Nursing and midwifery students' encounters with poor clinical practice:a systematic review

The aim of this paper was to systematically review evidence about nursing and midwifery students’ encounters with poor clinical care.We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students’ encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis.N=14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students.Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so

Accounting for actions and omissions:a discourse analysis of student nurse accounts of responding to instances of poor care

Aims: To explore how nursing students account for decisions to report or not report poor care witnessed on placement and to examine the implications of findings for educators. Background: Concern has been raised about the extent to which cases of poor care go unreported. Failure to report cases may have serious consequences for patient safety. Design: Semi structured interviews were conducted with 13 under graduate students at a UK university during 2013. They were asked to consider their response to episodes of poor practice witnessed on placement. Methods: Data were transcribed verbatim and categorized according to whether or not students reported concerns. Cases were analysed in accordance with Potter and Wetherall’s version of discourse analysis to identify the discursive strategies used to account for decisions to report or not report poor practice. Results: Participants took care to present themselves in a positive light regardless of whether or not they had reported an episode of concern. Those who had reported tended to attribute their actions to internal factors such as moral strength and a commitment to a professional code. Those who had not or would not report concerns provided accounts which referred to external influences that prevented them from doing so or made reporting pointless. Conclusion: This study provides information about how students account for their actions and omissions in relation to the reporting of poor care. Findings suggest ways educators might increase reporting of concerns

Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour

Objective: To assess whether the multitherapy antenatal education ‘CTLB’ (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings. Design: Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data. Methods: We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group. Results: If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to$A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95Conclusion: The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from$A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%. Trial registration number: ACTRN12611001126909

Presenting an absence

This is a PDF version of an article published in Performance practice © 1995 Kate Smith and Chester College.This article reflects upon the themes of blackness and whiteness, and presence and absence in a production of Our country's good by Timerblake Wertenbaker made by students in the Department of Drama & Theatre Studies at Chester College

The artificial body: Speaking through stammers and silences

This is a PDF version of an article published in Performance practice © Kate Smith/Chester College 1996.This article, originally delivered at the Body memory in performance conference at Lancaster University in August 1995, discusses some of the observed phenomena in rehearsal processes towards the performance of the damaged and dismembered bodies that inhabit Caryl Churchill and David Lan's A mouthful of birds (Methuen, 1986) and Timberlake Wertenbaker's The love of the nightgale (Faber & Faber, 1989)

How to achieve resilience as an older widower: turning points or gradual change?

ABSTRACT The paper draws together two conceptualisations of resilience in bereavement and widowhood that were developed b

What factors influence successful endotracheal intubation in the critically ill morbidly obese patient in the intensive care unit?

Objectives: To determine what factors influence successful endotracheal intubation in the critically ill morbidly obese patient in the intensive care unit? Method: An English language literature search was undertaken using Google scholar, Medline, MD Consult, Cochrane and Cinahl (1975-2009) with the key words ‘obesity’, ‘morbid obesity’, ‘ICU’, ‘intensive care’, ‘airway management’, ‘difficult intubation’, ‘positioning’, ‘critical care’, ‘bag mask ventilation’. Reference lists were examined manually to find further articles. Results: Obesity has become a worldwide epidemic and morbidly obese patients are accessing intensive care services. Thirteen articles were found for analysis. The incidence of difficult intubation was greater in obese patients rather than lean patients; 15.5% and 2.2% respectively (p<0.001). Mallampati scoring had a correlation with ease of laryngoscopy (p < 0.001). Mallampati score was more likely to be higher (loss of pharyngeal structures) in obese versus lean, 27% versus 13% respectively. Neck circumference was found to be an independent risk factor for difficult intubation. Ramped positioning for direct laryngoscopy provided a consistently better laryngeal exposure than the traditional sniff position. Difficult mask ventilation (DMV) was found to be present in those with a body mass index (BMI) >26kg/m². Difficult intubation and high Cormack-Lehane grades were significantly greater in the DMV group. The intubating laryngeal mask airway (ILMA) was inserted with similar ease regardless of Cormack-Lehane grade. Mean arterial oxygen saturations were similar during ILMA insertion for obese and lean, 96% and 98%, respectively. In the reverse Trendelenburg position it took longer for oxygen saturations to fall to 92% during apnoea when compared with the supine position. It took twice as long for patients in the supine position to reach oxygen saturations of 97% when ventilation was re-instituted than those in the reverse trendelenburg position. In the 25 degrees head up position gives 23% higher mean oxygen tension after three minutes of pre-oxygenation. Conclusion: Predictors of difficult intubation are Mallampati class and a large neck circumference for the morbidly obese. Ramped positioning provides a better laryngeal exposure for ease of intubation. With head up positioning oxygenation can be optimised reducing periods when oxygen saturation values fall. The ILMA is a safe and effective rescue device for a failed intubation

Increasing Nurse Knowledge Using a Formal Lung Transplant Education Program

This quality improvement project was completed to show that a formal lung transplant education course for nurses caring for lung transplant patients increased their knowledge. An eight-hour education course was developed by experts in the field of lung transplantation. A pretest was administered before the education course. A posttest was administered to determine if knowledge was improved. A three-month follow-up test was administered to determine knowledge retention. Based on the data analysis, nurse knowledge improved after formal education. Item analysis determined what areas of educational content need to be the focus of quarterly education. The education course was adopted as formal training for transplant nurses

The well-being of carers of older Aboriginal people living in the Kimberley region of remote Western Australia: Empowerment, depression, and carer burden

Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider