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  • Post Mortem Computed Tomography: An innovative tool for teaching anatomy within pre-registration nursing curricula
    Post Mortem Computed Tomography: An innovative tool for teaching anatomy within pre-registration nursing curricula Rutty, Jane; Biggs, M.; Dowsett, Deborah; Kitchener, A.; Coltman, N.; Rutty, Guy Background There is significant change throughout the world regarding Post Mortem Computed Tomography (PMCT) as an adjunct or a replacement to the traditional invasive autopsy. Of interest, is the ability to demonstrate visually two and three dimensional normal soft tissue, organ and skeletal anatomy, as well as natural disease and trauma pathology. Objectives The objective was to compare formal traditional methods of teaching anatomy and pathology (pictures and diagrams) to pre-registration student nurses with supplementary PMCT 2/3D generated images, videos and printed anatomical models. The specific objective was to determine if these tools would increase the students’ perception of their understanding and learning experience of the subject area. Design A quasi-experimental within-subject design was chosen. Setting A School of Nursing and Midwifery within a Higher Education Institution in the UK. Participants Purposeful sampling of 57 voluntary informed consented pre-registration student nurses. Method Students were initially exposed to teaching of normal anatomy and common fractures using traditional methods. Data was then collected following the teaching session using a questionnaire entailing both quantitative and qualitative elements. The teaching session was then repeated with the same students but with the inclusion of PMCT of all the same normal anatomy and fractures. Data was then collected again using the same questionnaire. Both questionnaires were then compared. Results The quantitative findings proved highly significantly proved (P = < 0.01) that the inclusion of Post Mortem Computed Tomography when teaching normal anatomy and pathology increases preregistration nursing students’ perception of their understanding and learning experience. The qualitative results revealed three positive themes concerning visual learning, realism and patient empathy. Conclusion Including Post Mortem Computed Tomography imagery enables nurse academics to provide students with a virtual tour of the human body and a rich, authentic learning experience of a real individual who experienced a relevant clinical scenario that nurses are likely to encounter in their careers. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • Buttock lesions resulting from heavy BDSM (Bondage / Discipline / Sadism / Masochism) play in an 82 year old male.
    Buttock lesions resulting from heavy BDSM (Bondage / Discipline / Sadism / Masochism) play in an 82 year old male. Pinson, Stuart An 82 year old male who was participating in a research study investigating consensual corporal punishment (CCP) disclosed that he had identified two areas of skin on his buttocks that were slow to heal. These corresponded to areas that broke down and bled almost immediately during CCP. Whilst the vast majority of participants in CCP receive no more than minor bruising / erythema, a substantial minority play at a level which is likely to result in more significant skin damage. He explained that this was a relatively common phenomenon afflicting practitioners who play at a severe level. There are no references to these in the academic literature. Clinicians who may see these lesions should be aware of their aetiology in order to identify appropriate treatment and offer suitable health promotion to either prevent formation or reduce the risk of recurrence. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • The development of a clinical policy ethics assessment tool
    The development of a clinical policy ethics assessment tool Garcia-Capilla, D.J.; Rubio-Navarro, A.; Torralba-Madrid, M.J.; Rutty, Jane Introduction: Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals’ etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. Aim: The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and guidelines. Methodology: The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols’ ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. Ethical consideration: The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. Results: Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test–retest reliability coefficient ¼ 0.86, r ¼ 0.84, a1 ¼ 0.817, a2 ¼ 0.824 and interclass correlation coefficient ¼ 0.874. Discussion: Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses’ education, values and quality of care. Conclusion: Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • Valproate preparations for agitation in dementia (Review)
    Valproate preparations for agitation in dementia (Review) Clifton, Andrew; Narayanan, U.; Baillon, S.F.; Luxenburg, J.S. Background Agitation has been reported in up to 90% of people with dementia. Agitation in people with dementia worsens carer burden, increases the risk of injury, and adds to the need for institutionalisation. Valproate preparations have been used in an attempt to control agitation in dementia, but their safety and efficacy have been questioned. Objectives To determine the efficacy and adverse effects of valproate preparations used to treat agitation in people with dementia, including the impact on carers. Search methods We searched ALOIS - the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register on 7 December 2017 using the terms: valproic OR valproate OR divalproex. ALOIS contains records from all major health care databases (the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources. Selection criteria Randomised, placebo-controlled trials that assessed valproate preparations for agitation in people with dementia. Data collection and analysis Two review authors independently screened the retrieved studies against the inclusion criteria and extracted data and assessed methodological quality of the included studies. If necessary, we contacted trial authors to ask for additional data, including relevant