'It's good to have the knowledge and the confidence': Mental health student nurses' views of a medication workshop.

The administration of medication in a safe manner is a key nursing role and nursing regulatory bodies mandate that it is part of undergraduate training. However, it has been noted that qualified nursing staff are dissatisfied with the knowledge demonstrated by students. As such, a 2-day evidence-based workshop on medication management for final-year nursing students was facilitated to address knowledge deficits. Content was delivered by academics and practicing nurses. The aims of this study were to evaluate internship mental health student nurses' experiences of a 2-day medication management workshop. A qualitative descriptive design was adopted. Three focus group interviews were held with student nurses who partook in the workshop. Data were analysed using reflexive thematic analysis. Three themes were identified: Developing Confidence around Medication Management, Reflections on Learning Gained from the Workshop, and Enhancing Awareness and Vigilance of Medication Errors. Overall, participation in the workshop was identified as having a positive impact on students' knowledge, competence, and confidence in relation to becoming a safe practitioner. Students reported that the timing of the workshop - during internship - was appropriate for their knowledge needs. Findings indicate that the right amount of information was delivered by the right people, at the right time, in the right way. This study has highlighted the positive impact of a 2-day workshop delivered in the final year of mental health student nurse training, on their confidence and competence in the area of medication management. It provides some insight into how a practical collaborative approach to this type of education between academics and clinicians can help students bridge the theory-practice gap.

Undergraduate student nurses' views of online learning.

Background: The COVID-19 pandemic and resultant public health restrictions saw the mass movement of higher education to online, remote delivery. There was wide variation in how this was implemented, and for many undergraduate programs, this was the first time teaching was conducted remotely. The aim of this study was to explore undergraduate student nurses' views of online learning. Methods: Reflexive thematic analysis was used to analyse focus group data from undergraduate nursing students. Findings: Two central themes described student preferences for learning environments and challenges associated with asynchronous learning. Participants reported a preference for face-to-face learning. Suggestions for optimising remote learning include an emphasis on synchronous live sessions rather than asynchronous learning, incentivised learning, and a focus on ongoing formative informal assessment to maintain engagement. Specific challenges related to poor retention, difficulty remaining motivated, and maintaining focus on content and learning outcomes. Conclusion: As more opportunities arise to engage with online pedagogies for undergraduate nursing students, educators need to ensure their approaches are evidence-based and learner-centric.

Nurses' Use of Appropriate Needle Sizes When Administering Intramuscular Injections.

BACKGROUND: In cases where patients are overweight or obese, administration of intramuscular medications can be ineffective due to inappropriate sizes of needles used. This study investigated whether the size of needles used to administer intramuscular injections is appropriate for patients on the basis of their weight or body mass index. METHOD: This retrospective review examined 100 instances of intramuscular injection on a 50-bed ward. RESULTS: In most instances, intramuscular medication was inappropriately administered. Needle sizes were not determined based on body mass index, and the possibility of true intramuscular penetration was minimal. Appropriate needle sizes were more likely to be chosen when instructions were provided with medications. CONCLUSION: Current available needle sizes may be inappropriate for certain patients. Nursing staff require further education to assist them in making correct needle choices. It is also important that health care settings have evidence-based policies in place and the necessary resources provided to ensure safe and correct administration of medication. J Contin Educ Nurs. 2018;49(11):519-525.

'I thought it would keep them all quiet'. Women's experiences of breastfeeding as illusions of compliance: an interpretive phenomenological study.

AIMS: To explore the experiences of breastfeeding women. BACKGROUND: There is a plethora of data demonstrating that human breast milk provides complete nutrition for human infants. While the rate of initiation of breastfeeding in the United Kingdom has shown a steady increase in the last 25 years, rates of exclusive breastfeeding in the early weeks and months over the same time period have shown only marginal increases. This study was designed to extend current knowledge around breastfeeding experiences, decisions and behaviours. DESIGN: Qualitative, interpretive phenomenological approach. METHODS: Data were collected between July 2009-January 2010 through in-depth interviews with 22 women from a city in the East Midlands where the prevalence of breastfeeding has showed a decreasing trend. Data were collected between 3-6 months after the birth of their youngest baby. FINDINGS: Analysis of data uncovered a key theme: illusions of compliance. The findings revealed that women's breastfeeding behaviours were socially mediated. They adopted a good mother image by conforming to the moral obligation to breastfeed immediately after their babies were born. Those women who struggled to establish breastfeeding tried to hide their difficulties rather than admit that they were not coping. CONCLUSION: This study provides insights into women's infant feeding decisions and behaviours, building on understandings of 'good mothering' in the wider literature. Importantly we highlight some of the previously unknown strategies that women employed to portray themselves as calm, coping and in control when in reality they were struggling and not enjoying breastfeeding.

