Case study: obesity, genital oedema and lower limb compression bandaging

The purpose of this article is to present an evidenced based rationale for lymphoedema compression bandaging one aspect of treatment for a patient with complex lower limb lymphoedema. The current health care climate requires treatment decisions to be transparent based on the best available evidence. The challenge faced by community nurses is to formulate treatment plans which incorporate the patients’ preferences and best utilise limited resources provided by clinical environments. The article appraises research in order to formulate a suitable treatment plan and provides discussion and reflection regarding the challenges faced by the nursing profession in achieving evidence based practice. Evidence based practice is beneficial in formulating patient centred and cost effective treatment plans, developing competence is not straightforward, however clinical guidelines can provide much needed guidance

Clinical innovation: wider collaboration on lymphoedema research is needed — footwear and gait analysis

Extending teams that research and manage lymphoedema to include orthotists and podiatrists may extend our understanding of the condition and component parts of treatment. New technology, some of which is low cost, enables an increasing range of data and outcome measures. This article highlights the reality of a shortage of studies involving gait analysis and a lack of consideration of the impact of inappropriate footwear on exercise as a key component of lymphoedema management

Interprofessional education (IPE) in clinical practice for pre-registration nursing students: a structured literature review

Objectives: To explore the experiences of nursing students after clinical IPE activities through a review of contemporary literature then use the context of nursing programmes in Singapore to consider the transferability of the findings. Design: Structured literature review. Data Sources: A search of international qualitative literature no older than five years and published in English was conducted on CINAHL, Embase, Medline and Pubmed. Review Methods: A systematic and structured approach was guided by Cooper's five-step approach to review the literature. The Critical Appraisal Skills Programme qualitative checklist and the Appraisal of Guidelines Research & Evaluation reporting checklist were used to critically appraise literature in this review. Results: 13 papers were included for qualitative synthesis. The literature most commonly reported that students had a better understanding of professional roles, improved communication and teamwork. In contrast, the most commonly reported negative experience involved some examples of disparity within the team. Conclusion: Overall findings show that positive student experiences outweigh negative ones. Nursing programmes might be able to reap similar outcomes subject to contextual and cultural differences. However, further research is recommended before IPE in clinical practice is implemented in current nursing programmes in the local setting

Self-reported training and confidence levels among practitioners managing genital lymphedema

Introduction Genital lymphedema (GL) can present with significant psychological, social, and physical impairments. Barriers to treatment include under-reporting, socio-cultural issues, patient/healthcare practitioner (HCP) perception/comfort, and lack of knowledge among HCPs.1-4 General lymphedema training utilizes hands-on approaches to learning for extremities; yet GL training is often minimal with little to no hands-on component. This self-reporting retrospective study investigates GL training, instruction methods, and confidence levels among HCPs. Methods An online 20 question survey was disseminated via direct email to HCPs that had previously downloaded tools for males/females with GL, announcements on social media pages related to lymphedema, links provided at conferences/courses, and in a published article. Respondents include 245 HCPs from 19 countries. Results Respondents presented from different countries, professions, and practice settings. Initial lymphedema training included a genital component for 66% of HCPs but included hands-on learning for less than 50%. Only 29% reported confidence in treating GL post training. Additional GL training was sought by 37% of HCPs, 63% of which included a hands-on component. HCPs reported higher confidence post hands-on learning for both initial and additional training. The most common type of hands-on training included models attached to another HCP and 96% of HCPs who used this type reported it increased their confidence over other types/no models. 86% of all HCPs felt training with genital models attached to another participant would increase their confidence, and 75% said they felt they needed additional training to treat GL. Significance This study showed courses that not only included specific GL focused training, but included a hands-on component, lead to higher levels of confidence.Additionally, genital models on other HCPs also increased this perception in all HCPs who utilized this technique. This highlights HCPs’ need for comprehensive training in GL and lack of confidence following current training methods

The Asset-based Collaborative Working model (ACW model): pragmatic action research in healthcare service development

