Risk assessment in mental health: introducing a traffic light system in a community mental health team.

AIMS: To reports a study in which action research approach was utilised to introduce a new system of risk assessment, based on traffic lights, into a community mental health team. BACKGROUND: Risk management is a serious concern in community mental healthcare where there is less direct, real-time supervision of clients than in other settings, and because inadequate management of risk can have fatal consequences when service users are a risk to themselves and/or others. DESIGN: An action research design was undertaken, using three phases of Look, Think and Act. METHODS: Data were collected between January and March of 2012. In the action research phases, qualitative data were collected in focus groups with the team's multi-disciplinary mental health professionals. Data were transcribed verbatim and analysed thematically, which involved agreement of themes and interpretations by two researchers. The Look, Think and Act phases guided the development of the project; team members worked collaboratively on the traffic light system, implemented and evaluated it. FINDINGS: Themes were constructed that were discussed across the focus groups. These themes were: Ease of use; Risk identification and management; Legal status; Different teams' views of risk; Post-implementation evaluation. CONCLUSION: Action research has been used to implement change in mental health risk management. Others internationally would benefit from considering a Traffic Light System, and in using action research to implement it

A systematic Review and Comprehensive Critical Analysis Examining the Use of Prednisolone for the Treatment of Mild to Moderate Croup.

Abstract Background: Many randomised control trials and systematic reviews have examined the benefits of glucocorticoids for the treatment of croup in children, but they have reported mainly on dexamethasone as an oral treatment for croup. No systematic reviews have examined prednisolone alone. Aim: To determine in a systematic review of the literature whether a single dose of oral prednisolone is as effective as a single dose of dexamethasone for reducing croup symptoms in children. Search Strategy: A detailed search was conducted on the following databases: CINAHL, MEDLINE EBSCO, MEDLINE, OVID, PubMed, The Cochrane Library, ProQuest, EMBASE, JBI, Sum search, and OpenGrey. Study authors were contacted. Selection Criteria: Randomised Controlled Trials, clinical trials or chart reviews which examined children with croup who were treated with prednisolone alone, or when prednisolone was compared to a dexamethasone treatment and the effectiveness of the intervention was objectively measured using croup scores and re-attendance as primary outcomes. Data Collection and Analysis: Following PRISMA guidelines for systematic reviews, relevant studies were identified. Scores were graded agreed by two independent reviewers using QualSyst. Main Results: Four studies met the inclusion criteria, but were too heterogeneous to combine in statistical meta-analysis. The result suggests that although prednisolone appears as effective as dexamethasone when first given, it is less so for preventing re-presentation. Trial sample sizes were small, making firm conclusions difficult, however, a second dose of prednisolone the following day may be useful. More research including cost-benefit analysis is needed to examine the efficacy of prednisolone compared to dexamethason

Women’s experiences of personalised support for asthma care during pregnancy: A systematic review of the literature

Abstract Background Asthma and pregnancy are both sources of anxiety for women. Although there has been a focus on physiological management of asthma and pregnancy, there has been little research on the impact that personalised support can have on asthma care during pregnancy. This systematic review and narrative synthesis of the literature set out to answer the question ‘What are women’s experiences of asthma care, its management and education, during pregnancy?’ Methods This systematic review was carried out using accepted methodology from the York Centre for Reviews and Dissemination. Electronic database searches were conducted using PsycInfo, CINAHL, MedLine, Google Scholar and the Cochrane Library, using the combination search terms: ‘Asthma’ AND ‘Pregnancy’ AND ‘Care’ AND (‘Education OR Information OR Experience’). Hand searching of journals and searches for grey literature were also undertaken. Independent quality appraisal by the three authors took place using the criteria detailed by Kmet et al. (Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields, 2004). Results All papers scoring in excess of 60% were deemed to be of adequate quality for inclusion, of which there were five: two qualitative designs and three quantitative designs. The designs were too methodologically heterogeneous to permit statistical meta-analysis so narrative review and synthesis was undertaken. Despite an embryonic evidence bases, it is reasonable to conclude that personalised care has beneficial outcomes for pregnant asthmatic women. Conclusions Larger randomised controlled trials investigating personalised care are required to build an evidence base which can establish the efficacy of such interventions

Vocation, friendship and resilience: a study exploring nursing student and staff views on retention and attrition.

