Clinical academic research internships: What works for nurses and the wider nursing, midwifery and allied health professional workforce.

Nurse-led research and innovation is key to improving health experiences and outcomes and reducing health inequalities. Clinical academic training programmes for nurses to develop research and innovation skills alongside continued development of their clinical practice are becoming increasingly established at national, regional and local levels. Though widely supported, geographical variation in the range and scope of opportunities available remains. It is imperative that clinical academic opportunities for nurses continue to grow to ensure equity of access and opportunity so that the potential of nurse-led clinical academic research to improve quality of care, health experience and health outcomes can be realised. In this paper, we describe and report on clinical academic internship opportunities available to nurses to share internationally, a range of innovative programmes currently in operation across the UK. Examples of some of the tangible benefits for patients, professional development, clinical teams and NHS organisations resulting from these clinical academic internships are illustrated. Information from local evaluations of internship programmes was collated to report what has worked well alongside 'real-world' set-up and sustainability challenges faced in practice. Clinical academic internship schemes are often opportunistically developed, making use of hybrid models of delivery and funding responsive to local needs and available resources. Key enablers of successful clinical academic internship programmes for nurses were support from senior clinical leaders and established relationships with local universities and wider organisations committed to research capacity building.

Community midwives' and health visitors' experiences of research recruitment: a qualitative exploration using the Theoretical Domains Framework.

BACKGROUND: Successful research is frequently hampered by poor study recruitment, especially in community settings and with participants who are women and their children. Health visitors (HVs) and community midwives (CMs) are well placed to invite young families, and pregnant and postnatal women to take part in such research, but little is known about how best to support these health professionals to do this effectively. AIM: This study uses the Theoretical Domains Framework (TDF) to explore the factors that influence whether HVs and CMs invite eligible patients to take part in research opportunities. METHOD: HVs (n = 39) and CMs (n = 22) working in four NHS Trusts and one community partnership in England completed an anonymous, online survey with open-ended questions about their experiences of asking eligible patients to take part in the research. Qualitative data were analysed using directed content analysis and inductive coding to identify specific barriers and enablers to patient recruitment within each of the 14 theoretical domains. FINDINGS: Six key TDF domains accounted for 81% of all coded responses. These were (a) environmental context and resources; (b) beliefs about capabilities; (c) social/professional role and identity; (d) social influences; (e) goals; (f) knowledge. Key barriers to approaching patients to participate in the research were time and resource constraints, perceived role conflict, conflicting priorities, and particularly for HVs, negative social influences from patients and researchers. Enablers included feeling confident to approach patients, positive influence from peers, managers and researchers, beliefs in the relevance of this behaviour to health care and practice and good knowledge about the study procedures, its rationale and the research topic. The findings suggest that to improve research recruitment involving HVs and CMs, a package of interventions is needed to address the barriers and leverage the enablers to participant approach.

Parental presence during resuscitation in the PICU: the parents' experience. Sharing and surviving the resuscitation: a phenomenological study.

AIM AND OBJECTIVE: To provide in-depth understanding of the meaning for parents who were present or absent during a resuscitation attempt on their child in the PICU. BACKGROUND: Family presence during resuscitation remains a topic of debate with both benefits and disadvantages identified, yet few studies have asked parents of children in PICU to describe their experiences of being present or absent during this resuscitation and what this means to their understanding and coping. Additionally, minimal research has investigated parental presence during a successful resuscitation. DESIGN: A qualitative design was used based upon van Manen's interpretative phenomenological approach. METHODS: Fourteen parents of critically ill children from one paediatric intensive care unit in Australia, who had either survived or died following a resuscitation attempt were interviewed. RESULTS: Four main themes were identified: (1) being only for a child; (2) making sense of a living nightmare; (3) maintaining hope in the face of reality; (4) living in a relationship with staff. CONCLUSIONS: The findings underpin the inherent need for parents to choose to be present during resuscitation to make sense of the situation. Memories of the resuscitation were not long-lasting and distress was for the potential death of a child, rather than the resuscitation scene. Parents who did not witness their child's resuscitation were more distressed than those who did. Having the opportunity to make the decision to stay or leave was important for parents. Support during the resuscitation was best provided by experienced clinical nurses. RELEVANCE TO PRACTICE: Recognition of the parents' compelling need to stay will improve nurses' understanding of how witnessing this event may assist family coping and functioning. Ways in which parents may be better supported in making the decision to stay or leave during resuscitation are identified.

Establishing the contribution of nursing in the community to the health of the people of Scotland: integrative literature review.

AIM: This paper is a report of an integrative literature review to explore the evidence base for nursing in the community. BACKGROUND: The Scottish Executive (2005) in Scotland (UK), announced that a review of nursing in the community should be undertaken to inform implementation of the policy Delivering for Health. This policy called for a fundamental shift in the focus of care away from acute hospitals into the community where health care in the future will be concentrated. To inform this review of nursing in the community, the Scottish Executive commissioned a literature review. METHODS: An integrative literature review was carried out during 2006 (February to April). We carried out an extensive literature search using multiple electronic databases and hand-searched key texts to find suitable systematic reviews and primary quantitative and qualitative papers for review (1996-March 2006). We included English language publications describing systematic reviews and primary empirical research about community nurses' contributions to the health of people. FINDINGS: Seventy-three papers (12 systematic reviews and 61 studies) met our inclusion criteria. All of the studies were scored as either 'low' or 'medium' quality. None merited a 'high' quality rating. CONCLUSIONS: There is little research evaluating the impact of community nursing actions. Adequately resourced research is needed to strengthen the evidence base to support nurses in the community in delivering effective and efficient care that meet the health needs of people and communities.

Estimating core temperature in infants and children after cardiac surgery: a comparison of six methods.

BACKGROUND: Monitoring temperature in critically ill children is an important component of care, yet the accuracy of methods is often questioned. Temperature measured in the pulmonary artery is considered the 'gold standard', but this route is unsuitable for the majority of patients. An accurate, reliable and less invasive method is, however, yet to be established in paediatric intensive care work. AIM: To determine which site most closely reflects core temperature in babies and children following cardiac surgery, by comparing pulmonary artery temperature to the temperature measured at rectal, bladder, nasopharyngeal, axillary and tympanic sites. METHOD: A convenience sample of 19 postoperative cardiac patients was studied. INTERVENTIONS: Temperature was recorded as a continuous measurement from pulmonary artery, rectal, nasopharyngeal and bladder sites. Axillary and tympanic temperatures were recorded at 30 minute intervals for 6 1/2 hours postoperatively. STUDY LIMITATIONS: The small sample size of 19 infants and children limits the generalizability of the study. RESULTS: Repeated measures analysis of variance demonstrated no significant difference between pulmonary artery and bladder temperatures, and pulmonary artery and nasopharyngeal temperatures. Intraclass correlation showed that agreement was greatest between pulmonary artery temperature and temperature measured by bladder catheter. There was a significant difference between pulmonary artery temperature and temperature measured at rectal, tympanic and pulmonary artery and axillary sites. Repeated measures analysis showed a significant lag between pulmonary artery and rectal temperature of between 0 and 150 minutes after the 6-hour measurement period. CONCLUSIONS: In this study, bladder temperature was shown to be the best estimate of pulmonary artery temperature, closely followed by the temperature measured by nasopharyngeal probe. The results support the use of bladder or nasopharyngeal catheters to monitor temperature in critically ill children after cardiac surgery.