Working patterns and perceived contribution of prostate cancer clinical nurse specialists: a mixed method investigation.

BACKGROUND: Prostate cancer is prevalent worldwide. In England, men living with this malignancy often report unmet psychological, informational, urological and sexual needs. Their experience of care is correspondingly lower than that of other patient groups with cancer. To address this, prostate cancer clinical nurse specialist posts were established across England and Scotland. Their intent was to support men with this form of cancer, enhance symptom management and improve quality of service provision. OBJECTIVES: The research sought to investigate prostate cancer clinical nurse specialists' roles, determine whom they targeted services at, and determine their work practices and perceived contribution. DESIGN: A mixed method multi-site exploratory-descriptive design was employed. SETTINGS: Data were collected across four acute NHS Trusts-one in the South of England, one in the Midlands, one in Northern England and one in Scotland, respectively. PARTICIPANTS: Participants included 4 prostate cancer clinical nurse specialists, 19 of their clinical colleagues and 40 men they provided care to. METHODS: Data were collected through nurse specialists' completion of a Diary and Contact Sheets. Interviews were conducted concurrently with the nurses, stakeholders they worked alongside and patients on their caseload. Data were collected between November 2004 and January 2006. RESULTS: There was great variation in the qualifications and experience of nurse specialists and in the services they provided. Services ranged from generic support and information provided across the disease trajectory to provision of services to meet specific care needs, e.g. providing nurse-led clinics for erectile dysfunction. Patients and members of the multidisciplinary team welcomed the introduction of nurse specialists but were aware they could become over burdened through their rapidly growing caseloads. CONCLUSIONS: Variability in services provided by the prostate cancer nurse specialists arose from differences in local demand for nursing services and the skills and experiences of those appointed. Such variability - whilst understandable - has implications for access and equity across patient groups. Further, it can compromise efforts to define clinical nurse specialists' contribution to care, can impede others' expectation of their role, and render their outcomes difficult to evaluate.

Effectiveness of nursing-led inpatient care for patients with post-acute health care needs: secondary data analysis from a programme of randomized controlled trials.

OBJECTIVES: To determine whether transfer to a nursing-led inpatient unit (NLIU) prior to discharge from hospital can improve clinical outcome and reduce length of stay and readmission rate for medically stable post-acute patients assessed as requiring inpatient care. METHOD: Retrospective secondary data analysis of individual patient data (n=471) from a programme of three, purposefully replicated, pragmatic randomized controlled trials. Patients were referred to the NLIU by their consultant (attending doctor/surgeon) for nursing-led subacute/post-acute care and randomly allocated to a treatment group for planned transfer to the NLIU for the remainder of their hospital stay or to a control group for traditional consultant-led care in acute wards. Outcome measures were physical function (Barthel Index), length of stay, discharge destination, mortality, psychological well-being (General Health Questionnaire-12), health-related distress (Nottingham Health Profile Distress Index), incidence of complications and readmission within 7, 28, 90 and 180 days. RESULTS: Patients allocated to the NLIU showed greater improvement in physical function (P<0.001) and were more likely to be discharged to live independently in the community than controls [odds ratio (OR)=0.42, P=0.001] although they spent longer in hospital (P= 0.003). They showed greater improvement in psychological well-being (P = 0.001) and health-related distress (P =0.025) and a lower incidence of pressure ulcers (OR=0.33, P=0.011). CONCLUSION: Transfer to a NLIU can have a beneficial effect on outcomes of care for post-acute patients with complex health and social needs although length of stay is longer. This study strengthens the evidence of effectiveness of the NLIU model of care and provides evidence of effectiveness of post-acute and subacute models of care.

The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: a quasi-experimental study.

BACKGROUND: Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses' views and perceptions has been largely ignored. AIM: To determine the change in intensive care nurses' perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice. METHODS: The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses' perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units. RESULTS: Response rates were 79% (n=140) for Phase 1 and 62% (n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02). CONCLUSION: We conclude that nurse-directed protocolised-weaning had no effect on nurses' views and perceptions due to the high level of satisfaction which encouraged nurses' participation in weaning throughout. Control group changes are attributed to a 'reactive effect' from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

A European survey of general nurses' self assessment of competence.

