Bereaved UK military families: A mixed methods study on the provision of practical and emotional support.

Traumatic deaths of military personnel can have tragic consequences for the lives and health of bereaved significant others. To mitigate the effects, the UK Armed Forces enhanced the support for bereaved military families. However, little is known about whether the support has been satisfactory. The present research applied mixed methods to explore the experiences of bereaved UK military families (N = 264) with different types of support and how it historically changed over time. The findings suggest that although support has improved, further improvements are required in the provision of financial information, administrative support, and access to psychological support for all bereaved family members.

Development and Evaluation of the Validity and Reliability of the Leading and Managing Care Pre-Registration Nursing Student Assessment Tool.

BACKGROUND: Clinical nursing leadership influences patient safety and the quality of care provided. Nurses at all levels require leadership and management skills. Despite recognition of the importance of leadership, student nurses often feel ill prepared to make the transition to Registered Nurse and struggle with prioritisation and delegation. In order to standardise student experience and promote the development of skills and attributes, a leadership and management competency assessment was developed and implemented. AIMS: This study aimed to identify the constructs that should be part of an assessment of student nurse competence in relation to clinical nursing leadership, and to evaluate the tool's reliability. METHOD: The first phase was to construct the competency assessment tool, using a mixture of deductive methods, including literature and expert review. Second, psychometric evaluation of the tool, including tests to examine its internal consistency and reliability, comparing test and retest reliability, exploratory factor analysis and generalisability theory analysis to identify reliability and sources of error. RESULTS: Five attributes were identified for inclusion in the tool alongside a scale of competence. 150 assessments were conducted with an average time between each assessment of three days. The results show that the tool was consistent over time with no significant difference in the mean scores. The Cronbach alpha was 0.84 and the tool had good internal consistency. The results of the factor analysis revealed loading onto a single construct. Generalisability theory analysis revealed 0.90 global reliability, with students accounting for the majority of the variation in scores. CONCLUSIONS: The Leading and Managing Care assessment tool represents a valid and reliable assessment of student nurse competence to lead care delivery. Use of the tool during practice placement allows for a structured approach to the development of skills around prioritisation, management of resources, communication and the management of risk.

Developing an integrated approach to the assessment of student nurse competence using the Total Client Care (TCC) assessment tool.

The aim of this study was to evaluate the validity and reliability of an integrated assessment of competence using the Total Client Care (TCC) assessment tool within an undergraduate Nursing course. The Total Client Care Assessment Tool aims to assess multiple competencies in an integrated way thereby mirroring the way in which registered nurses are expected to practice. TCC is a tool designed to assess the student's ability to provide holistic care to a client over a specified period of time. TCC measures the student's performance around four constructs, these are: Communication, Planning and Responding, Care Delivery and Assessing and Evaluating. G-theory analysis revealed satisfactory levels of global reliability on single use G co-efficient 0.90 although this dropped to 0.76 when used on eight occasions to assess the same students over a two-year period. Analysis of variance revealed that students and assessment occasions accounted for most of the variance. The TCC assessment tool is useful as it provides data about the student's performance when providing actual care. When used as part of a wider system of assessment involving triangulation of evidence from a number of sources the tool can support mentor judgements about the achievement of competence.

Improving performance amongst nursing students through the discovery of discrepancies during simulation.

Discrepancy creation is a form of self-regulated learning which can be used to improve individual performance. Discrepancy can be created as a result of comparison against an occupational standard or when an individual strives to achieve higher personal goals. This study explores the process of discrepancy discovery and reduction following simulation sessions. Second year under-graduate nursing students undertook three simulation sessions over a one year period. After each session the participants completed a series of visual analogue scales to rate their own performance and the perceived performance of peers, final year student and a newly registered nurse. Once discrepancy had been identified, participants were asked to produce a short written action plan on how the discrepancy could be addressed and to work on this action plan between sessions. A total of 70 students completed discrepancy scores for all three scenarios. The most common areas of discrepancy were understanding physiology, understanding medicines and pharmacology, patient assessment and handover (hand off). Wilcoxon Signed Ranks suggested a statistically significant difference between student scores in all areas with the exception of team-work. All of the participants used peers as their comparator when identifying discrepancy. There was also a statistically significant difference in the scores following each simulation session suggesting improved performance.

