Development of a transition readiness scale for young adults with cystic fibrosis: face and content validity

Background: The process of moving from a paediatric to adult health care setting is known as health care transition (HCT). The current lack of transition planning to determine and ensure readiness means patients with chronic conditions experience less than ideal outcomes. There is a lack of a widely used, validated instrument to assess readiness to transition in adolescents with cystic fibrosis (CF). Objective: To develop the Cystic Fibrosis Health Care Transition Readiness Scale and assess this instrument for face and content validity

Feasibility trial of an early therapy in perinatal stroke (eTIPS)

Background: Perinatal stroke (PS) affects up to 1/2300 infants and frequently leads to unilateral cerebral palsy (UCP). Preterm-born infants affected by unilateral haemorrhagic parenchymal infarction (HPI) are also at risk of UCP. To date no standardised early therapy approach exists, yet early intervention could be highly effective, by positively influencing processes of activity-dependent plasticity within the developing nervous system including the corticospinal tract. Our aim was to test feasibility and acceptability of an "early Therapy In Perinatal Stroke" (eTIPS) intervention, aiming ultimately to improve motor outcome. Methods: Design: Feasibility trial, North-East England, August 2015-September 2017. Participants were infants with PS or HPI, their carers and therapists. The intervention consisted of a parent-delivered lateralised therapy approach starting from term equivalent age and continuing until 6 months corrected age. The outcome measures were feasibility (recruitment and retention rates) and acceptability of the intervention (parental questionnaires including the Warwick-Edinburgh Mental Wellbeing Scale (WEBWMS), qualitative observations and in-depth interviews with parents and therapists). We also reviewed clinical imaging data and undertook assessments of motor function, including the Hand Assessment for Infants (HAI). Assessments were also piloted in typically developing (TD) infants, to provide further information on their ease of use and acceptability. Results: Over a period of 18 months we screened 20 infants referred as PS/HPI: 14 met the inclusion criteria and 13 took part. At 6 months, 11 (85%) of those enrolled had completed the final assessment. Parents valued the intervention and found it acceptable and workable. There were no adverse events related to the intervention. We recruited 14 TD infants, one of whom died prior to undertaking any assessments and one of whom was subsequently found to have a condition affecting neurodevelopmental progress: thus, data for 12 TD infants was analysed to 6 months. The HAI was well tolerated by infants and highly valued by parents. Completion rates for the WEBWMS were high and did not suggest any adverse effect of engagement in eTIPS on parental mental wellbeing. Conclusion: The eTIPS intervention was feasible to deliver and acceptable to families. We plan to investigate efficacy in a multicentre randomised controlled trial

‘Slappers like you don’t belong in this school’: the educational inclusion/exclusion of pregnant schoolgirls

Policy in England identifies pregnant schoolgirls as a particularly vulnerable group and emphasises the importance of education as a way of improving the life chances of those who become pregnant while young. This paper draws on repeat interviews conducted over a twelve-month period to compare and contrast the stories of four young women. The narratives show that despite a common policy framework, there is great variability between schools in staff attitudes towards and responses to pupil pregnancy which produce different accommodations and support for pregnant girls, and seem likely to produce very different outcomes. We mobilise Iris Marion Young’s five faces of oppression to conduct a second reading of the stories. This situates the specificity of the girls’ school experiences into a wider socio-cultural and economic framing and indicates what might be involved in actually initiating and implementing the kinds of changes that the first ‘face value’ reading suggests are necessary

Knowledge and attitudes of secondary school students to breastfeeding

Research has indicated that adolescents had both negative and positive attitudes and have common misconceptions regarding breastfeeding that appear to result from their limited knowledge and reduced exposure to breastfeeding. The purpose of this study was to determine the knowledge and attitudes towards breastfeeding of adolscent rural and metropolitian secondary school students. A survey of a purposeful sample of 1845 male and female students was carried out. The study results indicated that, overall, Western Australian adolescent secondary school students have less than ideal knowledge of breastfeeding that is consistent with findings from other studies. Female students were found to be more positive towards breastfeeding than male students. The comparision of rural to metropolitian students found that metropolitian students had higher breastfeeding knowledge and were more positive towards breastfeeding than rural students. The study suggests that breastfeeding and lactation information needs to be addressed earlier than adolescence in order to increase breastfeeding knowledge and promote positive attitudes

A randomised controlled pilot study comparing Mepitel(®) and SurfaSoft(®) on paediatric donor sites treated with Recell(®).