Policy initiatives have prompted examination of the deployment and mobility of the nursing workforce within the European Union (EU). The European Health Care Training and Accreditation Network [EHTAN, 2005. Available from: ] project aims to improve the transparency of nursing qualifications, working practices, skills and experience, thus facilitating nurse workforce mobility, through compilation of a competency matrix [Cowan, D.T., Norman I.J., Coopamah, V.P., 2005a. European healthcare training and accreditation network. British Journal of Nursing 14, 613-617; EHTAN, 2005. Available from: ]. This paper reports on a survey across five EU countries in which the EHTAN nurse competence self-assessment tool was utilised. The purpose is to describe migrant nurses perception of their competence in: (a) the country where they trained and qualified and (b) the new country in which they are working and (c) to compare non-migrant nurses perception of their competence across different EU countries.

Impact of the role of nurse, midwife and health visitor consultant.

AIM: This paper describes the findings from one aspect of an evaluation study of the role of the nurse, midwife and health visitor consultant and the consultants' perceived impact of their role on services and patient care. BACKGROUND: The nurse, midwife and health visitor consultant role was established in 2000 in England to improve patient care, strengthen leadership and provide a clinical career opportunity for nurses, midwives and health visitors. An evaluative study was commissioned to report on the role 4 years after the new consultant posts were first established. METHOD: A multimethod evaluation was undertaken in 2002-2003 combining focus groups, telephone interviews and a comprehensive questionnaire survey of all the consultants in England. Four hundred and nineteen consultants responded to the questionnaire, 22 volunteered for the focus groups and 32 participated in the interviews. RESULTS: Nearly half (44%) the consultants who responded to the survey reported having a substantial impact on their service and 55% reported having some positive impact. High reported impact increased to 71% for those who had been in post for 2 years or longer. Consultants felt that they had been most successful in providing better support to staff, but only 10% said that they had a major impact on reducing unnecessary expenditure within the service. Factors associated with high levels of reported impact included engagement in a wide range of activities, perceived competence in the role and strong medical support. Those reporting most impact also reported the greatest dissatisfaction with salary. CONCLUSION: As consultants become more established in their posts, they are able to identify improvements in practice, service reconfiguration and educational advantages for staff. Our findings suggest that the true influence of these posts will become clearer over time as the impact of consultants on long-term organizational change becomes more apparent.

Economic evaluation of a nursing-led inpatient unit: the impact of findings on management decisions of service utility and sustainability.

AIMS: The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital wards and to improve patient outcome prior to discharge to the community. This paper aims to evaluate the cost, from the UK National Health Service perspective, of transfer to a nursing-led inpatient unit for intermediate care and to discuss the impact of these findings to the future development and sustainability of the nursing-led inpatient unit. BACKGROUND: Recent economic analyses have showed that nursing-led inpatient units are associated with increased costs of care with length of stay as the main driver of inpatient costs. METHOD: The cost-effectiveness analysis was part of a randomized-controlled trial with a sample size of 175, of which 89 were in the nursing-led inpatient unit arm and 86 in the control arm. Resource use data included length of stay, investigations performed, multiprofessional input and nursing input. Clinical outcome was measured using Barthel Index, a functional status measure. RESULTS: Cost per day was lower on the nursing-led inpatient unit although cost per hospital stay was higher due to significantly increased length of stay. Postdischarge community care costs were lower. The incremental cost-effectiveness ratio of the treatment was 1044 pounds sterling per point improvement of the Barthel Index. CONCLUSIONS: The nursing-led inpatient unit was associated with higher costs however, the question of whether the nursing-led inpatient unit is cost-effective has not been clearly answered because of the limited follow-up period of the study. The increased cost of care on the nursing-led inpatient unit was not a major factor in local management decisions about the future of the unit. The changes in the context of service provision within which the nursing-led inpatient unit operated as a result of substantial investment in intermediate care did have a major impact.

A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine.

