Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin-resistant Staphylococcus aureus in nursing homes for older people

The aim of this cluster randomised controlled trial was to test the impact of an infection control education and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing homes. Nursing homes were randomised to intervention (infection control education and training programme; N¼16) or control (usual practice continued; N¼16). Staff in intervention homes were educated and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good practice. Audit scores were fed back to nursing home managers in intervention homes, together with a written report indicating where practice could be improved. Nasal swabs were taken from all consenting residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and 338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff. The relative risk of a resident being colonised with MRSA in an intervention home compared with a control home at 12 months was 0.99 (95% con?dence interval: 0.69, 1.42) after adjustment for clustering. Mean infection control audit scores were signi?cantly higher in the intervention homes (82%) compared with the control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which may help to reduce MRSA in this setting.

A Bayesian Network Hybrid Model for Representing Accident and Emergency Waiting Times

The paper introduces a new modeling approach that represents the waiting times in an Accident and Emergency (A&E) Department in a UK based National Health Service (NHS) hospital. The technique uses Bayesian networks to capture the heterogeneity of arriving patients by representing how patient covariates interact to influence their waiting times in the department. Such waiting times have been reviewed by the NHS as a means of investigating the efficiency of A&E departments (Emergency Rooms) and how they operate. As a result activity targets are now established based on the patient total waiting times with much emphasis on trolley waits.

Emergency Management in Developed Countries: An Investigation of Hazard Risk, Vulnerability and Government Response in the UK and USA

During the summer of 2007 the United Kingdom experienced some of the worst flooding in its history, with the city of Hull amongst the worst affected. Meanwhile, the city of New Orleans, USA was subject to severe flooding in August 2005 as a result of Hurricane Katrina. The study has found that both the UK and US government disaster management programmes were ill prepared for these flood events. Many parallel issues have been discovered and discussed. The conditions of vulnerability that are evident in developing countries are not widely present in the UK or US but this must not be allowed to lead to complacency and lack of preparation and awareness. The cost in terms of mortality is relatively low compared to similar events in developing countries; however, the economic implications are considerable and must be addressed.

Fundamental patterns of knowing in nursing: The challenge of evidence-based practice

This article reconsiders the fundamental patterns of knowing in nursing in light of the challenge of narrowempirics in the formof evidence-based practice. Objections to the dominance of evidence-based practice are reviewed, and the reasons for it are examined. It is argued that it is partially the result of weaknesses in the alternative patterns of ethical, personal, and esthetic knowing, the ineffability of which compromises accountability. This ineffability can be countered only by introducing a wider form of empirics than countenanced by evidencebased practice into all patterns of knowing, to demonstrate their salience and to make their use in practice transparent.

Testing of the Factor Structure of the Nursing Work Index-Revised

Background: Recent research has questioned the reliability and validity of the Nursing Work Index-Revised (NWI-R) instrument, raising the possibility that managers reconfiguring hospitals in line with the factors derived from the NWI-R may be misdirecting resources.

Nursing babies at risk of cerebral palsy in the neonatal period

Cerebral palsy (CP) is a leading cause of physical disability in childhood with evidence that 90% of children with the condition sustain damage or malformation to their developing brain during the antenatal period. With half of all cases of children with CP being born prematurely many need extra help and support in the neonatal period. The aims of neonatal nursing for this high risk group include prevention of further neurological complications as well as working maintain stable infant physiology and provide information and support to parents. While a diagnosis of CP is seldom welcome there is now evidence that most children with CP are mildly affected, most have a normal life expectancy, most are well adjusted and most are happy, reporting a quality of life similar to children without CP. Neonatal nurses are ideally placed to communicate and prepare parents of children at high risk of developing CP about more positive future likely outcomes than previously thought.

An Educational Initative in Anaesthetic Nursing Practice

The National Board for Nurses, Midwives and Health Visitors in Northern Ireland (NBNI) has adopted the principles of the UKCC's recommendations for specialist nursing practice and Incorporated these within their continuing education framework. Stage two of this framework decrees the standard required for specialist nursing practice (NBNI, 1995) and, as a result, a specialist anaesthetic nursing course has been instigated. The course extends over 44 weeks and includes 8 weeks of consolidation practice, comprising seven modules at degree and diploma level. The course gives the students an opportunity to deepen their knowledge, skills and attitudes in the field of anaesthetic nursing. Nurses were taught the necessary skills to work in collaboration with other professionals, patients and families in order to coordinate a patient-centred approach to perianaesthetic care. The role of the anaesthetic nurse specialist should be viewed as complementary to that of the anaesthetist. This course facilitates and encourages practitioners to move beyond registered practice on qualifying to a more specialized role where care is delivered in an innovative and creative manner.

Stress, coping and satisfaction in nursing students

Aim. This article is a report of a study conducted to explore the relationship between sources of stress and psychological well-being and to consider how different sources of stress and coping resources might function as moderators and mediators on well-being.


Background. In most research exploring sources of stress and coping in nursing students, stress has been construed as psychological distress. Sources of stress likely to enhance well-being and, by implication, learning have not been considered.


Method. A questionnaire was administered to 171 final year nursing students in 2008. Questions were asked to measure sources of stress when rated as likely to contribute to distress (a hassle) and rated as likely to help one achieve (an uplift). Support, control, self-efficacy and coping style were also measured, along with their potential moderating and mediating effects on well-being, operationalized using the General Health Questionnaire and measures of course and career satisfaction.


Findings. Sources of stress likely to lead to distress were more often predictors of well-being than were sources of stress likely to lead to positive, eustress states, with the exception of clinical placement demands. Self-efficacy, dispositional control and support were important predictors, and avoidance coping was the strongest predictor of adverse well-being. Approach coping was not a predictor of well-being. The mere presence of support appeared beneficial as well as the utility of that support to help a student cope.


Conclusion. Initiatives to promote support and self-efficacy are likely to have immediate benefits for student well-being. In course reviews, nurse educators need to consider how students’ experiences might contribute not just to potential distress, but to eustress as well.