Comparison of the international Burn Injury Database nurse dependency tool with the Safer Nursing Care Tool: Observational study.

Background: Safe and effective nurse staffing is widely recognised as an important issue to ensure quality patient care and reduce mortality. There are many nurse dependency tools described in the literature but no gold standard tool that can be used in all specialities. In burn care there are even fewer burn specific tools and none reported for use in the UK to date. The international Burn Injury Database contains routinely collected information about burn injuries, including nurse dependency data which so far has not been reported in the literature. Objective: This study aimed to confirm whether the international Burn Injury Database nurse dependency tool can be used to measure nurse dependency in burn services. Methods: Over a two week period, nurses in three burn services scored the nurse dependency of their burn injured patients daily using the international Burn Injury Database Nurse Dependency Tool and the Safer Nursing Care Tool. Additionally all the participating nurses were asked to score three fictional case studies using the same two tools to assess inter-rater reliability. Results: There was a statistically significant positive correlation between the international Burn Injury Database Nurse Dependency Tool and the Safer Nursing Care Tool scores (ρ = 0.87, 95% CI = 0.82-0.90). The case study scores showed a similar correlation pattern as the daily comparison recordings. The inter-rater reliability between the participants was comparable for both the international Burn Injury Database  Nurse Dependency Tool (α =0.74, CI = 0.71-0.77) and the Safer Nursing Care Tool (α =0.79, CI = 0.76-0.81). Psychological support variable had the weakest correlation with the nurse dependency tools and the lowest agreement between nurses. Conclusion: This is the first report in the literature of the international Burn Injury Database Nurse Dependency Tool, the results of which suggest that it does measure aspects of nurse dependency and thus could be a valuable tool in the battle to ensure safe staffing. The good inter-rater reliability between the nurses, regardless of the nurse dependency tool used, should give confidence to nurses and managers using the dependency data to influence staffing.

Effectiveness of application of carbon-fibre polymer-fabric resistive heating compared with forced-air warming to prevent unintentional intraoperative hypothermia in patients undergoing elective abdominal operations: A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Unintentional intraoperative hypothermia was regarded as a common intraoperative symptom with serious complications. The active warming strategies of forced-air warming (FAW) and carbon-fibre polymer-fabric resistive heating were considered to be effective interventions for preventing hypothermia. However, the effectiveness of them was not reported consistently. AIM: To evaluate the effectiveness of carbon-fibre polymer-fabric resistive heating compared with FAW in preventing hypothermia in patients undergoing elective surgeries. DESIGN: Systematic review and meta-analysis. METHODS: A rigorous systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting checklist. Searching strategy was undertaken on the electronic databases of Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE and Medical Literature Retrieval Service. The assessment of study quality was performed through risk of bias of Cochrane handbook of systematic review of interventions. Data synthesis was conducted through meta-analysis with sensitive analysis. The quality of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: A total of five randomised controlled trials with 282 patients undergoing elective surgeries were included in the quantitative synthesis. Four studies concluded that FAW was as effective as carbon-fibre polymer-fabric resistive heating in preventing hypothermia. However, one study yielded a different conclusion that the efficacy of FAW was superior to carbon-fibre polymer-fabric resistive heating with small incidence of hypothermia. Meta-analysis found that FAW was more effective than carbon-fibre polymer-fabric resistive heating in preventing hypothermia. CONCLUSIONS: In the elective abdominal surgery, carbon-fibre polymer-fabric resistive heating was less effective than FAW on the prevention of hypothermia. However, hypothermia still occurred in the FAW group. It was more objective to assess the efficacy of warming technology combining the incidence of hypothermia and the core body temperature together, which was suggested for further research.

Bioscience learning in clinical placement: the experiences of pre-registration nursing students.

AIMS AND OBJECTIVES: The aim of this study was to explore student nurses' views and experiences of bioscience learning in clinical placement. The study focused on (1) how relevant students perceive bioscience knowledge to their professional role; (2) what opportunities students have to apply bioscience knowledge during clinical placements; (3) what students perceive about the support they receive from placement mentors regarding bioscience learning. BACKGROUND: Bioscience knowledge is required for safe and effective practice but is an area that students find challenging. Clinical placements offer students the ideal environment to integrate bioscience into clinical decision making. There is, however, a lack of research addressing specifically students' placement learning of bioscience. DESIGN: An explanatory sequential mixed methods approach was adopted. METHODS: The research involved two phases. In phase one predominantly quantitative data were collected via a survey. 112 final year BSc nursing students from across fields completed the survey (response rate = 66%). The results of this phase were then built upon by conducting three focus groups (n = 17) in a second qualitative research phase. RESULTS: Whilst students acknowledged the relevance of bioscience to their nursing role, this study suggests that its importance is not recognised as widely by practice educators. Findings highlight inconsistencies in the quality of mentor support, the opportunities for students to learn and the priority that bioscience is given in placement education. CONCLUSIONS: This study demonstrates the need for more explicit bioscience criteria in placement assessments and a greater level of mentor education to ensure more consistency in the standard of placement learning of bioscience. RELEVANCE TO CLINICAL PRACTICE: Providing insight into factors that influence student learning of bioscience during clinical placements provides focus on how higher education institutions and practice educators can better support students to confidently apply bioscience knowledge to deliver safe and effective patient care.

Evaluation of dementia training for staff in acute hospital settings.

The development, pilot and evaluation of a brief psychosocial training intervention (BPTI) for staff working with people with dementia in an acute hospital setting are described. The project had two phases. Phase one involved adapting an existing competency framework and developing the BPTI using focus groups. For the pilot and evaluation, in phase two, a mixed methods approach was adopted using self-administered standardised questionnaires and qualitative interviews. Qualitative analysis suggested that delivering skills-based training can develop communication, problem-solving and self-directed learning skills; benefit staff in terms of increased knowledge, skills and confidence; and be problematic in the clinical area in terms of time, organisation and the physical environment. These factors must be taken into consideration when delivering training. These changes were not reflected in the quantitative results and measures were not always sensitive to changes in this setting. Definitive conclusions cannot be drawn about the efficacy of the intervention, due to the contradictory outcomes between the quantitative and qualitative data. Further developments and research are required to explore how staff and organisations can be supported to deliver the best possible care.

'Putting words into action' project: using role play in skills training.

Research highlights the need to use experienced role-players with skilled facilitation to deliver effective communication skills training (CST) but this is challenging in a large faculty of health. In this pilot project, students from Birmingham City University's School of Acting and role-players from the Learning Disability nursing programme received role-player training (Phase I) before delivering 26 CST sessions to 520 first year BSc nursing students (Phase II), using role-plays based on clinical scenarios in adult, mental health, learning disability and children's nursing. A pre- and post-session survey assessed student confidence, with feedback gathered from role-players, and facilitators. Pre-session confidence levels in students who participated and observed the role-play were similar, and using Wilcoxon and Mann Whitney non-parametric tests, a statistically significant increase in post-session confidence levels was demonstrated across all four fields of nursing. This increase in confidence applied to role-play participating students and observers, although role-playing students gained the largest confidence increase. A Higher Education Academy Collaborative Grant extended the project in 2012/13.