OBJECTIVES: The long-term use of strong opioid analgesics among chronic noncancer pain (CNCP) patients remains controversial because of concerns over problematic drug use. However, previous surveys suggest that this is not necessarily the case. Therefore, we designed a controlled study to generate evidence in support of these findings. PATIENTS/SETTING: Ten CNCP patients attending the pain clinic in a district general hospital had been taking an average daily dose of 40 mg controlled-release morphine sulphate (mean 40, range 10-90, SD 21 mg), for an average of 2 years (mean 2.175, range 2-2.25, SD 0.2 years). DESIGN: Randomized, double-blind, placebo controlled cross-over study. The study was based on the premise that abrupt cessation of opioid drugs is most likely to highlight problematic use and the consequent inability to stop using opioids. Morphine was substituted with placebo for 60-hour periods to compare the effects of abstinence with those of continued use. Assessment of morphine cessation and abstinence effects was through direct observation, physiological measurements, questionnaire responses, and Brief Pain Inventory scores. RESULTS: Following cessation and abstinence, there were no indications of psychological dependence or drug craving, but there was evidence of the detrimental effects of pain intensity on activity, mood, relationships, sleep, and enjoyment of life. Three patients (30%) reported opioid drug withdrawal symptoms. Pharmacokinetic data demonstrated compliance with abstinence by all patients. CONCLUSION: The results suggest the existence of a group of CNCP patients whose long-term opioid consumption can be beneficial and remain moderate without them suffering from the consequences of problematic opioid drug use.

NHS cadet schemes: do they widen access to professional healthcare education?

AIM: The aim of this paper is to report a study investigating the extent to which National Health Service cadet schemes widen access to professional health care education. BACKGROUND: Cadet schemes have been reintroduced in the United Kingdom to increase recruitment of nurses and other health care staff to the National Health Service and also to widen access and increase participation in professional health care education by groups poorly represented in such education, including minority ethnic groups. METHODS: A questionnaire survey of all cadet schemes (n = 62) in England at the time of the study was carried out, and the respondents were cadet scheme leaders (n = 62) and cadet students (n = 411). The questionnaires to scheme leaders enquired about when the schemes were established, what the schemes were preparing cadets for, modes of delivery and entry qualifications. The questionnaires to cadets enquired about age, gender, family circumstances, prior experience and ethnic background. FINDINGS: The majority of schemes had been established since the health service reforms of 1999 and most were preparing cadets to enter professional nurse education programmes. Very few provided opportunities for part-time study and some asked for entry qualifications. Cadets were younger on entry than a comparator group of student nurses, fewer were married, fewer had previous employment or health-related employment and a lower percentage of cadets were white. CONCLUSION: Cadet schemes have the potential to widen access to professional health care study, but there is only limited evidence that they are doing so. In particular there was a lack of mature entrants to health care professional education via the schemes. However, the majority of schemes offered a route into professional education for students who did not hold sufficient educational qualifications for direct entry to professional health care education. It is encouraging that cadet schemes appear to be attracting a significantly greater proportion of students from Black and minority ethnic groups than preregistration nursing programmes overall.

Protocolized weaning from mechanical ventilation: ICU physicians' views.

BACKGROUND: The use of protocols during weaning from mechanical ventilation is uncommon in the UK, despite research pointing to their potential benefits. This may be because the research evidence is considered not to apply in different settings. Intensive care unit consultant physicians are the major decision-makers in weaning in the UK and any attempt to introduce protocolized weaning will require consideration of their views. AIM: The aim of this paper is to report a study exploring intensive care physicians' views on (i) weaning from mechanical ventilation, (ii) the utility of weaning protocols and (iii) nurses' roles in the weaning process. A specific goal was to identify potential aids and barriers to developing weaning protocols and their introduction into clinical practice. METHODS: Qualitative interviews were conducted with a purposive sample of 10 consultant physicians in two intensive care units in Northern Ireland and subjected to content analysis. FINDINGS: The primary themes identified were (i) information required for weaning decisions and clinical judgement, (ii) professional boundaries, (iii) protocol issues and (iv) timing of weaning. Three types of information were deemed to be required for weaning decisions - empirical objective, empirical subjective and abstract - and interviewees considered that it would be challenging to incorporate all into a protocol. They were divided on whether protocols were useful when nursing experience was limited. Some groups of patients were thought more suitable than others for protocolized weaning. CONCLUSIONS: Although local physicians were supportive in theory, introduction of protocolized weaning is likely to be difficult because of the breadth of information required for successful decision-making. Consultant views in this study were not consistent with American findings that physicians' caution may unnecessarily prolong weaning.

