Group-based PFMT programme for preventing and/or treating UI in pregnant women: protocol of a randomized controlled feasibility study.

BACKGROUND: Urinary incontinence (UI) is a prevalent health problem in women worldwide. Many women experience UI during pregnancy. The National Institute for Health and Care Excellence (NICE) recommended pelvic floor muscle training (PFMT) as the first-line conservative treatment for UI. However, it is not widely implemented due to the limited number of healthcare trainers. Group-based PFMT has been used with older women and a limited number of maternity studies. But the effectiveness of the group-based PFMT needs to be investigated because the overall quality of the studies is low. Therefore, this study aims to assess the feasibility of delivering a group-based PFMT programme for pregnant women in Nanjing city. METHODS: This feasibility study will be conducted in Nanjing Maternity and Child Health Care Hospital in China, using a mixed methods design to investigate the feasibility and acceptability of delivering group-based PFMT to pregnant women. Pregnant women with or without the symptoms of UI will be included. This study aims to recruit 48 pregnant women with 24 in each arm. Participants will receive either the group-based PFMT delivered by a midwife or usual antenatal care which includes only verbal instruction on PFMT. The study will assess the completion rates, acceptability of outcome measures, recruitment and retention rate and calculate an appropriate sample size for a future study. DISCUSSION: The results of this study will inform the design and implementation of a definitive randomized clinical trial to explore the effectiveness of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05242809.

The prevalence, associated factors, and impact of urinary incontinence in pregnant and postpartum women in Nanjing, China: A cross-sectional study.

Objective: Urinary incontinence (UI) is highly prevalent in antenatal and postnatal women while the prevalence of UI varied largely from 3.84% to 38.65%. This study was to assess the prevalence of UI, the associated factors, and the impact of UI on daily life in pregnant and postpartum women in Nanjing, China. Methods: The prevalence of UI and the impact of UI on life were assessed by the validated Chinese version of International Consultation on Incontinence Questionnaire-urinary incontinence-short form and the validated Chinese version of urinary incontinence quality of life. The associated factors were estimated by using logistic regression analysis. Results: UI affected 37.80% of pregnant women and 16.41% of postpartum women of the study population. Among the pregnant participants, the prevalence rates of stress UI, urge UI, and mixed UI were 25.77%, 4.47%, and 7.10%, respectively. Among the postpartum women, the prevalence rates of stress UI, urge UI, and mixed UI were 11.15%, 1.92%, and 2.69%, respectively. In both pregnant women and postpartum women, vaginal delivery had significantly increased the odds of reporting UI (p=0.007, p=0.003, respectively). The impact of UI on daily life was significantly greater in postpartum women compared to pregnant women especially in social embarrassment (p=0.000). Conclusion: The prevalence rates of UI were high in pregnant women in Nanjing, China. Vaginal delivery significantly increased odds of reporting UI. UI has a great impact on pregnant and postpartum women's life, especially in social embarrassment.

Facial ulcers in patients with COVID-19 admitted to ICU: review of the evidence.

OBJECTIVE: Many patients with COVID-19 admitted to intensive care undergo prone positioning. These patients are at risk of developing facial pressure ulcers (PUs). This study aimed to identify evidence-based recommendations to prevent or reduce their incidence. METHOD: A multi-case study was undertaken using secondary data published between November 2020 and April 2021 discussing facial PUs in patients with COVID-19. CINAHL and MEDLINE electronic databases were analysed. Sixteen publications met the inclusion criteria. The overall quality of evidence was low. RESULT: Studies reported a high incidence of facial PUs. The evidence suggests key preventive areas are skin assessment, pressure-redistribution surfaces, eye coverings, education, medical devices and prophylactic dressings. Recommendations included skin cleaning and moisturising, eye coverings, replacing endotracheal tube holders and using hydrocolloid or film dressings. CONCLUSION: Considering the severe implications for patients and healthcare systems caused by facial PUs, ICUs should develop strategies to prevent and minimise them.

The effectiveness of group-based pelvic floor muscle training in preventing and treating urinary incontinence for antenatal and postnatal women: a systematic review.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is prevalent in antenatal and postnatal women. Pelvic floor muscle training (PFMT) is the first-line treatment for UI. Group-based PFMT provides a way for professionals to deliver this intervention to more women who need to prevent and/or treat UI. This review aims to (1) assess the effectiveness of group-based PFMT in preventing and treating UI in antenatal and postnatal women and (2) explore the characteristics of group-based intervention and factors which had an impact on the success of group-based PFMT. METHODS: Randomized controlled trials (RCTs) were included in this review. A comprehensive search was conducted in PubMed, Embase, Medline, PsycINFO, Maternity and Infant Care Database, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database. The overall quality was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RCTs which included pregnant and/or postnatal women with or without UI investigating the effectiveness of group-based PFMT were included. RESULTS: Five RCTs were included in this review. The overall quality of the results of the included studies was low. Delivering group-based PFMT during pregnancy significantly reduced the prevalence of UI in both the pregnant period [risk ratio (RR) = 0.67, 95% confidence interval (CI) 0.57 to 0.80, P < 0.00001] and the postnatal period [RR = 0.66, 95% CI 0.52 to 0.84, P = 0.0008]. Only one RCT delivered group-based PFMT during the postnatal period. CONCLUSION: Evidence of weak quality supports the effectiveness of undertaking group-based PFMT in pregnancy to prevent UI during pregnancy and the postnatal period. No evidence showed the effectiveness of undertaking group-based PFMT in the postnatal period.