Wound assessment tools and nurses' needs: an evaluation study.

The purpose of this study was to ascertain how well different wound assessment tools meet the needs of nurses in carrying out general wound assessment and whether current tools are fit for purpose. The methodology employed was evaluation research. In order to conduct the evaluation, a literature review was undertaken to identify the criteria of an optimal wound assessment tool which would meet nurses' needs. Several freely available wound assessment tools were selected based on predetermined inclusion and exclusion criteria and an audit tool was developed to evaluate the selected tools based on how well they met the criteria of the optimal wound assessment tool. The results provide a measure of how well the selected wound assessment tools meet the criteria of the optimal wound assessment tool. No tool was identified which fulfilled all the criteria, but two (the Applied Wound Management tool and the National Wound Assessment Form) met the most criteria of the optimal tool and were therefore considered to best meet nurses' needs in wound assessment. The study provides a mechanism for the appraisal of wound assessment tools using a set of optimal criteria which could aid practitioners in their search for the best wound assessment tool.

An evaluation of factors influencing feeding in babies with a cleft palate with and without a cleft lip.

The objective of this article was to determine the impact of different bottles and teats for feeding babies with a cleft palate (with and without a cleft lip) on weight velocity, feeding behaviour, and maternal self-esteem. A mixed methods study incorporating the use of diaries to record feeding patterns of babies and levels of professional support received was used. Growth was assessed by converting weights into standard deviation scores and using the differences to express weight velocity over a six-week period. Visual analogue scales were used to assess mothers' perceptions of their children and themselves. The Edinburgh Postnatal Depression Score (EPDS) was used to identify maternal depression. The study demonstrated that the most significant effect on weight was determined by cleft type. Babies with isolated clefts of the hard and soft palate experienced greater feeding problems and suffered the biggest weight losses. This remained significant independently of the type of bottle/teat used. Poor weight gain was also associated with a mother's low perception of herself and her child, and her tendency towards depression. The study highlights the importance of the early assessment of babies' feeding skills and regular follow-up and support from trained and experienced nurse specialists.

Practice improvement, breastfeeding duration and health visitors.

The primary purpose of practice improvement is to improve clinical practice through changing the behaviour of healthcare professionals. Breastfeeding is a key public health issue, conferring benefits associated with both infant and maternal health, yet breastfeeding rates in the U.K. and Ireland are among the lowest in Western Europe. In this paper, the ways in which practice improvement can be utilised to enhance both efficiency and effectiveness are described, using a case study of the potential contribution of health visitors to increasing breastfeeding duration in primary care in order to illustrate this in clinical practice.

Keeping in touch. Cell phone use in people with schizophrenia disorders.

There is limited research exploring telephone intervention for psychiatric clients; no studies specific to cell phone use have been conducted. This pilot study examined the feasibility and acceptability of cell phone use in individuals with schizophrenia spectrum disorders (SSDs). Ten outpatients with SSDs were provided with previously activated cell phones for 5 months; trained nurses contacted participants weekly. Seven participants completed the 5-month follow-up period. A minority of participants reported difficulty retrieving messages and answering or charging their phone. These preliminary findings indicate the majority of individuals with SSDs are willing to use this method of communication and are able to do so with few problems. Possible barriers to the use of cell phones with this group include lifestyle factors and poor decision making. Future investigations should examine the use of cell phone access to foster personal safety, gain a sense of connectedness to others, and enhance quality of life.

Thinking about the nature of research findings: a hermeneutic phenomenological perspective.

Written in response to an ongoing process of reflexivity, I deconstruct the findings of a recently completed qualitative hermeneutic phenomenological research study which was designed to answer the question: "How is study abroad manifest in the experience of nursing students?" The purpose is to assist and urge other researchers to locate their research, themselves and their research participants more transparently in the social and cultural worlds within which they move and are a part. Following a sketch of the research study upon which the paper is based, the relationships between structure, agency, researched and researcher are explored within a hermeneutic phenomenological framework. In particular, I relate some of the challenges encountered through reflections on specific aspects of the research process. I conclude that research findings might best be understood as being a dynamic and complex, two-way constructed interpretation of phenomena involving both structure and agency. I proceed from the stance that the discursive and the emotional, the artistic and the scientific, need to be balanced partners. Where this relationship is harmonious, intellectual ability increases leading to better meaning making, better decisions and greater understanding.

Uncovering study abroad: foreignness and its relevance to nurse education and cultural competence.

