Survey of nurses’ knowledge and practice regarding medication administration using enteral tubes

© 2020 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/jocn.15498Aim and objectives The aim was to identify the practice variation of the individual practitioners in medications’ formulation modification for patients using enteral feeding tubing; to support health practitioners involved in this process. Background Blockage of enteral tubes is a common problem that can sometimes be resolved but may require replacement of the tube. Medications are a common culprit. Design A survey of 73 registered nurses’ practices around medication administration via enteral feeding tubes. Methods A questionnaire study was undertaken within a district general hospital across a broad variety of wards to explore nurses’ experiences of medication administration via enteral tubes. The study is reported in accordance with the SQUIRE 2.0 guidelines from the EQUATOR network. Results Seventy‐three nurses responded. Twenty‐six percent reported never checking about drug modification for administration via a tube, 12% check every time and 61% when unsure about a new drug. The volume of fluid flushes administered after medication ranged from 7.5‐150mls. Seventy‐one percent of participants reported stopping feed when medications are required, varying from 1‐60 minutes. Sixty percent had experienced a blocked tube and 52% the tube being removed for these reasons. The clinical nurse specialist was the commonest first point of call to help. Staff named 15 medications as the most problematic to administer, lactulose and omeprazole were the top two. Conclusions Practice varies significantly amongst nurses around medication administration. Theoretically this may contribute to blocked tubes and excessive fluid administration to some patients. Barriers to medication administration were thematically grouped into: time, difficulty modifying medication, medication interactions and knowledge. Areas identified to support staff include training, devices to crush medications, medication suitability, multidisciplinary approach to streamline care and quick reference guides. Relevance to clinical practice Health professionals may use these results to reduce and ultimately avoid problems with administering medications through feeding tubes. Organisations may use these results to develop their local practice pathways for prescribing, dispensing and training around administration of medications through enteral tubes. In a community setting, this paper may improve the awareness of patients, caregivers and prescribers of the possible implications of tubing blockages

The Application of Diabatic Heating in Q

An extended version of the Q-vector form for the ω-equation that includes diabatic (in particular latent) heating in the Q-vector itself is derived and tested for use in analyzing the life-cycle of a midlatitude cyclone that developed over the central United States during 24–26 December 2009. While the inclusion of diabatic heating in the Q-vector ω-equation is not unique to this work, the inclusion of diabatic heating in the Q-vector itself is a unique formulation. Here it is shown that the diabatic Q-vector gives a better representation of the forcing contributing to the life-cycle of the Christmas Storm of 2009 using analyses derived from the 80-km NAM

Improving the Quality of Care in Care Homes Using the Quality Improvement Collaborative Approach: Lessons Learnt from Six Projects Conducted in the UK and The Netherlands.

The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts of six QICs and share their learning of applying the QIC approach in the care home sector. Overall, five care home-specific lessons were learnt: (i) plan for the resources needed to support collaborative teams with collecting, processing, and interpreting data; (ii) create encouraging and safe working environments to help collaborative team members feel valued; (iii) recruit collaborative teams, QIC leads, and facilitators who have established relationships with care homes; (iv) regularly check project ideas are aligned with team members' job roles, responsibilities, and priorities; and (v) work flexibly and accept that planned activities may need adapting as the project progresses. These insights are targeted at teams delivering QICs in care homes. These insights demonstrate the need to consider the care home context when applying improvement tools and techniques in this setting

Governing England through the Manor Courts, c.1550-1850

Using records from 113 manors in Yorkshire and elsewhere, this article surveys the changing role of manor courts in English local government over three centuries. These institutions allowed juries of established tenants to deal cheaply and easily with a variety of chronic concerns, including crime, migration, retailing, common lands, and infrastructure. Their focus varied significantly according to region, topography, settlement size, and time period, but active courts existed in most parts of the country throughout the seventeenth and eighteenth centuries. Ultimately, they had many valuable functions which historians have barely begun to explore. This article thus offers the most systematic analysis to date of the role of these institutions in making and enforcing by-laws in this period, showing that many of the courts evolved to suit the changing priorities of local tenants rather than falling rapidly into ruin as has sometimes been assumed

The importance of staff engagement to the development of positive workplace cultures

Background and context: This paper uses Kolb’s learning cycle as a reflective framework to critically reflect on personal experience in the workplace and to carry out a review of the literature of workplace culture. Through this reflection, factors that impact on workplace culture are discussed; in particular the effect of staff engagement as a central concept in developing positive workplaces is explored. The factors that reduce staff engagement in the workplace are presented and reflections on what is necessary to improve workplace cultures for the benefit of the staff, patients and the healthcare organisation are discussed. Aims and objectives: To reflect on the importance of staff engagement as a mechanism for, and an outcome of, developing positive workplace cultures. Conclusions: I have critically reflected on my and others’ experience of poor workplace cultures. This journey has led me to raise questions pertinent to this field, as identified by my review of the literature. This review uncovered a number of factors that positively and negatively influence healthcare culture. Implications for practice: Given the importance of engagement to the development of positive and effective workplaces, I suggest that this is an important area for practice development research. I am developing a study that will describe the factors that contribute to workplace satisfaction and therefore staff engagement and disengagement. These factors will be examined in the everyday work life of nurses and may assist in understanding behaviour in the workplace and developing strategies to help build individual resilience and more effective workplaces

Mindfulness and Transition Pedagogy

Mindfulness practices, which focus on developing concentration and self- awareness skills through a set of meditative techniques derived from Buddhism, have been shown to have a wide variety of positive effects in clinical and educational settings. This article describes a developing project at the University of Wollongong to devise and integrate a variety of approaches to mindfulness into curriculum development and co-curricular activities. It describes a pilot mindfulness-training project for low SES students and a theoretical framework for integrating mindfulness approaches with transition pedagogies

Encouraging engagement at work to improve retention

Similar professional standards link nurses together but healthcare professionals practise across a variety of areas and have different experiences of the workplace. It cannot be assumed that a positive experience in one setting will be replicated in another, even if it is in the same organisation. This article explores the factors that affect workplace culture and outlines the rudiments underpinning nurse engagement from a work perspective. It also analyses staffengagement in the health service sector by examining the status, certainty, autonomy, relatedness and fairness (Scarf) model, and demonstrates the relevance of this framework

The health and health preparation of long-term Australian travellers

A growing number of Australians are travelling domestically for extended periods. This creates challenges in both continuity of health care and burdens on health services. This paper reports a cross-sectional survey aimed to explore the health needs and health planning of long-term travellers. In total, 316 respondents who had travelled for more than 3 months consecutively in the last year participated. Most respondents were retired (n=197; 62.3%); however, ages ranged from 26 to 89 years. Nearly half of the respondents or their travel companion had a long-term illness that affected their daily life (n=135; 42.7%). Nearly half of respondents visited a GP (n=133; 42.1%), nearly one-quarter visited an Emergency Department (n=72; 22.8%) and 19.9% (n=63) visited another health provider while travelling. The level of preparation around health while travelling varied between participants. This study highlights that long-term travellers have significant health needs and are likely to require health services during their extended travel. Additionally, it identifies that currently few strategies are used to plan for health care during travel. This raises issues for rural and remote health services in terms of both capacity and continuity of care