Yvonne Robb

'Show us you know us': Using the Senses Framework to support the professional development of undergraduate nursing students

As students, fledgling nurses need to feel they belong to a community of academics, peers and mentors who value their contribution to learning and knowledge. Creating a sense of community allows students to experience academic and practice integration at the beginning of their professional journey, recognising that positive learning experiences at an early stage of professional maturation can shape lifelong attitudes to learning and discovery. The Senses Framework has been used to develop supportive working in relation to older adults; it also has resonance for the development of undergraduate nurses. This article focuses on the student experience, exploring the potential for the Senses Framework to underpin a learning community, promoting collaboration and acknowledging the emotional, academic and professional work that is now essential for the preparation of registered nurse in the 21st Century.

The duality of professional practice in nursing: academics for the 21st century.

Although pre-registration nursing in the United Kingdom (UK) is moving towards a graduate exit, the vocational/professional debate is still live and continues to be played out in both popular and professional literature. This study considers the nature of contemporary academic communities and the challenge of duality in professional nursing life. More than a decade after the move into higher education (HE) however the role of the academic is still controversial, with much of the debate focussed on the nature of clinical credibility. This article considers the dimensions of academic nursing, reports the views of academics and clinicians and introduces a model of working that could potentially harness and blend the skills of academics and clinicians, nurturing a culture of applied scholarship throughout the professional/academic journey.

Family nursing in intensive care part two: the needs of a family with a member in intensive care

It was demonstrated in Part one that the family is a justifiable concern to nurses in intensive care and that family-focused care is appropriate in such an area. If this approach to care is to be considered, it is necessary to identify the needs of families when they have a member in an intensive care unit. This is a well-researched area and some of the relevant literature is discussed within this paper. Before this literature is addressed, an attempt is made to define the concept of need. The methodologies used in the identification of family needs could be adapted to explore whether or not the needs of the families of patients in a particular intensive care unit are being met. This paper suggests that if it was shown that the meeting of family needs was an area of care which could be improved upon, then a family-centred approach to care would be a reasonable option. If however, it is shown that families already perceived their needs as being met, then changing the system of care to a more formal family nursing approach would seem to be unnecessary.

The effectiveness of interventions to reduce undernutrition and promote eating in older adults with dementia: A systematic review

Executive summary Background Older adults with dementia may have feeding difficulties for several reasons: they may experience deterioration in motor and cognitive skills making eating difficult, they may forget to eat, fail to recognise food or they may suffer from dysphagia. Food intake is often poor and malnutrition is common, leading to adverse health outcomes. This review specifically focussed on how best to promote and achieve ‘normal’ eating and feeding in older adults with dementia, in order that undernutrition and its consequences could be avoided. Review Objectives The aim was to identify and assess the effectiveness of interventions that encouraged eating and minimised risk of undernutrition in older adults with dementia. Types of Participants Adults over the age of sixty with dementia in any care setting (who were not living independently). People receiving enteral tube feeding were excluded. Types of Interventions Any intervention that promoted dietary intake e.g. changes in practice of health care workers, family or volunteers, educational interventions, changes in food service. Types of Outcomes The primary outcomes were improvement in dietary intake and/or nutritional status. Measurements included: dietary intake, anthropometry, clinical outcomes, functional indicators. Types of Studies Randomised controlled trials, controlled trials and quasi‐experimental studies with a ‘before and after’ design. Search Strategy The search strategy aimed to find both published and unpublished studies using a three‐step approach. Papers were limited to the English language and a date restriction of 1999 to 2009 was set. Critical appraisal Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Disagreements that arose between the reviewers were resolved through discussion. Data Extraction For quantitative studies, data was extracted using a data extraction form developed to include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. This was based on the JBI data extraction tool from MAStARI and 2 reviewers extracted data independently. Data synthesis Heterogeneity in study designs, interventions and outcomes meant meta‐analysis was not possible. Findings were discussed in a narrative summary. Results The review included 11 studies. This included one RCT, 1 randomised crossover study, 3 controlled non‐randomised trials, 6 quasi‐experimental studies. None of the studies provided robust evidence, however there was moderate evidence (Level 3) to support a Grade B recommendation for improvements in dietary intake and/or nutritional status with the following interventions: education of healthcare staff, simple environmental manipulations such as the use of high contrast tableware or small dining rooms, the introduction of something of interest such as an aquarium or background music, or the provision of feeding assistance, provision of enhanced menus, use of a decentralised food service, enhanced nutritional screening combined with increased dietetic time. Conclusion There is moderate (Level 3) evidence to support each of the interventions appraised in this review. Implications for Practice There is moderate support that warrants consideration of the interventions listed above. Careful monitoring of weight of individual residents would help to determine the effectiveness of any such change in delivery of care. Implications for Research Future research into interventions to improve eating and minimise undernutrition in older people with dementia should feature the following: inclusion of reliable outcome measures, full details of interventions, randomisation of participants, inclusion of control groups, adequate sample sizes, longitudinal follow up, consideration of baseline demographics of intervention groups, and experimental design that allows the determination of the effectiveness of individual definable changes in delivery of care.

