An investigation of the nutritional care given by nurses to acute medical patients, and of the influence that ward organisational patterns may have upon that care

SIGLELD:D48042/83 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Beliefs, knowledge, and the self-management of diabetes

In 2 volsAvailable from British Library Document Supply Centre- DSC:DX179817 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Insulin initiation in adults: evidence based or context driven?

Aim.  To describe insulin initiation practices across the United Kingdom (UK) and identify factors influencing current practice. Background.  The number of people commencing insulin therapy has escalated in recent years; due to increased incidence of diabetes and the evidence that improvements in glycaemic control can reduce and delay the onset of diabetic complications. However, the process of insulin initiation is not well described and the optimal way to start insulin therapy is unclear. There is currently a strong emphasis on moving diabetes care from secondary to primary care and this change in policy may also influence insulin initiation. Methods.  A quantitative, cross-sectional, nationwide survey of diabetes specialist nurses (DSNs) and practice nurses (PNs) was completed in 2006. Data were gathered using a postal questionnaire, 1310 were returned (37·7% response rate). Results.  Almost all DSNs working in secondary, or across primary and secondary, care initiate insulin in people with type 1 diabetes, but only 37·7% of DSNs working in primary care or 2·5% of PNs (p < 0·001). Most DSNs initiate insulin in adults with type 2 diabetes compared with only 37·7% of PNs (p < 0·001). Only 23·5% of respondents initiate insulin for those with gestational diabetes (GD), most working in secondary care (p < 0·001). The most commonly used insulin regimen was multiple injection in type 1 diabetes (43·9%), a twice-daily mixture (19·2%) and night only basal insulin (17·9%) in type 2 diabetes and multiple injection in GD (46·8%). Analogue insulins were more frequently used than non-analogues in type 1 and 2 diabetes but almost equally in those with GD. Conclusion.  Despite the drive for much more diabetes care to be delivered in primary care insulin initiation remains largely the province of secondary care, and regardless of the contested nature of the evidence base, analogue insulins are widely used. Relevance to clinical practice.  The focus of this study was on one aspect of diabetes care (insulin initiation), however the findings illustrate that whilst policy relating to the care of people with a long-term condition such as diabetes may change, the practice implications in terms of community provision and availability of appropriate expertise are complex

Mentoring today - the students views: An investigative study of pre-registration nursing students' experiences of mentoring in one theory/practice module of the Common Foundation Programme on a Project 2000 course

The study reported in this paper investigated the mentoring experiences and perceptions of pre-registration nursing students in one organization, on a theory/practice nursing module. It considered the extent to which students' understanding and expectations matched their actual experiences. Interviews were conducted with 35 students on a Common Foundation Programme, and 15 allocated mentors, using a semi-structured interview guide. These were done within the clinical setting of the wards on which the students were placed as part of their requirements for completion of the module. A distortion of the actual meaning of mentoring appears to be present because of the lack of clarity provided, both internally by organizations and by the English National Board (ENB) who have provided loose guidelines. The implications of this distortion are discussed. The application of a mentoring role in practice needs to be re-examined, with the provision of a clear structured guide internally and externally, with regard to the needs of students and staff who are expected to act as mentors. The study was small scale and cannot be generalized. Mentoring, however, is now widely used within pre-registration nursing education, even though it is generally considered that its use may not be appropriate. Follow-up studies need to be undertaken on an ongoing basis, to examine what actually happens in practice, and to consider ways of ensuring that the benefits for staff and students are enhanced