Biomedical subjects

Sue Jordan

Publications and source records attributed to Sue Jordan.

At least 19 recordsLinked to original sources

PubMed2006

Percutaneous endoscopic gastrostomies: the burden of treatment from a patient perspective.

AIM: This paper reports a study of patients' experiences of this relatively new technology, and explores possible strategies for defining, delineating and addressing patients' concerns, problems and needs. BACKGROUND: The number of patients in the community relying on percutaneous endoscopic gastrostomy for their nutritional needs is increasing, but percutaneous endoscopic gastrostomy feeding is not problem-free. However, few studies report on its impact from a patient perspective. METHODS: Twenty adults with long-term percutaneous endoscopic gastrostomies were interviewed in their own homes, using both semi-structured and structured approaches. Qualitative data were analysed thematically and related to a symptom checklist and an established quality of life measure, the Short Form-12. FINDINGS: Most participants felt that insertion of a percutaneous endoscopic gastrostomy had been life-saving, but found that percutaneous endoscopic gastrostomy feeding came to dominate their lives and was associated with an appreciable "burden of treatment". Some, but not all, of the problems recounted were unavoidable: percutaneous endoscopic gastrostomy feeding inevitably imposed physical restrictions on mobility; 17/20 participants had experienced serious technical problems with their percutaneous endoscopic gastrostomy tubes. On structured questioning, all interviewees had some, potentially treatable, gastrointestinal symptoms, and eight had continuous problems. In some cases, the burden of treatment was exaggerated by being unanticipated and, for 13 patients, difficulties with care provided by non-specialist services. Describing this "burden of treatment" for each patient required both a narrative and a structured approach: without the symptom checklists, some important and treatable problems were missed. Both physical and mental health Short Form-12 scores were low, and mental health scores were congruent with the interview data. CONCLUSIONS: It might be possible to reduce the "burden of treatment" identified by incorporating a structured approach to patient monitoring and by reviewing the occupational territories of specialist and non-specialist practitioners. Further research with larger numbers of participants is needed to explore the integration of narrative and quantitative data when determining patients' clinical needs.

Adult↗

PubMed2005

The biological sciences in nursing: a developing country perspective.

AIM: This paper reports a study to inform curriculum development by exploring the contribution of bioscience education programmes to nurses' clinical practice, their understanding of the rationale for practice, and their perceptions of their continuing professional development needs. BACKGROUND: The future of the health services worldwide depends on nurse education programmes equipping practitioners to deliver safe and effective patient care. In the developed world, the structure and indicative content of nursing curricula have been debated extensively. However, despite the rapid expansion in nursing roles brought about by social change, there is little information on the educational needs of nurses in developing countries. METHODS: This study was undertaken in government teaching hospitals in Cape Town, South Africa in 2003. A purposive sample of 54 nurses from a range of clinical settings completed questionnaires and described critical incidents where bioscience knowledge had directed practice. Questionnaires were analysed descriptively, in the main. Analysis of critical incident reports was based on Akinsanya's bionursing model. FINDINGS: Most nurses felt that their understanding of the biological, but not the physical sciences, was adequate or better: all felt confident with their knowledge of anatomy, compared with 57.4% (31/54) for microbiology. Respondents attributed the successes and failures of their education programmes to their teachers' delivery of content, ability to relate to practice and management of the process of learning. The biological, but not the physical, sciences were universally (96-100%) regarded as relevant to nursing. However, the critical incidents and nurses' own reports indicated a need for further education in pharmacology (40/54, 74.1%) and microbiology (29/54, 53.7%). CONCLUSION: To meet the needs of nurses in developing countries, and empower them to meet the increasingly complex demands of their expanding roles, nurse educators need to consider increasing the curriculum content in certain key areas, including pharmacology and microbiology.

Adult↗

PubMed2005

The impact of intrapartum analgesia on infant feeding.

OBJECTIVE: To investigate the impact of intrapartum analgesia on infant feeding at hospital discharge. DESIGN: Retrospective cohort. SETTING: Maternity unit of a UK district general hospital. POPULATION: A random sample of 425 healthy primiparae delivering healthy singleton babies at term in 2000. METHODS: A random sample of primiparae delivering term neonates was identified from the birth register. We retrieved and analysed the corresponding joint midwifery/obstetric case notes. MAIN OUTCOME MEASURE: Infant feeding method at discharge from hospital. RESULTS: Women [190/424 (45%)] were exclusively bottle feeding their babies at discharge from hospital. No one commenced breastfeeding after hospital discharge. Regression analysis revealed that the main determinants of bottle feeding were as follows: maternal age [odds ratio (OR) 0.90, 95% confidence interval [CI] 0.85-0.95 per year]; occupation (OR 0.63, 95% CI 0.40-0.99 for each category, unemployed, manual, non-manual); antenatal feeding intentions (OR 0.12, 95% CI 0.080-0.19 for each category, bottle feeding, undecided, breastfeeding); caesarean section (OR 0.25, 95% CI 0.13-0.47, caesarean or vaginal delivery); and dose of fentanyl administered intrapartum (OR 1.004, 95% CI 1.000-1.008, 90% CI 1.001-1.007 for each microgram administered, range 8-500 mug). CONCLUSIONS: A dose-response relationship between fentanyl and artificial feeding has not been reported elsewhere. When well-established determinants of infant feeding are accounted for, intrapartum fentanyl may impede establishment of breastfeeding, particularly at higher doses.