NHS cadet schemes: student experience, commitment, job satisfaction and job stress.

In the context of various policy initiatives concerning widening access to and strengthening recruitment and retention in the health services, cadet schemes--predominantly in nursing--have proliferated over the last few years. As part of a larger national evaluation of National Health Service (NHS) cadet schemes, this paper reports on a survey of senior cadet students across 62 cadet schemes in England and examines their experience of being a cadet on such a scheme. Cadets forming the most senior cohort from each of the 62 schemes (n = 596) were surveyed using a questionnaire. The questionnaire included self-rated measures of job satisfaction, job stress and commitment. A 5% sample of these cadets participated in follow-up telephone interviews. Cadets reported high satisfaction with their courses. One of the most positive aspects of the schemes was the first-hand experience of working in the NHS they provided, whilst also giving cadets the opportunity to gain recognisable skills and qualifications. Cadets scored highly on the job satisfaction scale and, on the job stress scale, showed low stress overall. A significant positive correlation was found between satisfaction and stress, indicating that the cadets who are most satisfied are also more highly stressed. A negative correlation was found between stress and the dimensions of commitment indicating that those cadets who are stressed are less committed to the NHS. A negative correlation was also found between satisfaction and the dimensions of commitment, suggesting that commitment to the NHS is not contingent on high satisfaction. The implications for the findings of the survey are discussed.

Randomized controlled trial of biofeedback for fecal incontinence.

BACKGROUND & AIMS: Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care. METHODS: A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry. RESULTS: Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment. CONCLUSIONS: Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.

[Health education. Heart surgery]. / Educación sanitaria. Cirugía cardiaca.

By means of a literature review of nursing articles, the authors aim to evaluate the importance of educational programmes before and after cardiac surgery, to assess the advantages and drawbacks of these programmes and to evaluate the need for following-up patients and their carers after being discharged from hospital. Health Education and cardiac surgery: Delivering information following cardiac surgery is an essential task, not only to achieve a behavioural change and the development of patients' self-care attitudes but also to reduce their anxiety. It is also essential to educate family members as they are the most importance source of physical and emotional support following surgery. Issues about in-hospital teaching programmes: Despite the numerous benefits of in-hospital teaching programmes, the actual tendency to shorten hospitalisation length in association with the high levels of anxiety, impede patients and carers' learning. Some studies suggest that these educational programmes have not completely achieved the task of preparing patients and their families to face the early recovery. Education during the early recovery: The authors highlight those studies that have focused on patients and their carers' needs for information following discharge from hospital. Results from these studies show the need for following-up patients and their carers at this period. Educational programmes can extent and reinforce the information provided at hospital.

[Saphenectomy in ambulatory surgery. Patients' expectations]. / Safenectomía en cirugía ambulatoria. Expectativas de los pacientes.

OBJECTIVE: Describe the expectations and the experiences which patients who undergo saphenactomy in outpatient surgery (CMA) have regarding their recuperation and to ascertain if their knowledge about this process corresponds with reality. MATERIAL AND METHODS: A descriptive-comparative survey with one part being quantitative and the other qualitative. A consecutive sample by 25 patients who completed 8 questionnaires. Data obtained was analyzed with the Chi-squared test and content analysis procedures. RESULTS: The majority of these patients received health education, 100% had postoperative symptoms but their recuperation was good along general lines. Their expectations were precise since there were no significant differences between the recuperation they expected and that which they underwent. Previous experiences in CMA had a very significant influence in the perceptions patients held, (p < 0.01). CONCLUSIONS: Saphenactomy in outpatient wards obtained satisfactory results although there are aspects which need be researched in greater detail, mainly those related to Health Education.