subscales, or for other missing information. We pooled data in meta-analyses where possible. This is an update of a Cochrane Review last published in 2009. We found no new studies for inclusion. Main results The review included five studies with 430 participants. Studies varied in the preparations of valproate,mean doses (480 mg/day to 1000 mg/day), duration of treatment (three weeks to six weeks), and outcome measures used. The studies were generally well conducted although some methodological information was missing and one study was at high risk of attrition bias. The quality of evidence related to our primary efficacy outcome of agitation varied from moderate to very low. We found moderatequality evidence from two studies that measured behaviour with the total Brief Psychiatric Rating Scale (BPRS) score (range 0 to 108) Valproate preparations for agitation in dementia (Review) Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. and with the BPRS agitation factor (range 0 to 18). They found that there was probably little or no effect of valproate treatment over six weeks (total BPRS: mean difference (MD) 0.23, 95% confidence interval (CI) -2.14 to 2.59; 202 participants, 2 studies; BPRS agitation factor: MD -0.67, 95% CI -1.49 to 0.15; 202 participants, 2 studies). Very low-quality evidence from three studies which measured agitation with the Cohen-Mansfield Agitation Index (CMAI) were consistent with a lack of effect of valproate treatment on agitation. There was variable quality evidence on other behaviour outcomes reported in single studies of no difference between groups or a benefit for the placebo group. Three studies, which measured cognitive function using the Mini-Mental State Examination (MMSE), found little or no effect of valproate over six weeks, but we were uncertain about this result because the quality of the evidence was very low. Two studies that assessed functional ability using the Physical Self-Maintenance Scale (PSMS) (range 6 to 30) found that there was probably slightly worse function in the valproate-treated group, which was of uncertain clinical importance (MD 1.19, 95% CI 0.40 to 1.98; 203 participants, 2 studies; moderate-quality evidence). Analysis of adverse effects and serious adverse events (SAE) indicated a higher incidence in valproate-treated participants. A metaanalysis of three studies showed that there may have been a higher rate of adverse effects among valproate-treated participants than among controls (odds ratio (OR) 2.02, 95% CI 1.30 to 3.14; 381 participants, 3 studies, low-quality evidence). Pooled analysis of the number of SAE for the two studies that reported such data indicated that participants treated with valproate preparations were more likely to experience SAEs (OR 4.77, 95% CI 1.00 to 22.74; 228 participants, 2 studies), but the very low quality of the data made it difficult to draw any firm conclusions regarding SAEs. Individual adverse events that were more frequent in the valproate-treated group included sedation, gastrointestinal symptoms (nausea, vomiting, and diarrhoea), and urinary tract infections. Authors’ conclusions This updated review corroborates earlier findings that valproate preparations are probably ineffective in treating agitation in people with dementia, but are associated with a higher rate of adverse effects, and possibly of SAEs. On the basis of this evidence, valproate therapy cannot be recommended for management of agitation in dementia. Further research may not be justified, particularly in light of the increased risk of adverse effects in this often frail group of people. Research would be better focused on effective non-pharmacological interventions for this patient group, or, for those situations where medication may be needed, further investigation of how to use other medications as effectively and safely as possible. The file attached to this record is the Publisher's version.
  • Nurses' experiences of undertaking fertility-related discussions with Teenagers and Young Adults with cancer: an interpretive phenomenological analysis
    Nurses' experiences of undertaking fertility-related discussions with Teenagers and Young Adults with cancer: an interpretive phenomenological analysis Norton, Wendy; Wright, E.; Geary, Martyn Aims: To explore and interpret nurses’ experiences, feelings and associated meanings attached to undertaking fertility-related discussions with teenagers and young adults with cancer. To advance an understanding of factors which facilitate or hinder such discussions, in order to progress clinical practice. Background: Improved cancer treatments have increased survival rates for many teenagers and young adults. However, as a side-effect of treatment, infertility may result. International and UK studies suggest this patient population may not be provided with adequate opportunities to discuss this important issue. Little is known about nurses’ experiences of undertaking fertility-related discussions. Design: Qualitative Interpretive Phenomenological Analysis. Methods: Eleven semi-structured interviews were conducted between February-May 2016 with purposively selected nurses working in a Teenage Cancer Trust Unit within a UK hospital. Interviews were recorded and transcribed verbatim. Data were analysed using Interpretive Phenomenological Analysis. Findings: Nurses experienced a perceived lack of knowledge resulting in avoidance of raising fertility issues. Nurses expressed a specific need for more knowledge and education which was viewed as an essential pre-requisite to their participation in discussions. The limited time frame for female patients to preserve fertility prior to commencement of treatment was felt to inhibit both fertility-related discussion and fertility preservation. Conclusion: On-going education and support for nurses may ensure teenage and young adult cancer patients’ reproductive needs are met. Nurses need to consider ways to ensure female patients benefit from improved information regarding infertility risks and preservation options to support their reproductive needs. The file attached to this record is the author's final peer reviewed version.