Embedding researchers in clinical practice may not be an obvious consideration in asset-constrained healthcare settings. However, with increasing calls for best practice and value-for-money, understanding what works, for whom and why, is of paramount importance. This article illustrates how a researcher embedded in a healthcare professional group not only facilitated a service development within existing resources, but also enabled the group to identify relevant theories, and their interrelationships, underpinning the group's actions during the developmental process. This resulted in the construction of a new theoretical model, the Asset-based Collaborative Working model. This research suggests that embedding research in service development is feasible and can result in substantive learning and an understanding of group working which is required in contemporary healthcare provision. While developed in the clinical field of lymphoedema, the Asset-based Collaborative-Working model may be applicable in other care settings

Modelling the development of an online learning resource by health care professionals

The aim of this study was to model the process of development for an Online Learning Resource (OLR) by Health Care Professionals (HCPs) to meet lymphoedema-related educational needs, within an asset-based management context. Previous research has shown that HCPs have unmet educational needs in relation to lymphoedema but details on their specific nature or context were lacking. Against this background, the study was conducted in two distinct but complementary phases. In Phase 1, a national survey was conducted of HCPs predominantly in community, oncology and palliative care services, followed by focus group discussions with a sample of respondents. In Phase 2, lymphoedema specialists (LSs) used an action research approach to design and implement an OLR to meet the needs identified in Phase 1. Study findings were analysed using descriptive statistics (Phase 1), and framework, thematic and dialectic analysis to explore their potential to inform future service development and education theory. Unmet educational need was found to be specific to health care setting and professional group. These resulted in HCPs feeling poorly-equipped to diagnose and manage lymphoedema. Of concern, when identified, lymphoedema was sometimes buried for fear of overwhelming stretched services. An OLR was identified as a means of addressing the unmet educational needs. This was successfully developed and implemented with minimal additional resources. The process model created has the potential to inform contemporary leadership theory in asset-based management contexts. This doctoral research makes a timely contribution to leadership theory since the resource constraints underpinning much of the contribution has salience to current public services. The process model created has the potential to inform contemporary leadership theory in asset-based management contexts. Further study of a leadership style which incorporates cognisance of Cognitive Load Theory and Self-Determination Theory is suggested. In addition, the detailed reporting of process and how this facilitated learning for participants contributes to workplace education theor

The Asset-based Collaborative Working model (ACW model): pragmatic action research in healthcare service development

Embedding researchers in clinical practice may not be an obvious consideration in asset-constrained healthcare settings. However, with increasing calls for best practice and value-for-money, understanding what works, for whom and why, is of paramount importance. This article illustrates how a researcher embedded in a healthcare professional group not only facilitated a service development within existing resources, but also enabled the group to identify relevant theories, and their interrelationships, underpinning the group's actions during the developmental process. This resulted in the construction of a new theoretical model, the Asset-based Collaborative Working model. This research suggests that embedding research in service development is feasible and can result in substantive learning and an understanding of group working which is required in contemporary healthcare provision. While developed in the clinical field of lymphoedema, the Asset-based Collaborative-Working model may be applicable in other care settings

The Lymphoedema Genitourinary Cancer Questionnaire in urology follow‐up clinics

Is the Lymphoedema Genitourinary Cancer Questionnaire (LGUCQ) useful to men treated for genitourinary cancer through facilitating symptom disclosure? Lymphoedema can be debilitating and progressive and its association with bladder, prostate, testicular and penile cancer, either as a consequence of treatment or progressive disease is well recognized. However, lymphoedema is generally unrecognized during follow‐up. Research on genitourinary cancer‐related lymphoedema is sparse with a lack of reliable prevalence figures. A lack of empirical understanding of the experiences of these men led to the development of the LGUCQ, a simple two‐sided tool to facilitate self‐reporting of symptoms and difficulties associated with lymphoedema. Related pilot work suggests that written self‐report tools enable men to disclose more sensitive information than they would verbally. However, the LGUCQ had not been formally evaluated in an uro‐oncology department to identify the benefits from the perspective of the patients and health professionals. Thematic analysis of completed LGUCQs and interviews with patients and staff were performed. Emergent themes included the perceived barriers to symptom disclosure, the LGUCQ as facilitator and pragmatic addition, the support needs of patients and health professionals and refinements required for roll out. Issues limiting identification of lymphoedema within uro‐oncology services existed. Findings suggest the inclusion of the LGUCQ within uro‐oncology clinics could lead to earlier identification of lymphoedema. Patients could identify genital oedema problems with the LGUCQ increasing prompt and accurate disclosure and normalizing the experience