Models and frameworks that enable nurses to develop their public health practice-A scoping study.

AIMS AND OBJECTIVES: This scoping review commissioned by the Public Health England, WHO collaborating Centre, aimed to explore the models and frameworks which enable nurses to develop their public health practice and deliver public health interventions to individuals, families and communities. BACKGROUND: There is a plethora of literature regarding the role, activities and scope of practice undertaken by public health nurses across the world. However, only two reviews have explored the models and frameworks used for public health nursing practice. DESIGN: The study drew upon an established framework with a narrative review drawing upon five methodological steps. METHODS: A search of databases, Medline, PsycINFO, Embase, CINHAL and British Nursing Index, was undertaken. The search took place between April 2018 and June 2018 retrieving 9,513 peer-reviewed articles published from 2008. RESULTS: Ninety-five studies were retrieved and analysed thematically. From an initial review of literature, two themes were identified: public health models used in practice and models used in public health education. Within the first theme, three subthemes were emerged: Characteristics of the interventions; Characteristics of the public health nurse; and Lack of measurable health benefits. Within the second theme, three subthemes were identified: Faculty and Students Working Together; The Experiential Academic Approach, and What works in Educating Nurses for Public Health. CONCLUSION: The review identified that many models and frameworks are used in practice. However, within public health practice there is a limited evidence base and it fails to demonstrate that the frameworks and models developed for practice result in measurable health benefits on an individual or population level. However, within education innovative models were apparent with collaborative partnerships enabling preregistration nursing students to develop public health nursing competencies. RELEVANCE TO CLINICAL PRACTICE: Innovative approaches to education of preregistration nursing students could point the way forward for the delivery of public health nursing practice.

Analysis of sexual healthcare provided by school nurses.

AimThe aim of this study was to explore the role and activities of the school nursing service in sexual health within a large inner London borough. BACKGROUND: School nurses (SNs) are specialist community public health nurses working with the school age population to promote their health and well-being and therefore are arguably in a prime position to promote the sexual health of children and young people. This is particularly pertinent in inner city boroughs where the rates of sexually transmitted infections and under-18 conceptions are a significant problem. METHODS: Following a review of the literature, a mixed methods study was undertaken which included an audit of documentary data to identify the referrals received in relation to sexual health and also included questionnaire surveys of school staff and SNs on their views of the role of the SN in sexual health.FindingsSNs and school staff identified that SNs have a role in sexual health, which was reflected in the referrals received during the audit of documentary data. There appeared to be inconsistencies across the service and evidence suggested that the school nursing service may be underutilised in comparison to the number of students who require sexual health support. The current service appears to be predominantly reactive, particularly for males and those less than 12 years old. However, both SNs and school staff would like to see a more preventative approach; including greater sexual health promotion, condom distribution and school health clinics.

New models to support the professional education of health visitors: A qualitative study of the role of space and place in creating 'community of learning hubs'.

BACKGROUND: In response to a policy-driven workforce expansion in England new models of preparing health visitors for practice have been implemented. 'Community of Learning hubs' (COLHs) are one such model, involving different possible approaches to student support in clinical practice placements (for example, 'long arm mentoring' or 'action learning set' sessions). Such models present opportunities for studying the possible effects of spatiality on the learning experiences of students and newly qualified health visitors, and on team relationships more broadly. OBJECTIVES: To explore a 'community of learning hub' model in health visitor education and reflect on the role of space and place in the learning experience and professional identity development of student health visitors. DESIGN: Qualitative research conducted during first year of implementation. SETTINGS: Three 'community of learning hub' projects based in two NHS community Trusts in London during the period 2013-2015. PARTICIPANTS: Managers and leads (n=7), practice teachers and mentors (n=6) and newly qualified and student health visitors (n=16). METHODS: Semi-structured, audio-recorded interviews analysed thematically. RESULTS: Participants had differing views as to what constituted a 'hub' in their projects. Two themes emerged around the spaces that shape the learning experience of student and newly qualified health visitors. Firstly, a generalised need for a 'quiet place' which allows pause for reflection but also for sharing experiences and relieving common anxieties. Secondly, the role of physical arrangements in open-plan spaces to promote access to support from more experienced practitioners. CONCLUSIONS: Attention to spatiality can shed light on important aspects of teaching and learning practices, and on the professional identities these practices shape and support. New configurations of time and space as part of educational initiatives can surface new insights into existing practices and learning models.

An innovative strategy to increase a professional workforce: the fast track initiative for health visitors in England.

