Reports 1999

With at least three decades of experience in developing roles that are still in their infancy in the UK, the aim of the study was to witness directly the ways in which advanced paediatric nursing practice has been interpreted and implemented in North America.

Extensive observation of Masters students, experience paediatric nurse practitioners and clinical nurse specialists in a variety of hospital and primary care settings provided insight into the realities of nurses who have expanded their skills.   The depth and breadth of nurses' skills and abilities were clearly demonstrated.

This report details the outcomes of an extended study tour to Sydney and Brisbane, Australia, in August and September 1999.

An explicit aim of the report was to examine, compare and contrast the range of skills required by mental health professionals to work with people who have serious and enduring mental illnesses.   The visit specifically focused upon the processes of "case management" and "keyworking" as a framework for assessing the skills required by professionals to co-ordinate the effective delivery of care in community settings.

The purpose of this study was to explore the factors which are influencing recruitment and retention of NHS Qualified Operating Theatre Staff.   Following a review of the literature, critical aspects of human resource management were identified which would be most likely to influence recruitment and retention of staff.

The data was analysed using two methods.   First, the responses were examined within the framework of critical factors, to isolate the most significant responses.   The second test applied was the CHI-Squared test of significance which identified where a statistically significant relationship existed between responses and the variables of age, gender and grade.

This study explored the views of 200 randomly selected midwives in the South Thames Region.   The methodology included focus group discussion and a postal survey using a semi-structured questionnaire.  

A response rate of 68% was obtained.  79.8% of respondents viewed risk management as a positive initiative, where improved quality of care and reduction in litigation were the main benefits.   Effective communication was identified by 88.8% of respondents as having a central role in the risk management process.   Protocols and incident report forms were described as useful tools to aid risk management programmes and risk management meetings were considered a productive forum for debate.   91.4% of participants felt risk management was relevant to all staff, and that all members of the multi-disciplinary team should be included.   A minority of respondents expressed feelings of anxiety and intimidation at being involved in risk management but this was a result of their personal experiences.

A benchmark audit was undertaken on the Scholar's ward to assess its standards, using the Crosby format.   A literature search was carried out using the university library, professional journals and the Internet. Observational visits to an acute stroke unit, a stroke rehabilitation unit and the community rehabilitation services in Newcastle upon Tyne were arranged.

The evidence showed that it was now understood that stroke patients required a multidisciplinary approach to augment outcome potential.   The Newcastle approach to stroke patients and rehabilitation appeared to be a significant advance in stroke treatment and recovery.

Within the UK effective leadership is receiving attention as an important aspect in improving nursing care.   The purpose of this study tour was to examine clinical leadership in Australia and to see what lessons could be learned for the UK.   The study tour was based on the premise that if nursing practice is to be enhanced then investment must be made in preparing leaders in nursing.

Child and Adolescent Mental Health (CAMH) issues are currently being highlighted in the UK.   The prevalence of moderate to severe CAMH problems is estimated as 15-20%.   Disruptive behaviour problems and disorders constitute a significant burden of illness to society in human, social and fiscal terms.

The aim of this study was to develop a therapeutically and cost effective parenting programme which would be acceptable and accessible to a range of parents, particularly "socially excluded" parents (whom research indicates are less likely to access/utilise parenting programmes), to implement this programme in Newcastle upon Tyne, and ultimately to disseminate lessons learned to the UK.

Diabetes is a miserable life-long disease that impacts upon all areas of life.   The gold standard for glycaemic control, demonstrated by the DCCT, is aiming for an HbAIc of 7%.   The majority of young, type 1 patients in the UK do not reach this standard.

In Germany this standard is reached by a 5-day, in-patient, structured, intensive education programme, the aim of which is for patients to self-manage their diabetes by matching insulin doses to food and lifestyle.   This programme has been adopted by 80% of German primary and secondary care health providers.   In the Netherlands the aim is the same but achieved by structured, individual, out-patient methods.

The Scholar visited Australia to investigate the rigorous approach to preceptorship as developed and introduced in Newcastle, New South Wales.   The new graduate follows a structured programme which includes self-directed learning, learning contracts, reflective diary and performance appraisal co-ordinated by a named preceptor, assisted by a clinical educator.

The purpose of this Critical Theory Study was to explore nurses' thoughts and reasons behind practice in a Surgical High Dependency Unit, as it is in Critical Care environments that nurses most commonly adopt expanded roles into practice (Last et al, 1992;  Carver, 1998).   Moreover, it has been indicated that Critical Care Nurses desire autonomy and report greater job satisfaction when they exercise it (Bucknall and Thomas, 1996).