  • The National Maternity and Perinatal Audit
    The National Maternity and Perinatal Audit Harris, Tina The National Maternity and Perinatal Audit (NMPA) is a national audit of the NHS maternity services across England, Scotland and Wales, commissioned in July 2016 by the Healthcare Quality Improvement Partnership (HQIP). The overarching aim of the NMPA is to produce high-quality information about NHS maternity and neonatal services which can be used by providers, commissioners and users of the services to benchmark against national standards and recommendations where these exist, and to identify good practice and areas for improvement in the care of women and babies. The first clinical report of the NMPA includes analysis of almost 700,000 births which took place between 1/4/15 and 31/3/16. During this presentation, midwives will be introduced to the NMPA and the first Clinical Report which will include the characteristics of women giving birth in Britain today, the audit findings relating to labour and birth, the variation identified and how midwives can use this information to consider improvements in care. The aim of the session is to inform and inspire midwives to use the audit findings to stimulate thought, ask challenging questions and to reflect on local regional and national findings to identify priority areas for improving the care of women and their babies
  • Mental health and well‐being in parents of excessively crying infants: Prospective evaluation of a support package
    Mental health and well‐being in parents of excessively crying infants: Prospective evaluation of a support package Powell, Charlotte; Bamber, Deborah; Long, Jaqui; Garratt, Rosemary; Brown, Jayne; Rudge, S; Morris, T.; Bhupendra Jaicim, N; Plachcinski, R.; Dyson, Sue; Boyle, E.; St James-Roberts, Ian Background: During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well‐being and mental health of parents who judge their infant to be crying excessively. The resulting “Surviving Crying” package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy‐based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use. Methods: Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty‐two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder‐7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards. Results: Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep. Conclusions: The findings suggest that the Surviving Crying package may be effective in supporting the well‐being and mental health of parents of excessively crying babies. Further, large‐scale controlled trials of the package in NHS settings are warranted. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • A sense of belonging: The importance of fostering student nurses affective bonds
    A sense of belonging: The importance of fostering student nurses affective bonds Dunbar, Helena; Carter, Bernie Fundamental to child health care is the next generation of professionals who will be providing services and supporting children and families. Nurses comprise the largest proportion of the professionally qualified workforce, therefore it is imperative that the training of children’s nurses is both effective and affective. Nursing students are not ‘traditional’ students in the sense of higher education as they are expected to learn and achieve in two different environments, academic and placement. While maintaining a pedagogy which meets academic standards nurse lecturers must also train nurses for practice and for working within a diverse profession. Furthermore, student nurses must adapt to and experience student life while grasping and understanding the realities of what it means to be a nurse. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link
  • Sexuality and the Older Woman
    Sexuality and the Older Woman Tremayne, P.; Norton, Wendy Sexual health is a key public health issue. The older woman faces a number of changes to their sexual health, wellbeing and sexuality. These changes result in many older women having to adapt to a series of complex transitions that can be challenging. This article aims to identify and explore some of these changes and how they can have a significant impact on women’s quality of life. Nurses play an important role in assessing and helping women to manage normal and pathological age changes in order to improve the sexual health of older women and ensure they receive the advice and support needed at this stage of their life. The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.
  • Building and sustaining work engagement – a participatory action intervention to increase work engagement in nursing staff
    Building and sustaining work engagement – a participatory action intervention to increase work engagement in nursing staff Knight, Caroline; Patterson, Malcolm; Dawson, Jeremy; Brown, Jayne This study evaluated whether a participatory action research intervention with nursing staff on acute care older people National Health Service wards in the United Kingdom was effective for increasing work engagement. Mediation analyses between job resources (social support, influence in decisionmaking), job demands, work-related needs (autonomy, competence, relatedness), and work engagement explored the presumed psychological mechanisms underlying the intervention. A non-randomized, matched control group, pretest, post-test design involved three intervention and five control wards. A significant decrease in relatedness, and a borderline significant decrease in competence, was observed in the intervention group compared to the control group, with no effect on work engagement (N = 45). Work-related needs mediated between resources and work engagement, supporting the job demands-resources model and self-determination theory as an underlying explanatory theory. Intervention implementation was difficult, highlighting the need for participant and organizational readiness for change, and strong management support. This is the first known study to apply participatory techniques to increase work engagement in nursing staff and explore the underlying explanatory psychological mechanisms, offering a novel means of taking work engagement research forward. Crucially, it highlights the challenges involved in intervention research and the importance of including evaluations of intervention implementation alongside statistical evaluations to avoid erroneous conclusions Work undertaken with the University of Sheffield Institute of Work Psychology; The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.

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