INTRODUCTION: There is international concern about retention of student nurses on undergraduate programmes. United Kingdom Higher Education Institutions are monitored on their attrition statistics and can be penalised financially, so they have an incentive to help students remain on their programmes beyond their moral duty to ensure students receive the best possible educational experience. AIMS: to understand students' and staff concerns about programmes and placements as part of developing our retention strategies. DESIGN: This study reports qualitative data on retention and attrition collected as part of an action research study. SETTING: One University School of Nursing and Midwifery in the South West of England. PARTICIPANTS: Staff, current third year and ex-student nurses from the adult field. METHODS: Data were collected in focus groups, both face-to face and virtual, and individual telephone interviews. These were transcribed and subjected to qualitative content analysis. RESULTS: FOUR THEMES EMERGED: Academic support, Placements and mentors, Stresses and the reality of nursing life, and Dreams for a better programme. CONCLUSIONS: The themes Academic support, Placements and mentors and Stresses and the reality of nursing life, resonate with international literature. Dreams for a better programme included smaller group learning. Vocation, friendship and resilience seem instrumental in retaining students, and Higher Education Institutions should work to facilitate these. 'Vocation' has been overlooked in the retention discussions, and working more actively to foster vocation and belongingness could be important

Undergraduate Nurses’ and Midwives’ Participation and Satisfaction with Live Interactive Webcasts

INTRODUCTION: E-Learning methods such as webcasting are being used increasingly in healthcare education, including that of nurses and midwives. Webcasting means live synchronous broadcasting over the internet, where students participate simultaneously in text ‘chat room’ interactive discussions when logged on to a webpage where they can see and hear a presentation such as a PowerPoint lecture, a list of other participants, and access ‘chat rooms’. AIMS: This paper reports student participation and satisfaction with the use of webcasting in a third year undergraduate nursing and midwifery research methods module in one higher education institution faculty of health and social work in the southwest of England, with students from distributed geographical locations. MATERIALS AND METHODS: Students chose either webcasts or face-to-face lectures. Following each of the four webcasts, a web-based evaluation questionnaire was administered in a cross-sectional survey design. RESULTS: Two thirds of students took part in webcasts and found them to be an acceptable teaching and learning strategy. Travel and cost savings were noted through not travelling to the main university campus, and these were statistically significantly correlated with students’ perception of gaining from the module and their overall satisfaction with webcasting. Across the four webcasts 5446 purposeful messages were posted indicating engagement with the material under study. CONCLUSIONS AND RECOMMENDATIONS: Webcasting is an effective teaching and learning strategy which is popular with students, allows remote access to teaching and learning, and offers time and cost savings to students. Further research is required to investigate the educational potential of this new technology

Phase 1 pilot study of e-mail support for people with long term conditions using the Internet.

BACKGROUND: Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a 'digital divide' prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group. METHODS: Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants' confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes. RESULTS: Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via 'Information Prescriptions'), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable. CONCLUSION: E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs

Investigating Women's Experiences of Asthma Care in Pregnancy: A Qualitative Study.

Background : Most asthmatic women have normal pregnancies and complications are infrequent when their asthma is well-controlled. Symptom control and medical treatment are concerning to pregnant asthma suffers, as is the impact that their illness and treatment might have on their unborn baby. The aim was to investigate in a qualitative study the thoughts and feelings of women's experiences of asthma in pregnancy. Twenty-two women with asthma who had a pregnancy within two years were asked to participate. Seven women were interviewed when data saturation was achieved. Interviews were transcribed and analysed using the 'Framework' Method, independently analysed by two researchers and consensus reached concerning the construction of themes. The key themes that emerged were Asthma and pregnancy; Pregnancy and post-natal experiences; and Health professionals. These findings are globally interesting because of the prevalence of maternal asthma and they illustrate participants' experiences concerning their asthma care and their views on its improvement. Pregnant asthmatic women have concerns about their care and treatment which might be alleviated by outreach, joint working between respiratory doctors and nurse specialists, midwives and General Practice nurses. Targeted educational activities could form a part of this care delivery

Improving student support in professional placement learning: findings from the South west peninsula pilot of a new english national placement quality assurance and enhancement process.

English stakeholder collaboration has resulted in a new quality assurance process for non-medical health and social care placement providers and higher education institutions. This study aimed to discover the impact on student support that taking part in a pilot had on participating placement areas. Using a questionnaire survey with longitudinal follow-up one year later, we found that placement staff valued the opportunity to review and improve student support practices. This was still in evidence a year later where the pilot was described as giving the opportunity to provide evidence of aspects of student support practice; communicating and changing or developing aspects of that practice. Benefits accrued from interdisciplinary working in sharing and collaborating with other professions and organisations. Such activity could enhance clinical support staff activities and facilitate strategic partnerships between placement providers and higher education institutions