This randomized controlled pilot study examined the effects of a silicone net dressing (Mepitel(®)) and a monofilament polyamide woven dressing (SurfaSoft(®)) on the rate of epithelialisation and epidermal maturation, pain, and ease of dressing removal on paediatric donor sites treated with epithelial cell suspension (ReCell(®)). Fifteen children (1-15 years) admitted for acute or reconstructive burns procedures in a tertiary referral hospital in Australia were randomly assigned to the experimental group, Mepitel(®) (n=8) and to the control group, SurfaSoft(®) (n=7). All donor sites were treated with ReCell(®) and covered with the assigned dressing. Measurements of rate of epithelialisation and epidermal maturation, pain, and ease of dressing removal were recorded every two days until the wound was healed. Results showed that there was no difference in the rate of epidermal maturation between the two groups. Less pain and force to remove the dressing was shown in the Mepitel(®) group when compared to SurfaSoft(®). The rate of epithelialisation was found to be an unreliable measure. Although additional research is required to support the results of this study, these results suggest that Mepitel's(®) pliable, self-adhesive and atraumatic properties may improve healing of ReCell(®) treated donor sites with less pain at dressing changes. This pilot study provides a strong base for further research in this area

EN to RN: The transition experience pre-and post-graduation

The context for this study is a conversion program for enrolled nurses (ENs) or division 2 level nurses who want to further their career as a registered nurse (RN) or division 1 nurse. While the conversion program is available to both metropolitan and rural nurses, it is designed specifically for experienced rural ENs. The conversion program is able to offer an educational alternative that does not disrupt family life or adversely impact the rural nursing workforce. This alternative is necessary for both the rural EN's career opportunities and for the health outcomes of rural communities in particular. This article reports on the experiences of the first cohort to graduate from the EN to RN conversion program. The conversion program offers three semesters of advanced standing within a seven-semester Bachelor of Science (Nursing) degree. The advanced standing or recognition of prior learning is awarded to applicants with more than one year's clinical experience, regardless of the type of enrolled nurse course completed. Enrolled nurses with a technical college qualification or higher meet university entry criterion but students from a hospital-based program are required to complete a mature-age university entry test. The degree to which the three semesters of advanced standing within an external conversion course for ENs would adversely affect participants' transition to student status and course completion is not known. The conversion program: The two-year, fully external EN conversion program relies on learning centre partnerships with country hospitals and agencies. Teaching strategies consist of a mix of external-mode strategies, including fully web-based units, and a compulsory eight-day on-campus foundation study block at the beginning.The compulsory study block provides the opportunity for students to familiarise themselves with the various areas of the university they need to contact as an external student, prepare for expectations of their first unit, including assessment expectations, and to practise selected nursing skills that are not common to the EN role. With the program being delivered from the metropolitan area of a vast state that occupies one-third of the Australian landmass, a key feature is the establishment of rural learning centres to support students. Apart from two of the seven clinical units in their course, the designated rural academic mentors arrange clinical placements in school-approved health care agencies situated locally or in nearby towns. This later strategy avoids the necessity for students to relocate to the metropolitan area or larger towns to complete the clinical component of the course. The conversion program has enrolled a limited number each year since 2000 and continues to be in high demand. Rural EN's are given preference and metropolitan enrolled nurses are included when quota allows. Purpose: The purpose of this article is to describe the two aspects of the transition experiences of graduates from an external conversion degree. First, their transition experience from experienced enrolled nurse to undergraduate student and, second, from graduate to novice RN. Participants: Participants were volunteer graduates from the Bachelor of Science (Nursing) two-year conversion degree. The 10 study participants were mature-age females, aged between 33 and 53 years (mean = 42 years). Five were from rural areas. Their educational background included hospital-based diploma or technical college certificate.Method: Data were collected using open-ended questions in semi-structured interviews. The interviews were transcribed and thematic analyses of the data were undertaken. Major categories were identified and relationships among them detailed. Results: The four categories identified included adjusting to higher education, achieving academically, becoming critical thinkers and adjusting to the RN role: accepting responsibility. Participant responses in this study have highlighted the necessity for timely responses to email, feedback on assignments and more mentor support for rural students during the course. Participants report changing the way they approached their nursing practice.Conclusions: The transition experiences for participants in the external conversion program are generally positive although, as with other studies, the transition to student status is stressful. However, the course is able to facilitate the career aspirations of the study participants and to contribute to the retention of nursing staff in rural areas. Strategies to provide career opportunities for health-care professionals in rural areas are always a challenge. As one such strategy, the external mode EN to RN conversion program has proven to be effective for experienced EN's

