliminary study which aimed to explore quality of life (QoL) experienced by patients undergoing NPWT as part of their wound care treatment in comparison to that of patients with a wound using traditional (standard) wound care therapies. A quasi‐experimental study was undertaken, with patients treated in wound care/vascular clinics with chronic/acute wounds. QoL impact was measured using the Cardiff Wound Impact Schedule and administered post‐consent at timed intervals. Our results identified that there were no real differences in QoL scores recorded by patients over the 12‐week period. Although there was no overall interaction between the therapies used for wound healing, NPWT did have an effect on social life: during the first 2 weeks of the application of therapy, patients in the NPWT group reported an increase in the social life domain. The authors conclude that true QoL can only be elicited if an accurate baseline is established or if data is collected over a long enough period to allow comparison of scores over time.

Achieving International Consensus for the Prevention of Orthopaedic Wound Blistering; Results of a Delphi Survey

This article presents the results of an international 2 stage Delphi survey carried out via e‐mail to achieve consensus as to the most effective postoperative wound management to prevent blistering and other complications. Seventeen prospective participants were invited to be members of the Delphi Panel of which 13 agreed to be involved. The panel suggested that an ideal wound dressing would conform easily to the wound, be easy to apply and remove, allow for swelling and minimise pain on removal. Participants were in agreement that the primary wound dressing should be left in situ for as long as possible, providing there was no excessive oozing or signs of infection. The authors recognise that the Delphi Panel was relatively compact; however, the study arguably provides some useful data that can be used to identify the consequences of wound blistering and important factors that need to be considered when choosing a wound dressing to prevent blistering.

The English national risk-reduction programme for preservation of sight in diabetes

This paper discusses the new national guidelines for a systematic screening programme to detect sight-threatening diabetic retinopathy in the population of people with diabetes in England. A review of the literature examines the evidence base to support screening interventions and effective management and treatments in diabetic retinopathy. The current evidence supports the establishment of a digital retinal photography system using pupil dilation. A Policy Advisory Group has been formulated by the National Screening Committee to guide the meeting of this target in England. A conclusion is made that with increased effort and organisation, health care professionals can ensure that the screening programme is successfully implemented and rates of visual impairment and blindness caused by diabetic retinopathy can be reduced significantly. (Mol Cell Biochem 261: 183–185, 2004)

The impact of pre-diabetes diagnosis on behaviour change: an integrative literature review

Type 2 diabetes is a growing global problem that not only affects individuals but also has an impact upon the economic health of countries. The number of people developing type 2 diabetes can be reduced by up to by 80%; this can be achieved by targeting those who are ‘at risk’. This reduction can be achieved by appropriate lifestyle changes to diet and physical activity. It is not known what the impact of being informed of a diagnosis of pre‐diabetes has on an individuals motivation to make appropriate lifestyle changes.

Wound healing in pre-tibial injuries - an observation study

Pre‐tibial lacerations are complex wounds affecting a primarily aged population, with poor healing and a potentially significant impact on social well‐being. Management of these wounds has changed little in 20 years, despite significant advances in wound care. A retrospective observational study was undertaken to observe current wound care practice and to assess the effect of various medical factors on wound healing time on 24 elderly patients throughout their wound journey. Wound length was found to be substantively and significantly associated with wound healing time, with a reduction in instantaneous healing rate of about 30% for every increase of 1 cm in wound length. Hence, longer wounds are associated with longer wound healing times. Prescription of several categories of drugs, including those for ischaemic heart disease (IHD), hypertension, respiratory disease or asthma; and the age of the patient were not significantly associated with wound healing times, although substantive significance could be inferred in the case of prescription for IHD and asthma. Despite the small sample size, this study identified a clear association between healing and length of wound. Neither the comorbidities nor prescriptions explored showed any significant association although some seem to be more prevalent in this patient group. The study also highlighted other issues that require further exploration including the social and economic impact of these wounds.

Effective management of acute faecal incontinence in hospital: review of continence management systems

This paper reviews the scientific literature regarding current systems available for the management of acute faecal incontinence (FI) in hospital patients. The review searched Medline from 1950 to October 2009 using the adapted search strategy, as devised by the Cochrane Incontinence Group, in order to identify studies relevant to this review, yielding 197 records. Ten studies fitted the inclusion criteria with none of the studies being randomised control trials. Characteristics identified from the studies included: duration of the management devices, cost implications, length of patient stay, contraindications and patient assessment. The management of acute FI in acute settings is a relatively ignored problem, with little available evidence to support a standardised approach to its management. The review highlights the need for early identification of contraindications when FI management systems are being used, particularly in patients administered antithrombotic drugs such as aspirin.

Developing a culture of publication: a joint enterprise writing retreat

Purpose – Many students irrespective of level of study produce excellent course work which, if given support and encouragement, could clearly be of a publishable standard. Academic staff are expected to produce quality publications meeting peer-review standards although they may be relatively novice authors. All are engaged in some aspects of academic writing practices but not as frequently involved in co-production of publications emanating from student work. This activity is still at the margins of much of the student experience. The paper aims to discuss these issues. Design/methodology/approach – Mindful of these issues, the authors designed and offered a writing programme including a writing retreat. This brought together undergraduate and postgraduate students from a range of applied disciplines (health and art, design and architecture) and their supervisors with the aim of co-producing publications and participating in a community of scholarly practice. The project was delivered over nine months. I...

Knowledge levels of diabetic eye disease in people with diabetes: results of a descriptive survey

Abstract An epidemiological questionnaire delivered to patients attending a mobile community based photographic screening unit for detection of diabetic eye disease (n=2386) has yielded demographic, prevalence and knowledge data. The main results of this report focus on the knowledge of eye complications, which show that there is a considerable lack of knowledge in people with diabetes in this area. This paper presents the results of two questions pertaining to knowledge of effects of diabetic eye disease and control of blood glucose levels. Results show that 1021 (42.8%) of responders were aware that diabetes can cause blindness and 1439 (60.3%) were aware that good control of diabetes was very important. Health education strategies need to be developed in order that people with diabetes have the correct information, necessary to make positive cognitive decisions regarding their diabetes management and lifestyle. Trained workers delivered the closed response questions via a structured interview. The coded responses were entered onto an Epi-Info database with measures to limit unreliability and ensure validity. Data were then analysed to present descriptive data and broad recommendations were made on potential effective health education strategies.

Nurses’ contributions to the resolution of ethical dilemmas in practice

Background: Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas. Aims: To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice. Design: An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee. Findings: Four major themes emerged: ‘best for the patient’, ‘accountability’, ‘collaboration and conflict’ and ‘concern for others’. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas. Discussion: Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making. Conclusion: Nurses’ professional relationships are central to nurses’ contributions to the resolution of ethical dilemmas.