Biomedical subjects

Alison Twycross

Publications and source records attributed to Alison Twycross.

At least 19 recordsLinked to original sources

PubMed2006

What is the impact of theoretical knowledge on children's nurses' post-operative pain management practices? An exploratory study.

Despite the availability of the evidence to guide pain management practices, practices are often sub-optimal with children experiencing moderate to severe pain post-operatively. Limited theoretical knowledge about managing pain has been suggested as one reason for this. Several studies have identified gaps in nurses' theoretical knowledge. However, the affect of theoretical knowledge on pain management practices has not been explored. This explored whether there is a relationship between nurses' theoretical knowledge and the quality of their practices. Nurses (n=13) on one children's surgical ward were shadowed for a five-hour period during two-four shifts. Data about post-operative pain management practices were collected using a pain management checklist and field notes. Nurses (n=12) also completed the revised pain management knowledge test. Questionnaire scores were compared to the observational data. No positive relationship was found between nurses' level of theoretical knowledge and how well they actually managed pain. Nurses did not appear to routinely apply theoretical knowledge in practice. This may explain, at least in part, why pain management practices remain poor despite the evidence to guide practice being readily available. The hypothesis, put forward in other studies, that increasing nurses' theoretical knowledge about pain will improve practices may be overly simplistic.

Adult↗

PubMed2006

Children's nurses' post-operative pain management practices: an observational study.

BACKGROUND: Children continue to experience unrelieved moderate to severe pain post-operatively despite the evidence to guide practice being readily available. Previous studies have relied on self-report measures; there is a need to establish exactly how nurses manage children's pain in practice. OBJECTIVES: To ascertain how nurses actually manage post-operative pain in children and whether pain management practices adhere to current best practice guidelines. DESIGN: An observational study was carried out. Structured and unstructured data were collected. SETTING: A children's surgical ward in the English Midlands caring for children from birth to 16 years. PARTICIPANTS: Registered nurses (n=13) took part in the study. METHODS: Each participant was observed continuously for a period of 5 hours per shift for two to four shifts each. The role of the observer as participant was adopted whereby the researcher could shadow the nurse and act primarily as an observer. Data were collected for 36 shifts (185 hours). RESULTS: While nurses administered analgesic drugs when a child complained of pain, in most other areas practices did not conform to current recommendations and are in need of improvement. Nurses did not, for example, routinely assess a child's pain, nor use non-drug methods of pain relief on a regular basis. CONCLUSIONS: The sub-optimal pain management practices may be attributable to several factors. The professional culture of nursing and/or ward culture may result in poor pain management practices being perpetuated. Nurses may not have the requisite theoretical knowledge to manage pain effectively. A lack of priority may also be attributed to pain management. These areas need exploring further.

Adolescent↗

PubMed2006

Negotiation of parental roles within family-centred care: a review of the research.

AIMS AND OBJECTIVES: To review research published in the past 15 years about how children's nurses' negotiate with parents in relation to family-centred care. BACKGROUND: Family-centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision-making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents. CONCLUSIONS: Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses' lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context. RELEVANCE TO CLINICAL PRACTICE: For family-centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision-making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.

Attitude of Health Personnel↗

PubMed2006

How do children's nurses make clinical decisions? Two preliminary studies.

AIMS AND OBJECTIVES: To gain an understanding of how children's nurses make clinical decisions. BACKGROUND: Several studies have explored how nurses make clinical decisions and the factors that may affect the decision-making strategies used. However, the results of these studies are contradictory. Further, little is known about children's nurses' decision-making strategies. DESIGN: The think aloud technique. METHODS: Nurses (n = 12) from three surgical wards and nurses (n = 15) from three medical wards in a Scottish children's hospital were presented with clinical scenarios and asked to think aloud. The verbal protocols were analysed to provide an indication of how children's nurses made decisions. Whether there were any differences in decision-making between experienced and less experienced nurses and between graduates and non-graduates was also explored. RESULTS: Analysis of verbal protocols obtained using the think aloud technique suggested that all the nurses in the sample used a hypothetico-deductive (analytical) model of decision-making. Further, all participants appeared to use backward reasoning strategies regardless of their level of expertise. This is a characteristic of non-expert decision-making. Experienced and less experienced nurses collected similar additional information before planning nursing interventions, supporting the conjecture that they were functioning at a non-expert level in relation to decision-making. No differences were seen in the information collected by graduate and non-graduate nurses. CONCLUSIONS: The decision-making strategies of children's nurses need exploring further and further research is needed to identify factors that may affect decision-making strategies. Several strategies to support nurses' clinical decision-making have been proposed but need testing to ascertain their effectiveness. RELEVANCE TO CLINICAL PRACTICE: In clinical practice nurses make numerous decisions throughout the course of a shift. Sub-optimal decision-making strategies may adversely affect the quality of nursing care provided. It is imperative, therefore, to ascertain how nurses make clinical decisions and the factors that may influence the decision-making strategies used.

Adult↗

PubMed2006

Negotiation of care by children's nurses: lessons from research.

Parental participation and role negotiation are central elements in family-centred care, but research suggests that such negotiation tends to be ad hoc, depending on the relationships developing between the family and health professionals. Lack of effective communication, professional expectations and issues of power and control often prevent open and mutual negotiation between families and health professionals, especially nurses. This article summarises key lessons from a critical review of relevant research literature (Corlett and Twycross 2006) which suggests that nursing staff often control parental participation leaving parents feeling disempowered and deskilled. Poor communication and lack of information sharing exacerbate the situation. Where parents do not comply with nurses' expectations conflict can arise, resulting in more anxiety for already stressed parents. Current health policy requires that health workers listen to children and their families, to actively involve them in the decision-making process and to plan care around their needs and wishes. Nurses need to be aware of the way they interact with parents and the control they may unwittingly exert. A greater emphasis on communication, interpersonal and negotiation skills within nurse education is also needed.

Child↗

PubMed2005