Enrolled nurse to registered nurse: is there a link between initial educational preparation and course completion?

Summary There is a shortage of registered nurses (RN) globally and equally in rural areas of Australia. The sparsely populated areas of rural Australia prompted the development of an external-mode EN-to-RN pathway course for enrolled nurses (EN) who want to complete a nursing degree. However, the awarding of advanced standing for EN clinical experience, regardless of educational background, is anew initiative that needs to be evaluated. Hence, this paper reports on the link between initial EN educational preparation and its impact on course completion. This exploratory correlation study used existing course data from four cohorts between 2000 and 2003. The comparisons included educational background, years of experience, and location of the EN-to-RN students. Significant differences were not found between rural and metropolitan students who completed or who withdrew from the course. Logistic regression analysis indicated that ENs in this sample with a hospital-based certificate rather than a technical college qualification were more likely to complete the course: Location and years of experience as an EN did not contribute significantly to course completion.

Healthcare-transition risk assessment for emerging adults with diabetes type 1

Aim: To identify potential risk indicators for emerging adults transitioning to adult health care. Background: Without maturity, independence, knowledge and motivation to manage their diabetes and successfully transition to adult healthcare, a proportion of emerging adults will struggle, leaving themselves vulnerable to diabetes-related complications. Methods: Fifty-three emerging adults (aged 17 - 19 years) recently transitioned from pediatric to adult healthcare were recruited. Data included demo-graphic, glycated haemoglobin, Body Mass Index, base-line and 12-month data from four psychosocial measures: Problem Areas in Diabetes, Diabetes Empowerment Scale, Hospital Anxiety and Depression Scale and dichotomous questions from the Eating Attitude Test. Missed appointments were obtained from hospital re-cords. Results: No significant differences in age, gender, BMI and individual survey scales between three appointment groups. Median HbA1c in the Sat-1 group was 7% (53 mmol/mol), compared with 8.6% (70 mmol/mol) and 8.5% (69 mmol/mol) respectively in the Sat-2 and Unsatisfactory groups. A ROC curve analysis and classification tree analysis identified optimal threshold values for the survey scales and their linear combinations. These values were used to make comparisons across two appointment and three HbA1c status groups. The unsatisfactory appointment group was characterised by statistically higher proportions of participants with (1) a low score for empowerment alone or in combination (less) with perceived problems and (2) statistically higher perceived problems and anxiety scores.Conclusions: Findings suggest that diabetes self-care confidence, less perception of diabetes as a problem, could be a useful indicator of future appointment attendance. Similarly, depression levels could be a useful predictor of better metabolic control following transition. Relevance to clinical practice: This study offers an innovative use of existing metrics to identify at-risk emerging adults in a busy clinic. Rather than the emphasis being solely on blood glucose control, it may be time to consider including psychosocial measures to identify at-risk individuals at the first appointment in adult healthcare

The characteristics of hospital nursing staff and patient outcomes: A response to Garland and Glenn (2011): commentary

We thank the IJNS editor for the opportunity to clarify our position as we did not intend to advance a causal link between NHPPD and patient outcomes. We agree that the What this paper adds statement should read that it provides evidence of an association between implementation of the NHPPD staffing method and a decrease in nurse-sensitive outcomes and improved patient safety, and the first sentence of the conclusions section should read “…was associated with improvement in a number of patient outcomes” rather than “the increases in nurse hours after implementation of the NHPPD staffing method improved a number of patient outcomes”