Newly qualified Saudi nurses' ability to recognise the deteriorating child in hospital

Background: It is recognized that nurses' failure to recognize and respond promptly to deterioration in children's physiological status can result in increased morbidity and mortality. Aim: The aim of this study was to explore the ability of Saudi-educated, newly qualified nurses, working in paediatric wards, to recognize children's deterioration.Methods: A pilot study was carried out to assess nurses' responses to three clinical vignettes (deteriorating child, improving child and ambiguous scenarios). The nurses' ability to make a correct identification was captured using a 'Think Aloud' approach and quantified using a visual analogue scale. Results: Twenty-seven nurses in two geographical regions in Saudi Arabia participated. Only half the nurses (51·8%) correctly identified the deteriorating child vignette. Of those who could not, 37% were unsure and 11% responded incorrectly. No nurses correctly identified all three vignettes, and four nurses (15%) responded incorrectly to all vignettes. Conclusions: The recognition of the deteriorating child is complex, and even in non-stressful simulated scenarios using vignettes, many newly qualified nurses working with children failed to recognize clear signs of deterioration. A focused (culturally specific) educational intervention is being developed to target this, taking into account Saudi nurses' perceived education and training needs. Relevance to clinical practice: Newly qualified nurses working in paediatric wards frequently find it difficult to identify the deteriorating child

Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review

Background Globally, people with intellectual disabilities, autism, or both, experience health inequalities. Death occurs at a younger age and the prevalence of long-term morbidities is higher than in the general population. Despite this, their primary healthcare access rates are lower, their health needs are often unmet, and their views and experiences are frequently overlooked in research, policy and practice. Aim To investigate the barriers and facilitators reported by individuals with intellectual disabilities, autism or both, and / or their carers, to accessing and utilising primary healthcare for their physical and mental health needs. Design and setting An integrative review utilising systematic review methodology. (PROSPERO: CRD42018103103). Method Electronic databases MEDLINE, Embase, CINAHL and Cochrane were searched for relevant studies (all languages) using a search strategy. Two researchers independently screened the results and assessed the quality of studies. Results Sixty-three international studies were identified. Six main themes relating to barriers and facilitators emerged from an analysis of these studies. The themes included training; knowledge and awareness; communication; fear and embarrassment; involvement in healthcare decision-making; and time. All the themes were underpinned by the need for greater care, dignity, respect, collaborative relationships and the need for reasonable adjustments. Opposing barriers and facilitators were identified within each of the main themes. Conclusions Adolescents and adults with intellectual disabilities, autism, or both, experience several barriers to accessing and utilising primary healthcare. The findings highlight the reasonable adjustments and facilitators that can be implemented to ensure that these individuals are not excluded from primary healthcare. How this fits in? This review synthesises evidence on the barriers and facilitators to accessing and utilising primary healthcare perceived by people with intellectual disabilities, autism or both. The findings highlight important considerations for primary healthcare policy, practice and further research

A comparison of two survey measures of health status

Health service planning requires information on levels of health and illness in the population. Surveys, such as the British General Household Survey (GHS) rely on self-reports of health, illness and restriction, but interpretation of results is problematic. Multi-item measures such as the Nottingham Health Profile (NHP) tap different aspects of health and allow respondents less freedom to define health and illness. In a survey of 1962 adults, health questions from the GHS and the NHP were used, and the results compared. Responses to GHS questions were associated with NHP scores, but the strength of the associations between the four GHS questions and the six NHP items varied considerably. Reporting a recent restriction was only weakly associated with NHP scores. Associations between GHS questions and NHP scores were weakest for the NHP items measuring emotional reactions, sleep and feelings of social isolation. Reporting good health or no illness in response to GHS questions was no guarantee that respondents experienced no health problems. Those who use health data from the GHS, NHP or similar surveys should look closely at whether such data provide appropriate information for their purposes.health status measurement health survey illness

Feedback on quality: patients’ experience of surgical care

There is a growing consensus within the NHS of the importance of obtaining feedback from patients in order to improve the quality of health care; consequently, many patient satisfaction surveys are now undertaken. However, much research is based on provider-held assumptions about service quality. This study focuses on patient satisfaction with coronary bypass surgery, starting with the concerns expressed by patients and using these as a basis for evaluating different aspects of care. The paired comparison technique was employed to produce a ranked list of aspects of care that were perceived to be in greatest need of improvement. Some difficulties were encountered in administering the ranking technique to patients in a highly specialized health-care setting; however, results were obtained and validated for follow-up patients. The item of most concern to these patients was a lack of sensitivity about when patients felt ready for discharge

Barriers and facilitators to primary health care for physical and or mental health issues experienced by adolescents and adults with intellectual disabilities (only), autism (only), or both: an integrative review

Introduction: People with intellectual disabilities, autism (or both) experience health inequalities. They also experience obstacles when accessing and utilising health-care for their physical and mental health needs and issues. Methods: An integrative review utilising systematic review methodology was conducted to identify the barriers and facilitators that adolescents and adults with intellectual disabilities, autism (or both) experience in accessing and utilising primary healthcare. Results: 70 international studies were identified. Preliminary analysis of the review’s findings suggests several barriers and facilitators exist. For example, daunting primary care environments, communication challenges, unconscious bias, diagnostic overshadowing by staff, a lack of accessible information about services for this population, difficulties navigating services, and resource constraints for service providers. Facilitators identified include, for example, collaborative relationships between health and other care providers, virtual teams of practitioners (with skills and experience of working with people who have autism, intellectual disabilities or both), supportive staff, communication aids, preparing patients in advance of primary healthcare visits, and the inclusion of those with autism and intellectual disabilities in joint training and service developments. Implications: Findings have implications for primary healthcare research, policy and practice. Suggestions for primary healthcare research, policy and practice focus are included for consideration

Barriers and facilitators to primary healthcare for people with intellectual disabilities and/or autism: an integrative review

Background: globally, people with intellectual disabilities and/or autism experience health inequalities. Death occurs at a younger age and the prevalence of long-term morbidities is higher than in the general population. Despite this, their primary healthcare access rates are lower than the general population, their health needs are often unmet, and their views and experiences are frequently overlooked in research, policy, and practice. Aim: to investigate the barriers and facilitators reported by individuals with intellectual disabilities, autism, or both, and/or their carers, to accessing and utilising primary health care for their physical and mental health needs. Design & setting: an integrative review was undertaken, which used systematic review methodology. Method: electronic databases MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane were searched for relevant studies (all languages) using a search strategy. Two researchers independently screened the results and assessed the quality of the studies. Results: sixty-three international studies were identified. Six main themes relating to barriers and facilitators emerged from an analysis of these studies. The main themes were: training; knowledge and awareness; communication; fear and embarrassment; involvement in healthcare decision-making; and time. All the themes were underpinned by the need for greater care, dignity, respect, collaborative relationships, and reasonable adjustments. Opposing barriers and facilitators were identified within each of the main themes. Conclusion: adolescents and adults with intellectual disabilities and/or autism experience several barriers to accessing and utilising primary health care. The findings highlight the reasonable adjustments and facilitators that can be implemented to ensure that these individuals are not excluded from primary health care