Analgesics, Opioid↗

PubMed2004

Uptake of guidelines to avoid and report exposure to blood and body fluids.

BACKGROUND: Mucocutaneous and percutaneous exposure to blood and body fluids (inoculation injury) are major risk factors for occupational acquisition of bloodborne infection in health care professionals. Compliance with prescribed 'universal precautions' during exposure-prone procedures has been shown to reduce the risk of acquiring bloodborne viral infection. In addition, reporting such exposures facilitates prophylaxis. AIM: The aim of this paper is to report a study to identify strategies to minimize professionals' risks of acquiring bloodborne infections during exposure-prone procedures. METHOD: All surgeons, theatre nurses who scrub for surgery and midwives employed in general operating theatres and delivery suites within one UK National Health Service trust (n = 276) were surveyed by postal questionnaire. Data were analysed using univariate and bivariate techniques in SPSS version 10. Content analysis was undertaken on the one open-ended question. FINDINGS: The response rate was 72.5% (200/276). Only 1.5% (3/200) of respondents adopted universal precautions for all patients irrespective of whether their bloodborne viral status was known. On average, only half the recommended theatre-specific precautions were always adopted (mean 3.725/7, SD = 1.385). Most respondents (63.3%) admitted making judgements related to nationality, lifestyle or sexual orientation when making decisions about protective clothing. Many respondents (74%, 145/196) reported sustaining an inoculation injury in the 10 years prior to the study. However, under-reporting of injuries was common, and 32.4% (47/145) admitted failing to report injuries. Guideline adherence was influenced by profession, but not by time since qualification. CONCLUSIONS: The findings suggest that strategies must be developed to improve compliance with universal precautions and reporting guidelines by all health care professionals. The extent of, and reasons for, non-compliance with both local and national guidelines remain relatively unexplored.

Attitude of Health Personnel↗

PubMed2003

Introducing a nutrition screening tool: an exploratory study in a district general hospital.

BACKGROUND: Concerns have been raised that patients' nutrition is a neglected aspect of care. Accordingly, 'nutrition screening tools' have been devised to ensure that all patients are assessed by nurses and, where appropriate, referred to dieticians. The tool adopted in our hospital was the 'Nursing Nutritional Screening Tool'. AIM: To investigate the impact of this screening tool on: nutrition-related nursing documentation; patient care at mealtimes; dietician referral. METHODS: This study was conducted on two similar general medical wards in a United Kingdom (UK) district general hospital, with the help of staff and patients (n = 175) admitted during two study periods, May 1999 and January 2000. Data were collected over 28 days before and after introduction of the screening tool on one of the wards. For both wards, in each stage of the study, data were collected b: review of patients' notes, non-participant observations of mealtimes. Frequencies of dietician referral and documentation of weight were compared by cross-tabulations and chi2 tests. Nine months later, the findings were discussed with ward sisters in a group interview. FINDINGS: Introduction of the screening tool impacted on the process but not the outcomes of screening. Use of the screening tool increased the frequency of nutrition-related documentation: the proportion of patients with weights recorded increased on the intervention ward (P < 0.001), and decreased on the comparator ward. Frequency of dietician referral decreased on both wards, but differences were statistically insignificant. There was no observable change in patient care at mealtimes. The nurses in charge of the wards felt that introduction of the screening tool had raised awareness of nutrition-related care. CONCLUSIONS: Meeting patients' nutritional needs is a complex aspect of care which may benefit from introduction of structured guidelines. However, the potential of screening tools to improve care is limited by diverse factors, which warrant further exploration.

Adolescent↗

PubMed2002

Minimizing side-effects: the clinical impact of nurse-administered 'side-effect' checklists.

BACKGROUND: For those with chronic illness, the adverse effects of medication are important causes of morbidity and distress which may not always receive due attention. Guidelines and checklists may be one strategy to focus professionals' attention on long-term problems. Therefore, client-centred 'side-effect' evaluation checklists were developed to be administered and actioned by nurses. AIM: The purpose of this study was to explore the clinical impact of these checklists on long-term users of antipsychotic medication. METHODS: This study was undertaken with clients with enduring mental illness, in Community Mental Health Teams. In the first phase, 40 nurse-client interactions were observed. Following introduction of the evaluation checklists, 20 nurse-client interactions were observed with the checklists and 20 nurse-client interactions were observed for comparison. In addition, the views of professionals, service users and user groups on the value of the checklists were sought. FINDINGS: Amongst the 20 clients in the intervention group, the checklists highlighted several problems, two of which were urgent. In the intervention group, the mean number of problems actioned per client increased from 0.35 (range=0-4) with no checklists to 3 (range=0-6) with the checklists. The majority (51 of 59) of actions taken to alleviate adverse effects of medication concerned physical health problems. Nurses offered appropriate advice or encouraged clients to contact the relevant agencies. No such changes were observed in the comparator group. There were no differences between groups in the number of referrals to prescribers. IMPLICATIONS: The usefulness of the evaluation checklists for detecting unattended problems, in conjunction with the responses of service users, suggests that it may be clinically effective to establish procedures to systematically monitor people with serious mental illness for adverse drug reactions (ADRs). However, larger studies are needed to confirm this.

