A snapshot of clinical educational experiences for advanced practice nurses worldwide.

Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.

Decision-making experiences of patients with end-stage kidney disease (ESKD) regarding treatment in Ghana: a qualitative study.

BACKGROUND: This is the first qualitative study to explore patient decision-making regarding end-stage kidney disease (ESKD) treatment in sub-Saharan Africa. The study addresses an important gap in the literature concerning choice and decision-making in an international context. METHODS: The study employed a qualitative research design, using grounded theory methodology. In-depth interviews were conducted with twenty-two adult patients with ESKD in 3 clinical settings in Ghana. Data analysis involved coding and a constant comparative approach to generate key themes. Ethical approval was gained from relevant ethics committees both in Ghana and the United Kingdom. RESULTS: Four main factors (personal, financial, healthcare system, and support network) were identified to influence patient decision-making regarding ESKD treatment in Ghana. Treatment was initiated for various reasons, including, initially, the urgent need to avoid premature death. Many approached their condition hoping for a cure and did not always understand the chronic nature of their condition. Financial and geographical inaccessibility of renal replacement therapy (RRT), as well as a relative lack of biomedical treatment choices, made decision making daunting for the individual with ESKD in Ghana. The subject of death or conservative management was not openly discussed. Rather patients did everything possible to seek alternative forms of treatment, including the simultaneous use of other non-RRT and traditional or faith-based healing approaches. CONCLUSIONS: Whilst similarities exist, this study illuminates stark cultural and contextual differences which make decision-making on ESKD treatment a daunting experience for the individual with ESKD in Ghana - as compared to those in high-income countries. The challenges associated with ESKD management in Ghana calls for meticulous efforts at primary prevention of the disease, including interventions directed at effective management of diabetes mellitus, hypertension and other chronic kidney disease (CKD) precursor conditions. Enhancing information provision would promote informed decision making, particularly within the initial stages of patient decision-making.

EXPLORING DEPRESSION AMONGST KIDNEY TRANSPLANT RECIPIENTS: A LITERATURE REVIEW.

BACKGROUND: Despite the benefits of receiving a donor kidney, there is evidence of persistent depression amongst the transplant population. Healthcare professionals should endeavour to put in place strategies for the prevention, identification and management of depression. OBJECTIVES: To critically examine recent research concerning the prevalence, detection and impact of depression amongst kidney transplant recipients, leading to recommendations for practice improvement. DESIGN: The 'matrix method' was used to identify and review relevant literature. An online search was performed using three electronic databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE® and Web of Science. The search limits were that the papers reported the findings of primary research studies, published in English in a peer-reviewed journal; involved adult participants and were published between 2000 and 2015. Following critical appraisal of the included studies, a review matrix was produced that identified four emerging themes. RESULTS: The review confirmed that kidney transplant recipients experience less depression than those who receive other renal replacement therapies. However, depressive illness is still more common amongst kidney transplant recipients than the general population. There are many risk factors for depression and there is evidence of an association between depression and mortality in the transplant population. Routine screening for depression is highly recommended yet rarely seen in practice. CONCLUSION: Increasing awareness and educating healthcare professionals about depression amongst kidney transplant recipients is essential to allow for earlier identification and treatment. Screening could provide earlier detection of depression and allow for higher social and psychological support for these patients. Further intervention studies and longitudinal assessments would enhance the understanding of the development and effective management of depressive symptoms.

Advanced level nursing in England: organisational challenges and opportunities.

AIM: To explore the background, activities and future development needs of advanced practice nurses within a large NHS Trust in England, allowing for a wider review of the current situation within the UK. BACKGROUND: There are currently no national requirements for advanced practice nursing within the UK, which has led to considerable variability in these roles. Recently, focus has been placed on local governance rather than regulation of advanced practice nursing. However, governance and coordinated workforce planning within the UK is in its infancy. METHODS: An electronic survey was sent to all nurses within one Trust identified as practising at an advanced level; a total of 136 responses were received. RESULTS: The survey identified considerable variation in titles, educational preparation and current activities even within similar roles. Some participants identified the need for more support in undertaking professional development activities. CONCLUSIONS: The findings echo the wider picture within the UK, and point to the need to actively work on developing strategies for governance, education, and succession planning for advanced practice nursing. IMPLICATIONS FOR NURSING MANAGEMENT: In the absence of national regulation, UK NHS Trusts should develop their own registers of advanced practice nurses in order to facilitate improved management, governance and workforce planning systems.

Exploring the potential for advanced nursing practice role development in Kenya: a qualitative study.

BACKGROUND: Definitions of advanced nursing practice abound, yet little has been published concerning the context for advanced nursing in sub-Saharan Africa. This study set out to explore the existence of, and potential for, advanced nursing practice in Kenya. METHODS: Ten nurses were invited to participate in semi-structured qualitative interviews. Participants were purposively selected to provide insight into the practice of experienced nurses in urban, rural, community, hospital, public and private health care settings. Interview narratives were recorded, transcribed and subsequently analysed using a thematic approach. RESULTS: All participants reported that they were engaged in the delivery of expert, evidence-based care. The majority also undertook administrative activities, teaching in the practice area and policy and practice advocacy. However, only the two private practice nurses interviewed during the study were working with the level of autonomy that might be expected of advanced nurse practitioners. CONCLUSIONS: While participants were undertaking many of the activities associated with advanced nursing roles, advanced nursing practice as widely understood in the (largely western derived) international literature was not identified. The nurses practicing with the greatest autonomy were generally those with the lowest educational qualifications rather than the highest. Highly qualified nurses and midwives tend to move into management and education, and see little opportunity for advancement while remaining in clinical practice. It is notable that, although a growing number of universities offer master's level education, no African countries have yet regulated an advanced level of practice. The existence of the physician substitute 'clinical officer' cadre in Kenya, as in other Sub-Saharan African countries, suggests that the development of the advanced nurse practitioner role is unlikely at present. However, there is a pressing need for advanced nurses and midwives who can implement evidence-based practice and exercise clinical leadership in the drive to attain the Millennium Development Goals and their post-2015 successors.

Thinking outside the black box: the importance of context in understanding the impact of a preoperative education nursing intervention among Chinese cardiac patients.

OBJECTIVE: In a randomized controlled trial of a preoperative education intervention conducted for Chinese cardiac patients, we observed a greater effect on symptoms of anxiety and depression than that reported with regard to similar interventions in western care settings. The objective of this qualitative study was to help explain the findings of the trial by exploring Chinese patients' experience of seeking and receiving information before cardiac surgery. METHODS: Semi-structured interviews were conducted with a purposive sample of 20 trial participants before discharge (ten from the preoperative education group; ten from the usual care control group). Data were analyzed using a thematic analysis approach. RESULTS: A total of five themes were generated: the role of reputation and hierarchy; gaining strength from knowledge; information as a low priority; being kept in the dark; and learning through peer support. CONCLUSION: In health care systems where service users are given relatively little information, interventions designed to inform patients about their treatment are likely to have a much greater impact on their psychological health. PRACTICE IMPLICATIONS: Providers of services for patients undergoing cardiac surgery in China should be encouraged to incorporate information giving into routine practice, tailored according to individual need.

The 'sustainability lens': a framework for nurse education that is 'fit for the future'.

In this paper we describe and justify a framework for curriculum development that uses the concept of a sustainability lens. This is based on an understanding that we construct our social worlds and create a reality based upon what Gadamer (1977) called 'prejudices'. The social world of nurse education has its own prejudices, referred to by Scrimshaw (1983) as 'ideologies'. These form often taken for granted assumptions and values about what education is. The framework bases itself on how sustainability conceptualises health, and 4 approaches to health care delivery, along two continua of individual-society and illness-wellbeing. Further, we argue that in response to a wider education for sustainability agenda, nurse educators could develop their own sustainability lens and bring it to bear on this framework to interpret professional standards in a new way.

Addressing Issues Impacting Advanced Nursing Practice Worldwide.

Advanced practice nursing roles are developing globally, and opportunities for advanced practice nursing are expanding worldwide due to the need for expert nursing care at an advanced level of practice. Yet it is well recognized that barriers exist with respect to APRNs being able to practice to the full extent of their education and training. Addressing barriers to APRN practice worldwide and ensuring that APRNs are able to practice to the full extent of their education and training can help to promote optimal role fulfillment as well as assessment of the impact of the APRN role.

A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial.

BACKGROUND: Patients awaiting cardiac surgery typically experience significant physical and psychological stress. However, although there is evidence that preoperative education interventions can lead to positive postoperative outcomes for surgical patients in general, less is known about the effectiveness among patients undergoing cardiac surgery, especially Chinese cardiac patients. OBJECTIVES: To determine whether a preoperative education intervention designed for Chinese cardiac patients can reduce anxiety and improve recovery. DESIGN: Randomized controlled trial. SETTINGS: Cardiac surgical wards of two public hospitals in Luoyang, China. METHODS: 153 adult patients undergoing cardiac surgery were randomized into the trial, 77 to a usual care control group and 76 to preoperative education group comprising usual care plus an information leaflet and verbal advice. Measurement was conducted before randomization and at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by subscales of the Brief Pain Inventory-short form (BPI-sf), length of Intensive Care Unit stay and postoperative hospital stay. RESULTS: Of 153 participants randomized, 135 (88.2%) completed the trial. Participants who received preoperative education experienced a greater decrease in anxiety score (mean difference -3.6 points, 95% confidence interval -4.62 to -2.57; P<0.001) and a greater decrease in depression score (mean difference -2.1 points, 95% CI -3.19 to -0.92; P<0.001) compared with those who did not. There was no difference between groups in average pain, current pain, and interference in general activity, mood and walking ability. Patients randomized to the preoperative education group reported less interference from pain in sleeping (mean difference -0.9 points, 95% CI -1.63 to -0.16; P=0.02). There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among preoperative education patients (P=0.05) but no difference in length of postoperative hospital stay (P=0.17). CONCLUSIONS: This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients. Based upon existing evidence and international practice, preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery.

The impact of dialysis modality on quality of life: a systematic review.

BACKGROUND: This systematic review aims to generate evidence on which dialysis modality (in-centre haemodialysis HD, or peritoneal dialysis, PD) improves the quality of life (QOL) of end stage renal disease (ESRD) patients. METHODS: MEDLINE, CINAHL and EMBASE were searched from their inception to July 2010 for studies that compared QOL in both HD and PD patients. RESULTS: Only 26 of the 574 studies identified were included in this review. These were crosssectional, longitudinal or retrospective in design. QOL tools used include SF-36, Kidney Disease Quality of Life (KDQOL) and CHOICE Health Experience Questionnaire (CHEQ). PD patients mostly rate their QOL higher than HD patients. Yet HD patients may enjoy a relatively better QOL in the physical dimensions over time. Mental health components are comparable between both dialysis populations. CONCLUSION: There is no simple 'yes' or 'no' answer to the question of which dialysis modality improves QOL. However a good understanding of the evidence base will facilitate individual decision-making.

Uniforms, status and professional boundaries in hospital.

Despite their comparative neglect analytically, uniforms play a key role in the delineation of occupational boundaries and the formation of professional identity in healthcare. This paper analyses a change to the system of uniforms in one UK hospital, where management have required all professions (with the exception of doctors) to wear the same 'corporate' uniform. Focus groups were conducted with the professionals and patients. We analyse this initiative as a kind of McDonaldisation, seeking to create a new 'corporate' worker whose allegiance is principally to the organisation, rather than a profession. Our findings show how important uniforms are to their wearers, both in terms of the defence of professional boundaries and status, as well as the construction of professional identity.

Sleep disruption experienced by surgical patients in an acute hospital.

BACKGROUND: Sleep has a common structure and pattern and is thought to be a restorative process. Sleep deprivation and disruption can cause a myriad of physical and psychological changes, which can all have an impact on health care. As such, sleep is recognized as being beneficial to health and an important aspect of nursing care. METHOD: This study used an expansion component mixed-method design to describe the sleep experience of patients on surgical wards. This involved establishing the factors which disturb sleep and describing patients' experiences of sleep disruption. RESULTS: 17 of the 24 patients approached participated in the study, providing a 71% response rate. Environmental factors were found to be strongly correlated with sleep disruption with a Pearson's coefficient of +0.795. Personal factors were also found to be correlated with sleep disruption although, with a Pearson's coefficient of +0.590, not as strongly as environmental factors. DISCUSSION: This study found that environmental noise, pain and tension were most likely to disrupt the sleep of surgical patients. It has also established four recommendations to improve the sleep of hospital patients. LIMITATIONS: This study has some limitations that need to be considered: limited database access, a small sample size and a data collection tool which had not previously been tested for validity or reliability. CONCLUSION: This study produced some compelling findings. It is recommended, however, that these findings be tested by larger studies using simple random sampling and in-depth interviews.

The quality of social relationships as a public health issue: Exploring the relationship between health and community in a disadvantaged neighbourhood.

This paper explores the relationship between the health of residents and the quality of social relationships within a disadvantaged urban neighbourhood. The author draws on her experience both as a nurse and an elected district councillor to illuminate connections between crime, antisocial behaviour, health and well-being. It is argued that these connections are neglected in health literatures, to the detriment of the development of a theoretical basis for health related community development work.