OBJECTIVES: Fast tracking is one strategy that organizations use to ameliorate workforce shortfalls by attracting new recruits, and accelerating their skills development and experience. In response to the Government's target of rapidly expanding the number of health visitors in England's National Health Service, the fast track initiative was launched to recruit newly qualified (fast track) as well as experienced (standard entry) nurses and midwives onto health visiting programmes. This paper evaluates the fast track initiative, from the perspective of fast track and standard entry students, practice teachers and health visitor managers. METHODS: A mixed methods design was used comprising a questionnaire survey (n = 71 students), semi-structured interviews (n = 37 students), telephone interviews (n = 13 managers) and six focus groups (n = 24 practice teachers). Data were collected between April 2012 and July 2013. Descriptive statistics, t-tests and the Pearson Chi-square test were used to analyse the quantitative data. The qualitative data were analysed thematically. RESULTS: Motivations for health visiting as a career choice were similar for fast track and standard entry students, with career progression and interest in health promotion being key motivators. There was consensus that personal qualities and characteristics were more important than experience or qualifications. However, fast track students were significantly less confident about their public health competencies in leadership and management (p < 0.05) and communication (p < 0.02). Practice teachers and managers also reported that fast track students required more intensive supervision particularly at the beginning of the programme. Programme completion including pass rates and academic achievement showed no significant difference by route of entry (p > 0.5). CONCLUSION: Fast tracking offers a useful recruitment strategy in order to expand the health visitor workforce, but longitudinal research is needed to confirm benefits such as retention and career trajectories.

The efficacy of alarm therapy versus desmopressin therapy in the treatment of primary mono-symptomatic nocturnal enuresis: a systematic review.

AIM: To investigate the efficacy of alarm therapy versus desmopressin therapy in treating primary mono-symptomatic nocturnal enuresis (PMNE). BACKGROUND: PMNE is a common childhood disorder, which if left untreated can have a significant impact on a child's self-esteem and behaviour. Alarm therapy and desmopressin therapy are the two main treatments currently available in UK-based nurse-led enuresis clinics. METHODS: A systematic review of the literature was undertaken to assess the efficacy of PMNE treatments. Following application of inclusion/exclusion criteria eight randomised controlled/clinical trials were identified involving children aged 5-17 years with PMNE receiving either alarm therapy or desmopressin therapy. FINDINGS: Seven studies found no statistical difference in nocturnal continence improvement between the two interventions at the point when treatment was stopped. Four studies had a significantly larger relapse rate of nocturnal enuresis with desmopressin compared with alarm therapy when the treatment was withdrawn. Two papers reported that those participating in the alarm therapy intervention of the trials had a higher attrition rate than the desmopressin intervention. The overall findings from the eight studies showed that long term alarm therapy was more effective in treating nocturnal enuresis than desmopressin therapy. The review found that families and children receiving the alarm therapy intervention require more support from health care professionals to comply with treatment than those receiving the desmopressin therapy. However, if nurse-led clinics can support families to persist with the alarm therapy intervention, they are more likely to experience longer term improvement in continence.

Communities of practice, a phenomenon to explain student development in community nursing.

AIM: To explore practice teachers understanding of the process of professional education experienced by community nursing students. BACKGROUND: This paper analyses the concepts of situated learning and communities of practice as an underpinning theoretical framework to understand the professional education of community nurses in practice settings. The paper also highlights the strengths and limitations of the community of practice theory as applied to professional education. METHODS: A qualitative grounded theory study was undertaken involving interviews with 30 community nurse practice teachers. FINDINGS: Emerging from the data were the central components of Lave and Wenger's theory of communities of practice. The practice teachers appeared to use these components including legitimate peripheral participation, sponsorship and journeying to good effect in facilitating the development of community nurse students. The paper extends Lave and Wenger's community of practice phenomenon and identifies how communities are (re)produced over time. The development of professional practitioners over a lengthy period of time within supportive communities of practice where one person with expertise in professional education sponsors the student and takes responsibility for their journey was perceived by practice teachers to be an important and appropriate approach. An approach that was found by practice teachers to transform the student's professional identity, enabling them to undertake a complex multifaceted role using a holistic, problem solving and participative style with clients and communities. It is also an approach that was hypothesised to allow the profession itself to (re)produce in a way that supports continuity but also promotes changes in practice.

Strategies used by experienced versus novice practice teachers to enact their role with community nurse students.

This study offers an original analysis of how community nurse practice teachers learn to enact their role. A constructivist grounded theory approach was applied to a study of thirty community nurse practice teachers. Practice teachers were interviewed using a lightly structured interview approach following ethical approval. The study found that practice teachers considered relationships and nurturance to be of central importance. This led to emphasis being placed on providing experience for students and formative assessment. A number of key differences between the way novice and experienced practice teachers saw themselves functioning were discovered. These differences were theorised to explain the finding that novice practice teachers were much more likely to identify students as experiencing major difficulties than experienced practice teachers. It was discovered that practice teachers learn to enact their role within a socio-cultural context drawing upon a transformation approach to learning. This approach becomes firmly established over a period of approximately three years and is at odds with the current emphasis on competency based transmission models of learning.