Critical Care Nurses' Views and Experiences of Preanalytical Factors Influencing Point-of-Care Testing A Qualitative Study

The main users of point of care testing devices placed outside the central laboratory are clinicians, predominantly nurses. Understanding the factors influencing sample accuracy is important to ensure appropriate clinical decision making. Previous studies focus on the analysis process, however, errors can also occur during the pre-analytical phase, linked to user knowledge, skills and other factors associated with the wider context of care. This study explored adult critical care nurses’ views about point of care testing, the challenges they experience and their suggestions on how the pre-analytic phase might be improved. Using a qualitative design, four focus group discussions took place with 60 critical care nurses studying at two London based Universities between April and July 2019. Anonymized and verbatim-transcribed focus group data were uploaded into NVivo11 and underwent a standard process of inductive thematic analysis. Findings suggest that nurses’ concerns focus on three key areas: Training and competence; Sample frequency and volume; and impacts on patients, relatives and staff. Critical care nurses view POCT as a necessary task, which aids timely patient management. However, the process can detract nurses from performing other care duties. Being able to draw less blood was identified as an important way to increase patient comfort and to reduce risks. Collaborative working is key to ensure that improvements made to the pre-analytical process reflect users’ needs. Ensuring best use of nurses’ time by streamlining preanalytical processes and ensuring equipment is readily available for use is important to ensure other clinical priorities can be achieved

Recognition and management of critical illness by midwives: implications for service provision

This is the pre-peer reviewed version of the following article: Bench, Suzanne (2007) Recognition and management of critical illness by midwives: implications for service provision. Journal of Nursing Management, 15 (3). pp. 348-356. which has been published in final form at 10.1111/j.1365-2834.2007.00759.x.This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Aim  The aim of this study was to explore midwives’ recognition and management of critical illness in obstetric women in order to inform service provision. Background  Critical illness is not confined to Intensive Care. Limited published work was located examining factors affecting critical care provision by midwives. Methods  A multi-method design incorporating a paper and pencil simulation (n = 11) and in-depth interviewing (n = 5) was conducted with midwives from a large London National Health Service Trust. This study details and discusses the findings. Results  Findings indicated that frequency and type of critical illness experience impact upon midwives’ critical care knowledge and skills. Midwives, especially those who were more junior, expressed anxiety regarding this aspect of practice, and considered the support of senior midwives, medical and nursing staff as crucial to effective client management. Conclusion  This study has yielded important insights into midwives’ management of critical illness. Possible mechanisms to enhance the quality of service provision, and midwife support in this area are highlighted

Clinical skills: assessing and treating shock: a nursing perspective

This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Nursing copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see http://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2004.13.12.13260 This article outlines the pathophysiology associated with hypovolaemic, cardiogenic and distributive shock, and discusses how each of these might present clinically in the patient. Nursing assessment of a patient in shock is explored, and the use of tools such as the pulse oximeter are examined. The evidence base for a variety of interprofessional interventions is analysed, including fluid therapies such as blood transfusion, the use of crystalloids and colloids, and drug therapies such as the use of inotropic and vasoactive agents. The nursing role in managing the patient in shock is considered throughout. The importance of recognizing the clinical presentation of shock is highlighted, with an emphasis on understanding the pathophysiology and potential systemic effects. Treatment is discussed and covers: providing optimal oxygen therapy, appropriate patient monitoring and location of care, using effective communication skills, assisting with activities of living, psychological support, and working collaboratively to maximize the overall quality of patient care delivered

Orthopaedic nurses’ engagement in clinical research; an exploration of ideas, facilitators and challenges

Background: Previous international studies have identified individual and organisational barriers to nurses’ research utilisation, but there is little data reporting on nurses’ engagement in research design and/or delivery, particularly within the orthopaedic speciality. Aim: To explore orthopaedic nurses’ views regarding the research priorities for neuro-musculoskeletal care and the perceived barriers and facilitators associated with their engagement in the research process. Methods: A single centre mixed methods study (n=75) collected data via a survey and 14 focus group discussions. Findings: Our sample of clinical orthopaedic nurses showed little evidence of research engagement. Research priorities focused on 1. Understanding and improving patient and staff experiences 2. Improving processes, systems and workload models 3. Interventions to improve clinical outcomes. Key themes arising from the focus group discussion data were research activity, priorities and motivation, culture and leadership, and resources. Conclusion: Our findings suggest that there is still significant work to do build sufficient research capacity and capability within the nursing workforce. Key to success will be developing effective leaders, who can create a positive and supportive research culture across an organisation to strengthen the research voice of nursing, which will drive improvements in future care

Fatigue After CriTical illness (FACT): Co-production of a self-management intervention to support people with fatigue after critical illness