Safenectomía en cirugía ambulatoria. Expectativas de los pacientes / Saphenactomy in outpatient surgery

Objetivo: Describir las expectativas y experiencias que los pacientes sometidos a safenectomía en cirugía ambulatoria (CMA) tienen acerca de su recuperación y averiguar si su conocimiento sobre el proceso se corresponde con la realidad. Material y métodos: Estudio descriptivo-comparativo, con una parte cuantitativa y otra cualitativa. Muestra consecutiva de 25 pacientes que completaron 8 cuestionarios. Los datos se analizaron con el test Chi-cuadrado y análisis de contenido. Resultados: La mayoría de los pacientes recibió educación sanitaria. El 100 por ciento tuvo síntomas postoperatorios pero la recuperación fue en general muy buena. Sus expectativas fueron precisas ya que no hubo diferencias significativas entre la recuperación esperada y vivida. Las experiencias previas en CMA influyeron muy significativamente en las percepciones de los enfermos (p<0,01). Conclusiones: La safenectomía ambulatoria tuvo resultados satisfactorios aunque hay aspectos que necesitan ser investigados más en detalle, principalmente aquellos relacionados con la Educación Sanitaria (AU)

Educación sanitaria en cirugía cardiaca / Health education and cardiac surgery

Mediante una extensa revisión bibliográfica se evalúa el rol de la educación sanitaria en la cirugía cardiaca, las ventajas e inconvenientes de los programas de educación intrahospitalaria y la necesidad de instaurar programas de educación sanitaria después del alta hospitalaria. La educación sanitaria es esencial para proporcionar información a los pacientes antes de una cirugía cardiaca y durante el período postoperatorio, no sólo para conseguir una pronta recuperación y adaptación a un nuevo estilo de vida, sino también para reducir la ansiedad y los efectos adversos que de ella se derivan. La información a la familia puede desempeñar un rol clave en la recuperación de los pacientes ya que la familia constituye la principal fuente de soporte físico y emocional tras la cirugía. A pesar de los numerosos beneficios de la educación sanitaria intrahospitalaria, se analizan dos factores que dificultan el aprendizaje del paciente y/o familia: la ansiedad y el acortamiento del tiempo de ingreso. Los estudios aquí descritos sugieren que la información intrahospitalaria no es suficiente para preparar al paciente y familia a afrontar su recuperación y los cambios en el estilo de vida. La educación extrahospitalaria es pues una necesidad. Se muestran estudios sobre las necesidades de información y los problemas que surgen tras el alta hospitalaria, demostrando la conveniencia de programas de educación extrahospitalaria que extiendan y refuercen la información proporcionada (AU)

A survey of chronic noncancer pain patients prescribed opioid analgesics.

OBJECTIVES: Opioid analgesic drugs are sometimes advocated for chronic noncancer pain (CNCP). However, due to the paucity of studies assessing problematic opioid drug use in this population, evidence for such is inconclusive, and this issue remains controversial. This survey assessed problematic drug use among CNCP patients. PATIENTS/SETTING: Patients (N=104) prescribed opioids (mean duration of treatment 14.1 months) for severe CNCP at a pain clinic within a National Health Service hospital in London, United Kingdom. DESIGN: A review of pain clinic records to identify CNCP patients who had been prescribed opioids and subsequent assessment of those patients for problematic drug use using a substance use questionnaire. RESULTS: A total of 90 (86.5%) patients reported stopping opioid therapy at some point and, of these, 59 (65%) had ceased opioid therapy permanently. Of those patients who stopped opioids, 13 reported opioid withdrawal symptoms, two with severe and two with very severe symptoms. However, 72.5% of all patients derived benefit from opioids, although 77% of all patients reported opioid side effects. The addiction rate was 2.8%. CONCLUSION: These findings indicate that opioid therapy for CNCP does not necessarily lead to problematic drug use. Some problematic side effects are likely to be surmountable through appropriate prescribing. Further research is required into the long-term use of opioids in CNCP.

Suctioning: a review of current research recommendations.

Effective suctioning is an essential aspect of airway management in the critically ill. However, there are many associated risks and complications. These range from trauma and hypoxaemia to cardiac dysrhythmias and, in extreme cases, cardiac arrest and death. This paper identifies the current research recommendations for safer suctioning practices. The literature is reviewed in three parts: prior to suctioning; during suctioning; and post-suctioning. The recommendations prior to suctioning include patient assessment, patient preparation and hyperoxygenation. The recommendations during suctioning include appropriate catheter selection, depth of insertion, negative pressure, duration of procedure and number of suction passes. Measures for maintenance of asepsis, such as hand-washing, wearing gloves, goggles and aprons are other essential considerations, which must not be overlooked. The recommendations post-suctioning include reconnection of oxygen, patient assessment, reduction of oxygen to baseline level, and providing patient reassurance. In order to improve standards of care, it is imperative that nurses are aware of current research recommendations. This will enable nurses to make informed decisions about their own suctioning practices, based on the individual needs of the patient.