Exploration of the experiences of young mothers seeking and accessing health services

Objective: The objective was to explore young mothers’ experiences of seeking and accessing health services, specifically maternity care. Study design: A phenomenological approach underpinned by the work of Husserl and guided by the framework offered by Giorgi. Participants: A purposive sample of seven young mothers took part in audio-recorded unstructured interviews in either the young mother’s home or in a private room at their GP practice. Findings: Six themes emerged from the initial thematic analysis: (1) feeling abandoned, (2) information is vital, (3) feeling judged, (4) family and friends, (5) interference, (6) younger mothers need additional support. After ‘bracketing’ the preconceptions evident in the initial analysis, essential themes describing the young mothers’ experience of accessing healthcare were identified: (1) the need for support and information; (2) fear of stigmatisation and stigmatisation of self. Conclusions: The young mothers in this study experienced a need for support and information, which reflects the findings of previous studies. This study has added to the knowledge base as it also found that these young mothers were hindered from obtaining or making use of available support and information through fear or expectation of stigmatisation and self-stigmatisation. There is a need to improve availability of support and information for young mothers, who may benefit from one-to-one education to help them gain confidence to deal with pregnancy and parenthood issues. Further research on young mothers’ perceptions of maternity service provision will advance understanding of young mothers’ help and support needs during pregnancy, birth and the postnatal period.

Ethical considerations relating to terminal weaning in intensive care

The ethical considerations relating to terminal weaning from mechanical ventilation will be discussed within this paper. The principles of beneficence, non-maleficence and autonomy are seen to be the key considerations within the discussion. The difference between terminal weaning and regular weaning from a ventilator is that it proceeds as vital signs deteriorate and the expected outcome is death of the patient. A deterioration in vital signs would normally result in a change in the weaning process. The indications for terminal weaning have been classified into three categories by Campbell and Carlson. These are the patients informed request to have the ventilator withdrawn, reduction of patient pain and suffering and medical futility. These categories will be used to facilitate the discussion which will draw on both the relevant literature and clinical experience.

An exploratory qualitative analysis of student midwives views of teaching methods that could build their confidence to deliver perinatal bereavement care

BACKGROUND Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers. OBJECTIVE To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care. METHOD An exploratory qualitative thematic analysis was used to provide, analyse and report themes identified within data collected in a prior study. PARTICIPANTS Participants were student midwives (n=179) in their second/third year of a midwifery degree program at 1 of 3 universities in the UK were included in the study. DATA COLLECTION/ANALYSIS Data to evaluate effectiveness of the bereavement workbook as a teaching method was collected using a survey instrument. It was the comments written under questions by participants that were analysed in the present study. FINDINGS Three themes emerged: (1) increasing classroom interaction, (2) the importance of reflecting on emotions, and (3) need for experience. DISCUSSION Although this study has addressed delivery of education that relates to midwives, the findings are cross transferable to other healthcare educators, practitioners, and students. Several solutions are proposed that could potentially build student confidence to deliver bereavement care: lecturers should (1) encourage group discussion in the classroom to help build student confidence to emotionally cope during real bereavement events; (2) ensure students gain exposure by encouraging qualified midwives to include them in real bereavement events early on in their training, and (3) develop packages of perinatal bereavement scenarios for simulation and rehearsal in the clinical skills laboratory. Post-implementation, it is recommended that these teaching strategies be evaluated.

Potential conflicts in midwifery practice regarding conscientious objection to abortions in Scotland

Background: This study was developed as a result of a court case involving conflicts between midwives’ professional practice and their faith when caring for women undergoing abortions in Scotland. Research questions: What are practising Roman Catholics’ perspectives of potential conflicts between midwives’ professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the ‘conscience clause’ to midwifery practice today? and What are participants’ understandings of Canon 1398 in relation to midwifery practice? Research design: The theoretical underpinning of this study was Gadamer’s hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. Participants and research context: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. Ethical considerations: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. Findings: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. Conclusion: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection.