Management of pediatric skin-graft donor sites: a randomized controlled trial of three wound care products.

Skin grafts are used to treat many types of skin defects in children, including burns, traumatic wounds, and revision of scars. The objective of this prospective randomized controlled trial was to compare the effectiveness of three dressing types for pediatric donor sites: foam, hydrofiber, and calcium alginate. Children attending a pediatric Burns & Plastics Service from October 2010 to March 2013, who required a split-skin graft, were recruited to the trial. Patients were randomly assigned to the two experimental groups, foam or hydrofiber, and to the control group, calcium alginate. Data were gathered on the management of exudate, assessment of pain, time to healing, and infection. Fifty-seven children aged 1 to 16 years (mean = 4.9 years) were recruited to the trial. Fifty-six patients had evaluable data and one participant from the control group was lost to follow-up. Most children required skin grafting for a burn injury (78%). The median size of the donor site was 63.50 cm (8-600 cm). There was a statistically significant difference in time to healing across the three dressing groups (x [2, n = 56] = 6.59, P = .037). The calcium alginate group recorded a lower median value of days to healing (median = 7.5 days) compared to the other two groups, which recorded median values of 8 days (hydrofiber) and 9.5 days (foam). The greatest leakage of exudate, regardless of dressing type, occurred on day 2 after grafting. No statistically significant difference was found in leakage of exudate, pain scores, or infection rates across the three groups. Calcium alginate emerged as the optimum dressing for pediatric donor site healing in this trial.

Cultures of control: A historical analysis of the development of infection control nursing in Ireland.

Responses to the rise of antimicrobial resistance in Europe and North America included establishment of special hospital infection control teams of a microbiologist and a nurse. Based on the testimonies of seven infection control nurses in Irish hospitals appointed during 1979-1990, this article examines the early development and expressions of their disciplinary practice. Fairman's model of collaborative practice was used to examine the context in which the role emerged, the places practice was negotiated and mutually constructed, and exemplars of collaborative practice. Aspects of the relationship between theory and method in Wengraf's biographical narrative interpretive method (BNIM) used to generate the nurses' accounts of their early experiences in the role are highlighted. Practice was contingent on effective negotiation of places of practice, and disciplinary practice bore hallmarks of collaborative practice. The infection control nurse transitioned from conspicuous outsider and object of suspicion to valued resource for patients and staff. Infection control nursing came to be a prototype for new specialist nursing roles in hospitals.

The visibility of the discipline on the websites of academic nursing schools.

Critical discourse analysis was used to examine the visibility of nursing as a distinct discipline on the websites of academic nursing schools in Ireland. The analysis focused on the content of the schools' websites, including the available undergraduate curricular materials. The websites of a purposive sample of academic nursing schools in Canada, Scandinavia, and Australia were also analyzed for comparative purposes. The texts revealed that the disciplinary distinctiveness of nursing was only minimally represented on nearly all of the Irish nursing schools' websites. There was little evidence that nursing theory was informing the form and content of nursing programs. Instead, there was evidence of eclecticism in their form and content, with much reliance on imported knowledge from other disciplines. In contrast, nursing's disciplinary specialism was coherently and clearly articulated in website texts of the selected Canadian, Scandinavian, and Australian schools. Representations of nursing on official websites convey important messages to prospective students and to the public about the self-conceptualisation of nursing, including its knowledge forms and knowledge claims.

Boundary matters: clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care.

AIMS: To describe Irish nurses' views of clinical leadership and to describe their clinical leadership development needs. BACKGROUND: Nurses are often unclear about the precise nature of clinical leadership and its impact on the processes and outcomes of care and little is known about their self-perceived clinical leadership development needs. DESIGN: Seventeen focus group interviews were conducted with a purposive sample of 144 nurses from 13 practice settings. A conceptual lens was provided by the work of Bernstein and Young who emphasise the epistemological, practical and relational significance of boundaries and how they relate in fundamental ways to professionals' sense of their distinctive disciplinary identities and membership of specialised communities of practice. METHODS: Focus group data were collected using semi-structured topic guides. Analysis was facilitated by NVivo 7© and interpretation was informed by a conceptual framework arising from the interplay of emerging themes and the literature review. RESULTS: The implications for clinical leadership development of two critical concepts, 'representing nursing' and 'compensatory action', are discussed in detail. CONCLUSIONS: Clinical leadership development should emphasise the development of all nurses as clinical leaders in the context of the delineation, clarification and articulation of their distinctive contribution in multidisciplinary care settings. RELEVANCE TO CLINICAL PRACTICE: Clinical leaders are recognised as practice experts and as leaders in their particular fields. Recognition and influence in and beyond the immediate context of care depends greatly on their ability to articulate the distinct nursing contribution to patient care. This ability provides an essential resource to resist the ongoing blurring, effacement and dilution of nurses' roles.

Barriers to clinical leadership development: findings from a national survey.

AIMS AND OBJECTIVES: To describe self-reported barriers to clinical leadership development among nurses and midwives in Ireland. BACKGROUND: Effective clinical leadership is essential for optimising care and improving patient outcomes. Clinical leadership development is concerned with intrapersonal and interpersonal capabilities and is context bound. Barriers to clinical leadership development among nurses and midwives are associated with interdisciplinary and organisational factors, such as lack of influence in interdisciplinary care planning and policy. DESIGN: A national postal survey of nurses and midwives was administered to a simple random sample of 3000 nurses and midwives in Ireland. METHOD: The method of data collection was the Clinical Leadership Analysis of Need Questionnaire (CLAN-Q) Barriers Scale (CLAN-QBS), a self-administered, self-report questionnaire developed to measure the barriers to clinical leadership development. RESULTS: Mean scores for the CLAN-Q barriers subscales showed that barriers to clinical leadership development were perceived as lower in the dimension 'quality care factors', when compared with the dimensions 'interdisciplinary relationships, recognition and influence'. Staff and other promotional grades differed significantly in self-perceived barriers related to interdisciplinary working, influence and recognition of the disciplinary contribution. CONCLUSIONS: Differential experiences of barriers among higher and lower grades suggest that grade level may influence ability to negotiate work-related and organisational barriers to clinical leadership development. RELEVANCE TO CLINICAL PRACTICE: Overcoming the barriers to clinical leadership development requires attention to interdisciplinary relationships in the practicum and to the actual and perceived degree of relative influence that nurses and midwives have at wider departmental and organisational levels.

Nurses' and midwives' clinical leadership development needs: a mixed methods study.

AIM: This paper is a report of a descriptive study of nurses' and midwives' clinical leadership development needs. BACKGROUND: Nurses and midwives are expected to fulfil a leadership role at all levels, yet efforts to strategically support them are often unfocused. An analysis of clinical leadership development needs can provide the foundation for leadership initiatives to support staff. METHOD: A mixed methods design was used. A questionnaire was sent to 911 nurses and midwives and 22 focus groups comprising 184 participants were conducted. Data were collected between March and June 2009 across all promotional grades of nurses and midwives in Ireland. Repeated measures anova with Greenhouse-Geisser adjustment was used for post hoc pair wise comparisons of the subscale dimensions of clinical leadership. anova with Tukey's post hoc method was used for comparison between grades on each individual subscale. Thematic analysis was undertaken on the focus group data. RESULTS: Results reveal that needs related to development of the profession were the highest for all grades. The staff grade expressed a higher need in relation to 'managing clinical area', 'managing the patient care' and 'skills for clinical leadership' than managers. Qualitative analysis yielded five themes; (1) clinical leadership and leaders from a nursing and midwifery perspective; (2) quality service from a nursing and midwifery perspective; (3) clinical leaders' roles and functions; (4) capital and (5) competences for clinical leaders and leadership and the context of clinical leadership. CONCLUSION: Clinical leadership concerns quality, safety and effectiveness. Nurses and midwives are ideally placed to offer the clinical leadership that is required to ensure these patient care outcomes. Development initiatives must address the leader and leadership competencies to support staff.

The health of hospitals and lessons from history: public health and sanitary reform in the Dublin hospitals, 1858-1898.

AIMS AND OBJECTIVES: The aim was to examine, critically, 19th century hospital sanitary reform with reference to theories about infection and contagion. BACKGROUND: In the nineteenth century, measures to control epidemic diseases focused on providing clean water, removing waste and isolating infected cases. These measures were informed by the ideas of sanitary reformers like Chadwick and Nightingale, and hospitals were an important element of sanitary reform. DESIGN: Informed by the paradigmatic tradition of social history, the study design was a historical analysis of public health policy. METHOD: Using the methods of historical research, documentary primary sources, including official reports and selected hospital archives and related secondary sources, were consulted. RESULTS: Emerging theories about infection were informing official bodies like the Board of Superintendence of Dublin Hospitals in their efforts to improve hospital sanitation. The Board secured important reforms in hospital sanitation, including the provision of technically efficient sanitary infrastructure. CONCLUSIONS: Public health measures to control epidemic infections are only as effective as the state of knowledge of infection and contagion and the infrastructure to support sanitary measures. RELEVANCE TO CLINICAL PRACTICE: Today, public mistrust about the safety of hospitals is reminiscent of that of 150 years ago, although the reasons are different and relate to a fear of contracting antimicrobial-resistant infections. A powerful historical lesson from this study is that resistance to new ideas can delay progress and improved sanitary standards can allay public mistrust. In reforming hospital sanitation, policies and regulations were established--including an inspection body to monitor and enforce standards--the benefits of which provide lessons that resonate today. Such practices, especially effective independent inspection, could be adapted for present-day contexts and re-instigated where they do not exist. History has much to offer contemporary policy development and practice reform and is a relevant method for health professionals.