Hospice nurses’ views on single nurse administration of controlled drugs

noBackground: The involvement of two nurses to dispense and administer controlled drugs is routine practice in most clinical areas despite there being no legal or evidence-based rationale. Indeed, evidence suggests this practice enhances neither safety nor care. Registered nurses at two hospices agreed to change practice to single nurse dispensing and administration of controlled drugs (SNAD). Participants’ views on SNAD were evaluated before and after implementation. The aim of this study was to explore the views and experiences of nurses who had implemented SNAD and to identify the views and concerns of those who had not yet experienced SNAD. Method: Data was obtained through semi-structured interviews. Results: Qualitative thematic analysis of interview transcripts identified three key themes: practice to enhance patient benefit and care; practice to enhance nursing care and satisfaction; and practice to enhance organisational safety. Conclusion: The findings have implications for the understanding of influences on medicines safety in clinical practice and for hospice policy makers

An ethnographic investigation of maternity healthcare experience of immigrants in rural and urban Alberta, Canada

Background: Canada is among the top immigrant-receiving nations in the world. Immigrant populations may face structural and individual barriers in the access to and navigation of healthcare services in a new country. The aims of the study were to (1) generate new understanding of the processes that perpetuate immigrant disadvantages in maternity healthcare, and (2) devise potential interventions that might improve maternity experiences and outcomes for immigrant women in Canada. Methods: The study utilized a qualitative research approach that focused on ethnographic research design and data analysis contextualized within theories of organizational behaviour and critical realism. Data were collected over 2.5 years using focus groups and in-depth semistructured interviews with immigrant women (n = 34), healthcare providers (n = 29), and social service providers (n = 23) in a Canadian province. Purposive samples of each subgroup were generated, and recruitment and data collection – including interpretation and verification of translations – were facilitated through the hiring of community researchers and collaborations with key informants. Results: The findings indicate that (a) communication difficulties, (b) lack of information, (c) lack of social support (isolation), (d) cultural beliefs, e) inadequate healthcare services, and (f) cost of medicine/services represent potential barriers to the access to and navigation of maternity services by immigrant women in Canada. Having successfully accessed and navigated services, immigrant women often face additional challenges that influence their level of satisfaction and quality of care, such as lack of understanding of the informed consent process, lack of regard by professionals for confidential patient information, short consultation times, short hospital stays, perceived discrimination/stereotyping, and culture shock. Conclusions: Although health service organizations and policies strive for universality and equality in service provision, personal and organizational barriers can limit care access, adequacy, and acceptability for immigrant women. A holistic healthcare approach must include health informational packages available in different languages/media. Health care professionals who care for diverse populations must be provided with training in cultural competence, and monitoring and evaluation programs to ameliorate personal and systemic discrimination

Dementia in the Bangladeshi diaspora in England: a qualitative study of the myths and stigmas about dementia

Rationale, aims, and objectives: Although Bangladeshis are three times more likely to be carers than White British, Bangladeshi family carers are the most deprived, neglected, and effectively a hidden group in the UK.1 There is a paucity of research within the Bangladeshi community that is capable of explaining and predicting what the experiences and concerns of Bangladeshi family carers providing care for their relatives with dementia. The purpose of this study is to explore the perspectives of Bangladeshi family carers’ knowledge and day-to-day experiences living in England. Methods: Qualitative study involving semi-structured face-to-face interviews with six Bangladeshi family carers living in London and Portsmouth. Interviews were recorded with the consent and transcribed verbatim. Data was managed by using NVivo software and thematic analysis was performed. Results: This paper explores that most carers have a lack of knowledge and awareness of the symptoms of dementia. The results of this study are in contrast to previous studies, where South Asian carers perceived dementia as being possessed by evil spirits or God’s punishment for previous life’s sins, this study reveals Bangladeshi family carers believed dementia was a medical condition. Unlike earlier South Asian studies, however, all family carers in this study also believed there was no stigma attached to dementia. Conclusions: Further research is warranted to investigate the religious beliefs, familism, and interpersonal motives as theoretical perspectives to explain how Bangladeshi family carers negotiate and construct their caregiving roles for their relatives with dementia

Developing inter-professional training for conflict resolution : a scoping audit and training pilot

Managing violence is an important clinical and managerial responsibility within contemporary mental health practice and there have been considerable developments across the country to pave the way for a more ‘standardised’ approach to conflict resolution. Many trusts employ someone to lead on ‘conflict resolution’ but the precise nature of the lead role and the responsibility attached to it vary greatly between organisations. Similarly, some trusts have sophisticated systems for delivering and monitoring conflict training and updates, whereas others do not. The project described here sought to clarify how training for conflict resolution is organised within a sample of mental health trusts in England. Data was generated by questionnaire and telephone interview with trust leads, and the audit findings were then analysed and used to inform an inter-professional training pilot in one local trust. It is now expected that frontline staff will enter into conflict resolution training as defined by the NHS Security Management Service (2004) and be trained in accordance with a national syllabus of training standards. Audited opinion suggests that the training co-ordinator role is associated with improved governance in relation to conflict-resolution training. Arguably, if national benchmarks and standards are to be met in relation to conflict resolution, trusts need to invest in training infrastructure and at least consider the merits of funding a dedicated co-ordinator role and inter-professional training