Adult↗

PubMed2002

Managing adverse drug reactions: an orphan task.

BACKGROUND: Nurse prescribing initiatives have potential to impact on medication management for long-term conditions. Over time, the adverse effects of medications become increasingly onerous. This 'side-effect burden' is particularly heavy for users of antipsychotic medication. Although consensus exists that strategies are needed to alleviate these problems, currently, they are not clearly the responsibility of any one professional group. AIM: This paper explores the introduction of nurse-administered evaluation checklists, in relation to nurse prescribing initiatives and division of professional responsibilities for medication management. METHODS: This was an observation study, with a quasi-experimental comparator group design, undertaken with clients receiving long-term antipsychotic medication. In both intervention and comparator groups, before and after introduction of evaluation checklists in the intervention group, 20 nurse-client interactions were observed. Problems actioned by the nurses, with and without the checklists, were compared. Stakeholders' views were sought concurrently. FINDINGS: Implementation of evaluation checklists increased the numbers of adverse effects detected and actioned by nurses. They also served to apportion aspects of medication management between nurses and medical prescribers. Most actions taken by nurses to alleviate adverse effects concerned clients' physical health and advice on health-promotion. However, the nurses' interventions would have been more effective had they been able to supply clients with certain medicines either by prescribing from the Nurse Prescribers' Formulary or issuing under Patient Group Directions. For some clients, ameliorating the adverse effects of medication would have involved changes to prescribed antipsychotic medication; here decisions were more equivocal. IMPLICATIONS: The identification of previously unattended problems, together with the views of service users, suggests that empowering nurses to address the 'care gaps' in medication management may benefit service users. The 'checklist evaluation' approach warrants further investigation, ideally in conjunction with nurse prescribing initiatives.

Adult↗

PubMed2002

The impact of part-time post-registration degrees on practice.

AIM: This study aimed to identify how graduates from part-time, post-registration degree courses in nursing and midwifery perceived that their practice had changed as a result of the knowledge and skills acquired on their courses. BACKGROUND: Despite increasing investment in continuing professional education and expansion of nursing roles, little work has been undertaken to assess the impact of graduates' skills on nursing care and clinical outcomes. METHOD: Postal questionnaires were used to survey all graduates of post-registration Bachelor's and Master's courses in nursing and midwifery from one institution in the United Kingdom (UK) (n=60). Respondents were asked to describe how they felt their graduate skills were used in practice and if this was influenced by any factors in the workplace. Data were analysed descriptively, and by content analysis. FINDINGS: Forty-three of 58 graduates contacted responded (74%). The majority (33/43, 77%) of respondents felt that their graduate skills were used in practice. Although most felt that their clinical practice had changed as a result of their degree studies, no practical examples of this were given, despite specific questioning. Many examples of academic and research skills acquired on the course were cited, which raises the question of whether the degree courses provided graduates with academic rather than clinical knowledge. There was ambivalence as to their perceptions of barriers in the workplace, which may have impeded the application of knowledge acquired on the courses. IMPLICATIONS: The clinical effectiveness of education initiatives depends on the learners, the course and the workplace. To maximize the benefits accruing to patients from continuing professional education and role expansion, further exploration of the contribution of higher education programmes to clinical practice is required.

Clinical Competence↗

PubMedDate not supplied

Corticosteroids: implications for nursing practice.

Corticosteroids are essential in the management of various inflammatory conditions, but their adverse effects can be a problem. The authors describe the uses and effects of corticosteroids, and discuss the nursing role in minimising problems associated with their use.

Administration, Inhalation↗

PubMedDate not supplied

Administration of medicines. Part 1: The law and nursing.

The authors outline the legal and professional consequences for nurses of failing to adhere to the law relating to the administration of medications. Part 2, next week, will look at the biological consequences for patients of non-adherence to drug administration schedules.

Drug Prescriptions↗

PubMedDate not supplied

Administration of medicines. Part 2: Pharmacology.

In the second part of this article, the authors examine the biological consequences for patients of changes in drug formulation, non-adherence to drug administration schedules and failure to accommodate drug/food interactions.

Drug Administration Schedule↗

PubMedDate not supplied

Nurse prescribing: developing the evaluation agenda.

Nurse prescribing raises complex issues, including erosion of the medical monopoly on control of medication management, compensation for physician shortage and the introduction of guideline-driven prescribing (Jordan and Hughes 1996, McCartney et al 1999). This article sets the recent UK developments in context and discusses the evaluation agenda.

Drug Prescriptions↗

PubMedDate not supplied