Data was collected through audio taped, unstructured interviews, with the aim of unravelling the underlying consciousness of nurses who perform expanded roles.

This is a prospective, descriptive study which has used a quantitative approach to establish parents' perceptions of school age children's health needs and what input they would like from the school nursing service to help them meet their children's health needs and respond to parents' concerns.

Unsafe cultural practice can be defined as any action which diminishes, demeans or disempowers the cultural identity and well-being of an individual.

The study of Florence Nightingale's life in contrast to her work has been curiously neglected in the UK.   This study tour provided the opportunity to visit some of the key players in this field in North America.   It was apparent that the study of Miss Nightingale is more advanced both in terms of the number of projects undertaken and the use made of those studies in post-graduate and undergraduate programmes.   The study tour allowed the Scholar to explore these factors to various depths with students of Miss Nightingale's work.  

The focus of the study tour to several units in Australia and New Zealand was to investigate what had influenced the way nurses got research into practice.   The key areas examined were the strategic policy influences, the activity within leading academic units and the response in the practice areas.

This report gives a descriptive account of a three-week study tour to Stockholm, Sweden, in an attempt to seek an understanding of some of the issues facing nurse-led primary care services.

Three services have been the focus of this report, each detailing a different element of main nurse-led primary care services in Sweden.

In addition to service provision, visits to two nurses with responsibility for the monitoring and supervision of practice are included.

When a diagnosis of cancer is offered to a member of a family network then the whole family and not just the individual themselves may be thrown into a state of disequilibrium.   Family dynamics such as communication, problem solving, role reallocation, affective involvement and social support may be affected.   For the children in the family the illness and death of a family member can have long-term effects that may resonate throughout a lifetime and create difficulties in adulthood.   With correct assessment and intervention families can be helped towards a better understanding of each other's perspective and increased family harmony.

Within the domain of professional nursing education and practice there is increasing interest in the phenomena of the concept of reflection.   This work is a qualitative study of ten district nurses, the aim being to evaluate their use of reflection-on-practice in their everyday work.

This study considers the implications of continence training for healthcare practice.   It is based on the belief, supported by the literature, that there is an educational gap between taught practice and clinical practice.   Previous studies have shown continence education to be cost effective and that investment in techniques to promote continence can reduce dependence on containment products.

This study investigated the services on offer to drug users in two cities known for their drug related activities.  

A case study approach was utilised and three methods were identified as strategies useful in improving the health of these vulnerable groups.   The first is improving health through outreach work, the second is linking health care treatments to replacement drug therapy and the third is through the provision of a safe haven or social care.  

The Scholar lived with families in Mumbai (Bombay) and Ahmedabad and visited hospitals, GP surgeries, community groups and mothers' homes.   During this time she gathered qualitative information on religious ceremonies, child-rearing patterns, infant feeding, kin relations and family life.   Time was also spent with the national breastfeeding promotion group.

This report takes an historical perspective on the therapeutic use of horticulture in mental health services.   It brings together archive material from museums and local archives linked to some of the Victorian and Edwardian institutions across Britain and links them with current initiatives in horticultural work for people with mental health problems.

There would appear to be an impending world shortage of professional nurses.   In the United Kingdom recruitment and retention of nurses has become a major factor in the delivery of quality health care and safe practice in both the NHS and the Independent Sector.   This study combined the opportunity to explore the relevant contributory factors with a sabbatical study tour of Australia.

The study explores and develops the philosophy of "Partial Hospitalisation", meaning a total care package, alternative to traditionally based in-patient mental health service, delivered only part of the time in a mental health unit.   The study specifically describes and evaluates how clients with severe and enduring mental illness are managed within this philosophy in the USA and Eire.

The fieldwork for this dissertation took place within a toy library for children with special needs.   The idea of a toy library was conceived in 1967 by a parent who had a special needs child in order to provide a variety of quality toys.   From this beginning there has grown the National Association of Toy and Leisure libraries with over 1,000 individual libraries catering for the needs of a range of children, from special needs to inner city areas.

In recent years government policy and professional nursing organisations have called upon Mental Health Nurses (MHNs) to meet the needs of clients by adopting an increasing number of medication management roles.   It has been recommended that MHNs implement systematic assessment of the side effects of medication, improve the information given to clients and carers, promote choice and informed consent and improve communication and collaboration with prescribers.

The focus of the study tour to the USA was to gain experience of case management approaches and assertive outreach strategies within a team caring for a group of clients who have severe and enduring mental illness.   It has been recognised (Burns 1997, Huxley 1993) that these kinds of service should not be developed in isolation but that a full spectrum of support and facilities should be available to maximise the potential benefits of assertive outreach and case management approaches.