Análisis de un marco conceptual para el proceso de participación informal en el cuidado después de un ictus / Analysis of a conceptual framework for lay participation in stroke care

El objetivo del estudio ha sido analizar y describir un marco conceptual para la participación informal en el cuidado de los pacientes después de un ictus, desarrollado a partir del estudio de las percepciones de los pacientes y sus familiares. El material utilizado ha sido el correspondiente a una tesis de máster en ciencias de enfermería cursada en el King's College (Universidad de Londres). De ella surgió un marco conceptual que contiene cuatro fases: hospitalización, primera recuperación, alta y comienzo del cuidado en casa y autocorrección. También aparecieron una serie de elementos comunes a todas las fases: relaciones familiares, apoyo de los profesionales de la salud y legado de autoridad. Igualmente, emergieron otros elementos involucrados en el cuidado informal. Se han organizado según el momento del proceso en el que fueron considerados importantes por los participantes. El marco conceptual aporta las bases para el desarrollo de una futura investigación en enfermería (AU)

Tracheal suctioning: an exploration of nurses' knowledge and competence in acute and high dependency ward areas.

BACKGROUND AND RATIONALE: With an increasing demand for intensive care beds more nurses in acute and high dependency wards will be expected to care competently for patients with tracheostomy tubes. Tracheal suctioning is an essential aspect of effective airway management. However, this has many associated risks and complications, ranging from trauma and hypoxaemia to, in extreme cases, cardiac arrest and death. It is imperative that nurses are aware of these risks and are able to practice according to current research recommendations. Aims. This study was designed to explore nurses' knowledge and competence in performing tracheal suctioning in acute and high dependency ward areas and to investigate discrepancies between knowledge and practice using method triangulation. METHODS: Twenty-eight nurses were observed using nonparticipant observation and a structured observation schedule. Each subject was interviewed and questioned about their tracheal suctioning practices, and subsequently completed a knowledge-based questionnaire. Scores were allocated for knowledge and practice. FINDINGS: The findings demonstrated a poor level of knowledge for many subjects. This was also reflected in practice, as suctioning was performed against many of the research recommendations. Many nurses were unaware of recommended practice and a number demonstrated potentially unsafe practice. In addition, there was no significant relationship between knowledge and practice. However, during the interviews, many nurses were able to provide a rationale for specific aspects of practice that were perhaps not based on current research recommendations. CONCLUSIONS: The study raised concern about all aspects of tracheal suctioning and has highlighted the need for changes in practice, clinical guidelines and focused practice-based education.

Estudio desde la percepción de pacientes y familiares del proceso de participación informal en el cuidado después de un ictus: metodología y primeros resultados / Study of patients' and families' perception of lay caregiver participation in the care of stroke patients: methodology and preliminary results

En la actualidad, entre las enfermedades con mayor incidencia se encuentra el accidente cerebrovascular. Por ello, la participación de la familia en el cuidado de las personas que lo han padecido es de gran relevancia. El objetivo general de este estudio ha sido conocer el proceso de participación informal en el cuidado de los pacientes después de un ictus. Se ha desarrollado en el Departamento de Neurología de la Clínica Universitaria de la Universidad de Navarra y del Hospital de Navarra y en la Asociación de Daño Cerebral de Navarra (ADACEN). Se realizó un análisis cualitativo del contenido de las entrevistas semiestructuradas llevadas a cabo con 8 pacientes que habían sufrido un ictus y con 14 familiares, para obtener un total de 23 temas y 83 categorías para pacientes, y 28 y 107, respectivamente, para familiares. El análisis fue un proceso inductivo que objetivó la necesidad de que los cuidadores informales y los pacientes reciban información y educación sobre este proceso, su tratamiento y rehabilitación. Todo ello mediante un asesoramiento y educación continuos. (AU)