This paper reports some of the findings from a hermeneutic phenomenological research project designed to uncover the nature of the phenomenon 'study abroad' in the context of Nursing Higher Education in the United Kingdom. The research question asked was 'How is study abroad manifest in the experience of nursing students?' Informed by the philosophy of Martin Heidegger, the analysis of 26 study abroad students' diary accounts uncovered six general structures, or ways for study abroad to be, namely; leaving behind, escape, foreigner, self-discovery, learning and risk. The focus here is on the general structure 'foreigner' and the far-reaching implications this can have in terms of understanding how study abroad comes to be. The relationship between study abroad, positive disturbance and the development of students who are able to recognise diversity across different cultures is discussed. It is suggested that if one of the major aims of nurse higher education is the development of culturally competent practitioners, study abroad is deserving of far greater attention than is currently the case.

Antielastin autoimmunity in tobacco smoking-induced emphysema.

Chronic obstructive pulmonary disease and emphysema are common destructive inflammatory diseases that are leading causes of death worldwide. Here we show that emphysema is an autoimmune disease characterized by the presence of antielastin antibody and T-helper type 1 (T(H)1) responses, which correlate with emphysema severity. These findings link emphysema to adaptive immunity against a specific lung antigen and suggest the potential for autoimmune pathology of other elastin-rich tissues such as the arteries and skin of smokers.

Lung volume reduction surgery: a meta-analysis of randomized clinical trials.

BACKGROUND: Observational studies have suggested that lung volume reduction surgery (LVRS) is superior to optimal medical therapy for selected subsets of patients with advanced emphysema. Randomized clinical trials (RCTs) with the exception of the National Emphysema Treatment Trial (NETT), failed to enroll a sufficient number of patients to provide clinicians and patients with convincing outcome data on the usefulness of LVRS. It was postulated that a meta-analysis of these RCTs (3-12 months' follow up) may provide more compelling information on the value of LVRS in patients with emphysema. METHODS: A comprehensive search of the MEDLINE database between January 1994 and January 2004 for RCTs on LVRS was performed. RESULTS: From a total of eight RCTs on record, six studies (306 patients) with 3- to 12-month follow up were deemed suitable for meta-analysis. Key baseline features of these RCT populations included heterogeneous emphysema, comparable inclusion/exclusion criteria and, in retrospect, low walking capacity as measured by the 6-minute walk distance (6MWD). This profile closely resembles NETT's 'predominantly upper lobe--low exercise tolerance emphysema' cohort. The LVRS arm of the meta-analysis population showed better results than the medical cohort in terms of pulmonary function (FEV(1) p < 0.0001, FVC p < 0.0001, residual volume p < 0.0001, total lung capacity p = 0.004), gas exchange (arterial partial pressure of oxygen p < 0.0001) and exercise capacity (6MWD p = 0.0002). Although information on quality-of-life measures was not sufficiently uniform to qualify for meta-analysis, a survey of available data revealed better results in the surgical than in the medical arms of each RCT. Mortality 6-12 months after random assignment to treatment was similar in the two study arms, suggesting that the operative mortality from LVRS was offset, within months, by deaths in the medical arm. CONCLUSIONS: This meta-analysis showed that a selected subset of patients with advanced, heterogeneous emphysema and low exercise tolerance (6MWD) experienced better outcomes from LVRS than from medical therapy.

Novel method for measuring effects of gas compression on expiratory flow.

During forced vital capacity maneuvers in subjects with expiratory flow limitation, lung volume decreases during expiration both by air flowing out of the lung (i.e., exhaled volume) and by compression of gas within the thorax. As a result, a flow-volume loop generated by using exhaled volume is not representative of the actual flow-volume relationship. We present a novel method to take into account the effects of gas compression on flow and volume in the first second of a forced expiratory maneuver (FEV(1)). In addition to oral and esophageal pressures, we measured flow and volume simultaneously using a volume-displacement plethysmograph and a pneumotachograph in normal subjects and patients with expiratory flow limitation. Expiratory flow vs. plethysmograph volume signals was used to generate a flow-volume loop. Specialized software was developed to estimate FEV(1) corrected for gas compression (NFEV(1)). We measured reproducibility of NFEV(1) in repeated maneuvers within the same session and over a 6-mo interval in patients with chronic obstructive pulmonary disease. Our results demonstrate that NFEV(1) significantly correlated with FEV(1), peak expiratory flow, lung expiratory resistance, and total lung capacity. During intrasession, maneuvers with the highest and lowest FEV(1) showed significant statistical difference in mean FEV(1) (P < 0.005), whereas NFEV(1) from the same maneuvers were not significantly different from each other (P > 0.05). Furthermore, variability of NFEV(1) measurements over 6 mo was <5%. We concluded that our method reliably measures the effect of gas compression on expiratory flow.