Violence and aggression in the emergency department: factors impinging on nursing research

This paper examines issues involved in the debate regarding the role of research in nursing. The authors take the example of violence and aggression in the emergency field to discuss methodological, philosophical, professional, logistical, power differentials and leadership theory that influence and explain the process of conducting research surrounding violence and aggression experienced by nurses working in emergency departments. The paper examines the importance of research and discusses practical issues that impinge or frustrate clinical nursing staff who wish to conduct original research.

Meeting the health needs of people with learning disabilities: guidance for nursing staff

This guide has been produced to support registered nurses and nursing students in primary and secondary care, who are trained in branches other than learning disabilities, to deliver high quality health care to people with learning disabilities.

Student Experience of E-Learning (SEEL)

The Student Experience of E-Learning project (SEEL) was an institutional response to the university’s HEA/JISC Benchmarking exercise (Ryan and Kandler, 2007). The study had a social constructivist approach which recognised the importance of listening to the student voice (JISC 2007) within the University of Greenwich context, to interpret the student experience of e-learning. Nearly 1000 students responded to an online survey on their approaches to, and their use of, learning technology. The quantitative and qualitative questions used included identifying study patterns, using specific online tools, within the context of learning and beyond, and student’s attitudes towards using e-learning in their studies. Initially, individual responses to questions were analysed in depth, giving a general indication of the student experience. Further depth was applied through a filtering mechanism, beginning with a cross-slicing of individual student responses to produce cameos. Audio logs and individual interviews were drawn from these cameos. Analysis of the cameos is in progress but has already revealed some unexpected results. There was a mismatch between students’ expectations of the university’s use of technology and their experiences and awareness of its possible use in other contexts. Students recognised the importance of social interaction as a vehicle for learning (Vygotsky 1978, Bruner 2006) but expressed polarised views on the use of social networking sites such as Facebook for e-learning. Their experiences in commercial contexts led them to see the university VLE as unimaginative and the tutors’ use of it as lacking in vision. Whereas analysis of the individual questions provided a limited picture, the cameos gave a truer reflection of the students lived experiences and identified a gulf between the university’s provision and the students’ expectation of e-learning and their customary use of technology. However it is recognised that the very nature of an online survey necessarily excludes students who chose not to engage, either through lack of skills or through disillusionment and this would constitute a separate area for study.

Self-regulated learning and social media – a ‘natural’ alliance? Evidence on students’ self-regulation of learning, social media use and student-teacher relationship

Article is available at: http://www.tandfonline.com/doi/full/10.1080/17439884.2015.1064953.

An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: A quasi-experimental study

Background:
Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses’ views and perceptions has been largely ignored.

Aim:
To determine the change in intensive care nurses’ perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice.

Methods:
The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses’ perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units.

Results:
Response rates were 79% (n=140n=140) for Phase 1 and 62% (n=132n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02p=0.02).

Conclusion

We conclude that nurse-directed protocolised-weaning had no effect on nurses’ views and perceptions due to the high level of satisfaction which encouraged nurses’ participation in weaning throughout. Control group changes are attributed to a ‘reactive effect’ from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

Design-Build Experiences and Student Safety

Design-build experiences (DBEs) are an essential element of any programme based on the CDIO methodology. They enable students to develop practical hands-on skills, they enable the learning of theory by stealth and they provide a forum for developing professional skills such as team working and project management. The hands-on aspect of certain DBEs has significant risk associated with it, which must be addressed through the formal evaluation of risks and the development of a methodology for controlling them. This paper considers the aspects of design-build experiences that may impact on student safety. In particular, it examines the risk associated with each of the four stages of CDIO and gives examples of risks which may commonly apply across engineering disciplines. A system for assessing and controlling the risks in any particular DBE is presented and the paper finishes by discussing the significance of health and safety in the educational environment.

The impact of curricular change on medical students' knowledge of anatomy

Background: In recent years, following the publication of Tomorrow's Doctors, the undergraduate medical curriculum in most UK medical schools has undergone major revision. This has resulted in a significant reduction in the time allocated to the teaching of the basic medical sciences, including anatomy. However, it is not clear what impact these changes have had on medical students' knowledge of surface anatomy. Aim: This study aimed to assess the impact of these curricular changes on medical students' knowledge of surface anatomy. Setting: Medical student intakes for 1995-98 at the Queen's University of Belfast, UK. Methods: The students were invited to complete a simple examination paper testing their knowledge of surface anatomy. Results from the student intake of 1995, which undertook a traditional, 'old' curriculum, were compared with those from the student intakes of 1996-98, which undertook a new, 'systems-based' curriculum. To enhance linear response and enable the use of linear models for analysis, all data were adjusted using probit transformations of the proportion (percentage) of correct answers for each item and each year group. Results: The student intake of 1995 (old curriculum) were more likely to score higher than the students who undertook the new, systems-based curriculum. Conclusion: The introduction of the new, systems-based course has had a negative impact on medical students' knowledge of surface anatomy.