A qualitative study exploring the experiences and emotional responses of female community continence link workers and female patients in relation to performing clean intermittent self-catheterisation

Aim: This paper represents a report of a study designed to explore the experiences of female community continence link nurses in relation to female catheterisation and their psychological and educational preparedness to teach it. The lived experiences and emotional responses of female patients learning to perform Clean Intermittent Self-Catheterisation (CISC) are also examined. Background: There is general consensus that CISC should be considered in preference to indwelling catheterisation wherever feasible. Published literature has tended to focus on quality of life issues and technical and physical aspects. There has been less investigation into patients’ initial perceptions of CISC, and into their subsequent experiences of learning the technique. There has also been minimal investigation into how community continence link nurses feel about female CISC and into their perceived ability to teach it. Design: This qualitative study used a phenomenological research design. Method: A series of semi-structured, in-depth interviews were held with a self-selected sample of female continence link nurses and adult female patients performing CISC aged 34-64 years. Interviews were tape recorded and transcribed verbatim. Data were analysed using the ‘Framework’ method and recurrent themes identified. Results: The lived experiences of nurses in relation to the catheterisation of female patients were categorized into themes: the nurses’ emotional responses, their own and others’ coping mechanisms, visualisation of the female urethra, the approach adopted by their mentor and their knowledge deficit around CISC. Six recurrent themes were also identified from the patient sample: grief and loss, lack of knowledge (regarding female anatomy, bladder dysfunction and catheters), negative associations and stigma, psychological aversion and embarrassment, nursing approaches and coping mechanisms. Conclusion: Nurse recognised that although they felt competent in providing sensitive, individualised care for patients requiring in-dwelling catheterisation, they lacked the underpinning skills and knowledge to enable them to assess patients and feel confident in teaching CISC. Explicit recognition of their own and others’ psychological coping mechanisms promotes an individualised approach which translates into an enhanced experience for the patient. For the patients, loss of normal bladder function may represent a devastating event, and trigger emotional responses associated with grief and loss. Patients may experience a range of reactions whilst learning CISC, including embarrassment and aversion, which may not dissipate over time. However, psychological distress is not inevitable, and varies enormously between individuals. The nursing approach is vital, as individualised, empathic care is recognised and valued

Learning clinical skills in the simulation suite: the lived experiences of student nurses involved in peer teaching and peer assessment

Summary Background The benefits of peer teaching and assessment are well documented within nurse education literature. However, research to date has predominantly focused on the advantages and disadvantages for the inexperienced learner, with a dearth of knowledge relating to the perceptions of senior nursing students involved in teaching their peers. Aim This study sought to investigate the student experience of taking part in a peer teaching and assessment initiative to include the perceptions of both first year nursing students and second/third year participants. Method Data were collected via open-ended questionnaires and analysed with qualitative Framework analysis. Findings This initiative received a generally positive response both from students being taught and also from those acting as facilitators. Perceived benefits included the social learning experience, development of teaching skills, self-awareness and the opportunity to communicate both good and bad news. Suggestions for improvement included additional time working in small groups, specific supplementary learning materials and the introduction of peer teaching and assessment into other areas of the Adult Nursing Programme. Conclusions Peer teaching and assessment principles represent valuable strategies which can be utilised in nurse education to develop clinical skills and prepare nurses for real-life scenarios. Further research needs to investigate how to enhance the student learning experience and to fully exploit the potential for simulated experience to prepare students for their future role as registered nurses in clinical practice

Principles of teaching one-to-one and in small groups

A short summary detailing some important concepts in teaching clinical skills

Health needs assessment: caring for the individual and the population

Nursing for public health is a core textbook for students and staff which refelcts the growing need for nurses to maintain and imporive health as well as respond to illnesses and service user needs

Ferritin functions as a proinflammatory cytokine via iron-independent protein kinase C zeta/nuclear factor kappaB-regulated signaling in rat hepatic stellate cells

Circulating ferritin levels reflect body iron stores and are elevated with inflammation in chronic liver injury. H-ferritin exhibits a number of extrahepatic immunomodulatory properties, although its role in hepatic inflammation and fibrogenesis is unknown. Hepatic stellate cells respond to liver injury through production of proinflammatory mediators that drive fibrogenesis. A specific receptor for ferritin has been demonstrated on activated hepatic stellate cells, although its identity and its role in stellate cell activation is unclear. We propose that ferritin acts as a cytokine regulating proinflammatory function via nuclear factor kappaB (NF-B)-regulated signaling in hepatic stellate cell biology. Hepatic stellate cells were treated with tissue ferritin and iron-free apoferritin, recombinant H-ferritins and L-ferritins, to assess the role of ferritin versus ferritin-bound iron in the production of proinflammatory mediators of fibrogenesis, and to determine whether signaling pathways act via a proposed H-ferritin endocytosis receptor, T cell immunoglobulin-domain and mucin-domain 2 (Tim-2). This study demonstrated that ferritin activates an iron-independent signaling cascade, involving Tim-2 independent phosphoinositide 3 (PI3)-kinase phosphorylation, protein kinase C zeta (PKC) and p44/p42-mitogen-activated protein kinase, resulting in p50/p65-NF-B activation and markedly enhanced expression of hepatic proinflammatory mediators interleukin-1 (IL-1), inducible nitric oxide synthase (iNOS), regulated on activation normal T cell expressed and secreted (RANTES), inhibitor of kappa B (IB), and intercellular adhesion molecule 1 (ICAM1). Conclusions:This study has defined the role of ferritin as a proinflammatory mediator of hepatic stellate cell biology acting through the NF-B signaling pathway, and suggests a potential role in the inflammatory processes associated with hepatic fibrogenesis. (HEPATOLOGY 2009;49:887-900.