Purpose: Fatigue is a common and debilitating problem in patients recovering from critical illness. To address a lack of evidence-based interventions for people with fatigue after critical illness, we co-produced a self-management intervention based on self-regulation theory. This article reports the development and initial user testing of the co-produced intervention. Methods: We conducted three workshops with people experiencing fatigue after critical illness, family members, and healthcare professionals to develop a first draft of the FACT intervention, designed in web and electronic document formats. User testing and interviews were conducted with four people with fatigue after critical illness. Modifications were made based on the findings. Results: Participants found FACT acceptable and easy to use, and the content provided useful strategies to manage fatigue. The final draft intervention includes four key topics: (1) about fatigue which discusses the common characteristics of fatigue after critical illness; (2) managing your energy with the 5 Ps (priorities, pacing, planning, permission, position); (3) strategies for everyday life (covering physical activity; home life; leisure and relationships; work, study, and finances; thoughts and feelings; sleep and eating); and (4) goal setting and making plans. All material is presented as written text, videos, and supplementary infographics. FACT includes calls with a facilitator but can also be used independently. Conclusions: FACT is a theory driven intervention co-produced by patient, carer and clinical stakeholders and is based on contemporary available evidence. Its development illustrates the benefits of stakeholder involvement to ensure interventions are informed by user needs. Further testing is needed to establish the feasibility and acceptability of FACT. Implications for clinical practice: The FACT intervention shows promise as a self-management tool for people with fatigue after critical illness. It has the potential to provide education and strategies to patients at the point of discharge and follow-up

Abstract Argumentation / Persuasion / Dynamics

The act of persuasion, a key component in rhetoric argumentation, may be viewed as a dynamics modifier. We extend Dung's frameworks with acts of persuasion among agents, and consider interactions among attack, persuasion and defence that have been largely unheeded so far. We characterise basic notions of admissibilities in this framework, and show a way of enriching them through, effectively, CTL (computation tree logic) encoding, which also permits importation of the theoretical results known to the logic into our argumentation frameworks. Our aim is to complement the growing interest in coordination of static and dynamic argumentation.Comment: Arisaka R., Satoh K. (2018) Abstract Argumentation / Persuasion / Dynamics. In: Miller T., Oren N., Sakurai Y., Noda I., Savarimuthu B., Cao Son T. (eds) PRIMA 2018: Principles and Practice of Multi-Agent Systems. PRIMA 2018. Lecture Notes in Computer Science, vol 11224. Springer, Cha

The nature and extent of service user involvement in critical care research and quality improvement; a scoping review of the literature.

The importance of involving patients and the public in health care research is globally recognised, but how best to do this in critical care is unclear. The aim of this first published review was to explore the extent and nature of evidence on service user involvement in critical care research and quality improvement. Using the scoping review framework described by Arksey & O’Malley (2005) a team of service user and critical care researchers searched eleven online databases, reviewed relevant websites, conducted forward and backward citation searching and contacted subject experts. Extracted data were subjected to a narrative synthesis based on the objectives of the review. Findings from a broad range of evidence support that involvement is becoming more commonplace and that experiences are generally positive. Data extracted from 34 publications identify that involvement is most commonly reported at the level of consultation or participation in project teams, however, the extent to which involvement impacts on projects output remains unclear. Key barriers and facilitators relate to the challenge of recruiting a diverse group of service users, dealing with power hierarchies, being adaptable and effective consideration of the resource requirements. More research is required to identify the most effective methods to support the opportunity for involvement and more thorough reporting of service user involvement practices is strongly recommended

Intensive care discharge summaries for general practice staff: a focus group study

Understanding how patients and relatives can be supported after hospital discharge is a UK research priority. Intensive Care Unit (ICU) discharge summaries are a simple way of providing GPs with the information they require to coordinate ongoing care, but little evidence is available to guide best practice

Patient and family member experiences of involvement in critical care research and quality improvement projects

Background: Public and patient involvement in healthcare research is increasing, but the impact of involvement on the individuals, on service delivery and on health outcomes, particularly in specialist population groups like critical care, remains unclear, as does the best way to involve people who have experienced critical illness. Objectives: To explore former patients’ and family members’ views and experiences of involvement in critical care research and/or quality improvement. Methods: Using a qualitative methodology, semi-structured telephone interviews were conducted with seven former intensive care unit patients and three close family members, across England. Data were analyzed using a standard process of inductive thematic analysis. Results: Four key themes were identified: making it happen; overcoming hurdles; it helps; respect and value. Findings centre on the need for flexibility, inclusivity and transparency. They further highlight the particular challenges faced by critical illness survivors and their family members in relation to research involvement, the importance of individualised support and training and the vital role that project leads have in making people feel valued and equal partners in the process Discussion: This is the first study to explore patients’ experiences of involvement in critical care research. Despite the small, homogenous sample, the study provides valuable and important data, to guide future practice. It highlights the need to enable and support people to make informed choices at a time when they are ready to do so. It further highlights the importance of gatekeepers, to avoid vulnerable people contributing before they are ready, a practice, which could negatively affect their heath status