Structured, supported feeding admissions for restrictive eating disorders on paediatric wards.

BACKGROUND: Restrictive eating disorders in young people are increasingly requiring admission to the hospital and can be a challenge to manage on acute general paediatric wards. METHODS: We have developed a joint working model with Child and Adolescent Mental Health services (CAMHS) using short, structured, supported feeding admissions to supplement outpatient treatment in high risk or 'stuck' cases. RESULTS: We have successfully managed the majority of young people in the community avoiding lengthy, expensive, specialist CAMHS eating disorder inpatient unit admissions (tier 4). Local ward admissions are easier to manage and the attitudes of nursing and medical staff towards these young people have changed. DISCUSSION: Joint working between paediatric and CAMHS teams enables shorter, more manageable local ward admissions, reducing the need for tier-4 units.

Measles, rubella, and varicella among the crew of a cruise ship sailing from Florida, United States, 2006.

BACKGROUND: Cruise ship outbreaks of vaccine-preventable diseases (VPD) such as rubella and varicella have been previously associated with introduction and spread among susceptible crew members originating from countries with endemic transmission of these diseases. METHODS: During February to April 2006, we investigated a cluster of rash illnesses due to measles, rubella, or varicella on a cruise ship sailing from Florida to the Caribbean. Case-finding measures included review of medical logs, active surveillance for rash illness among crew members, and passive surveillance for rash illness in the ship's infirmary lasting two incubation periods from the last case of measles. Passengers with potential exposure to these VPD were notified by letters. All susceptible crew members with potential exposure were administered the measles, mumps, and rubella vaccine after informed consent. RESULTS: A total of 16 cases were identified only among crew members: 1 rubella, 3 measles (two-generation spread), 11 varicella (three-generation spread), and 1 unknown diagnosis. Of 1,197 crew members evaluated, 4 had proof of immunity to measles and rubella. Based on passive surveillance, no cases were identified among passengers, the majority of whom resided in the United States. CONCLUSION: The international makeup of the population aboard cruise ships combined with their semi-enclosed environment has the potential to facilitate introduction and spread of VPD such as measles, rubella, and varicella onboard and into communities. Cruise lines should ensure crew members have evidence of immunity to these diseases. Passengers should be up to date with all vaccinations, including those that are travel-specific, prior to embarking on cruise travel.

Learner contracts in nurse education: interaction within the practice context.

Learner needs in clinical practice can be identified by working within a framework where the focus is around learner strengths and learner weaknesses. By using their academic and experiential expertise, faculty can identify, for learners, individual strengths and weaknesses within the practice context. Once identified, the learner and faculty can work together to meet the learner's individualized learning needs. The learner and the faculty can interact so as to create a meaningful and effective teaching-learning partnership. This article describes the development, implementation and evaluation of nursing practice learner contracts (NPLC's) in a diploma nursing program and discusses how the contracts used learner strengths and weaknesses to mobilize learner needs.

Child disability case studies: an interprofessional learning opportunity for medical students and paediatric nursing students.

CONTEXT: We describe an interprofessional learning (IPL) opportunity for pre-qualification medical and paediatric nursing students using community-based case studies of disabled children and their families. METHODS: A total of 160 students were randomly allocated into interprofessional and uniprofessional pairs. Each pair visited a disabled child at home and school and presented their experience to the rest of the group. Quantitative and qualitative evaluation methods were used to explore the learning experience. Data collection tools included a scale measuring attitudes towards IPL, which was completed by all students before and after their visits and focus groups. RESULTS: The value of the community setting and independent working of the case study was appreciated by the students. The intimacy involved in working in IP pairs demonstrated both positive and negative features. Nursing students showed more open and positive attitudes towards IPL than medical students. Nursing students in IP pairs appear to have benefited most from the exercise, notably in terms of confidence and self-esteem. Professional differences in communication skills and approach were identified as particular learning points for all students. CONCLUSIONS: The added value of combining quantitative and qualitative research methods is well demonstrated by this study. Learning opportunities from the case study were greater as a result of working interprofessionally. Student attitudes towards IPL and professional stereotyping changed as a result of this IPL exercise. The importance of the social context of learning and the contact hypothesis are supported by our findings.

Staff knowledge and attitudes towards deliberate self-harm in adolescents.

This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm. A questionnaire survey was completed by 126 health professionals working with adolescents who harm themselves. The main outcome measures were a knowledge measure and three attitude measures (generated using factor analysis). The mean percentage of correctly answered knowledge questions, across all professional groups, was 60%. With regard to knowledge, over three-quarters of participants were unaware that homosexual young men and those who had been sexually abused are at greater risk of DSH, whilst one third of staff were unaware that adolescents who self-harm are at increased risk of suicide. Staff who felt more effective felt less negative towards this group of patients (B=-0.21, p=0.03). Forty-two per cent of the participants wanted further training in DSH amongst adolescents.