Central venous catheter dressing durability: an evaluation.

BACKGROUND: Skin organisms at the insertion site are frequently implicated in central venous catheter blood stream infections (CVC BSIs) yet few studies have compared the durability of CVC dressings in critically ill patients. AIMS: To undertake an evaluation of the durability and associated costs of different CVC dressings. METHODS: Dressing duration was captured prospectively using a pro forma on four different dressings on five critical care units over a 12-month period. Staff received training on CVC dressing evidence-based practices and a 'how to guide' was implemented. FINDINGS: A total of 1229 CVC dressings were observed from 590 CVCs. One dressing had a median (IQR) duration of 68.5 h (range, 32-105 h) compared to a median duration of 43.5, 46.0 and 40.5 h for the other dressings (P <0.001). The mean time to change a CVC dressing was 13.5 min and the cost of a dressing change was in the range of £1.97-4.97. During the 12-month study period we observed a downward trend in CVC BSIs. DISCUSSION: Despite few dressings remaining adherent for 7 days, the low rates of CVC BSI observed suggests good dressing practices. CONCLUSIONS: One dressing appeared more durable than the others, although it was still below the recommended standard and more expensive.

Temporal and quantitative profiles of growth factors and metalloproteinases in acute wound fluid after mastectomy.

Seventy-three samples of acute wound fluid were collected from 47 patients during the first 3 postoperative days (POD) following mastectomy for cancer (n=47 on POD-1, n=19 on POD-2, and n=7 POD-3). Samples were analyzed by enzyme-linked immunosorbent assay for growth factor levels (epidermal [EGF], platelet-derived [PDGF], basic fibroblast [bFGF], transforming growth factor-beta1 [TGF-beta1], vascular endothelial [VEGF]), interleukin-6 (IL-6), matrix metalloproteinases (MMPs-2, -3, -9), and the tissue inhibitor of metalloproteinase 1 (TIMP-1). The levels of EGF, bFGF, PDGF, and interleukin-6 peaked on POD-1, with a significant decrease by POD-3, while total and active MMP-2, MMP-3, and tissue inhibitor of metalloproteinase 1 showed a progressive and significant increase from days 1 to 3. The wounds that later developed an infection (11%) were found to have a significantly lower PDGF and EGF on day 1 (PDGF, median 169 pg/mL [range, 86-2,595]) than the noninfected wounds (2,098 [17-66,506] p<0.05, Mann-Whitney U-test). Sixty-two percent patients developed a seroma and the levels of bFGF were significantly less in these patients (441 pg/mL [45-4,108]) than in those patients where there was no seroma (807 [245-3,133] p<0.05). The levels of certain growth factors in acute wound fluid may be important markers for wound outcomes.

Effects of perioperative hypothermia and warming in surgical practice.

Perioperative hypothermia is common and adversely affects clinical outcomes due to its effect on a range of homeostatic functions. Many of these adverse consequences are preventable by the use of warming techniques. A literature search was conducted to identify relevant published articles on perioperative hypothermia and warming. The databases searched include MEDLINE (1966 to February 2005), EMBASE (1974 to February 2005), CINAHL, the Cochrane library and the health technology assessment database. Reference lists of key articles were also searched. The primary beneficial effects of warming are mediated through increased blood flow and oxygen tension at tissue level. Reduction in wound infection, blood loss and perioperative pain with warming is promising. However, more evidence from good-quality prospective randomised controlled trials is needed to evaluate the role of warming in improving overall morbidity, mortality and hospital stay as well as to clarify its role as an adjunct to resuscitation and during the pre-hospital transport phase of critically ill patients. Awareness of the risks of perioperative hypothermia is the key to prevention. Achieving normothermia throughout the patient's journey is a worthwhile goal in surgical patients.

The evidence base in wound healing.

The evidence base for wound healing management is lacking. This article discusses the methods of assessing evidence base and makes the plea for more research.