Search

Aim: To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. Design: Longitudinal qualitative study. Methods: Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. Results: Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. Conclusion: Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a ‘deaf’ or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. Impact: Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. Patient or Public Contribution: Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design.

To explore nurses' and midwives' experiences, views, perceptions and impact on their responses to out of work emergencies where first aid may be required.A constructivist grounded theory study was conducted between 2012 and 2019.In-depth, semi-structured interviews were undertaken with 16 nurses and midwives. Participants were recruited via a participant referral process with registered nurses and midwives being accessed from three NHS organizations. Data were analysed and coded using constant comparative analysis with the support of Nvivo 10 software leading to the construction of a substantive grounded theory.A core enduring in vivo theme, 'The Right Thing to Do', emerged as a central conceptual reality constructed via three key in vivo themes; 'Something I've Heard', 'Am I Covered?' and 'Just Who I Am', each with several sub-themes. A pervading anxiety about responding at off-duty situations requiring first aid was persistently evident across these themes.The study showed a strong sense of moral agency among nurses and midwives, despite a powerful underlying feeling of anxiety surrounding broader issues of urban myth, protection and personal and professional identity. The substantive theory emerged as 'doing "The Right Thing" in a climate of anxiety'.The study illuminates an area that has previously been the subject of anecdotal debate. The substantive theory, 'doing "The Right Thing" in a climate of anxiety' illustrates the issues and tensions that exist surrounding the off-duty response. Implications and recommendations for practice and education focus on the fostering of knowledge and understanding of professional identity, position in law and scope of practice, together with potential future research directions. This work provides the first in-depth qualitative study contributing a significant new perspective both nationally and globally.

Aims: To explore younger adults' experiences of stroke rehabilitation to inform practice, education and future health policy. Design: Qualitative analysis of digital and other media sources on public platforms. Methods: Between March and June 2020, the experiences of younger adult stroke survivors aged 18 to 45 at the time of the stroke were collected. Data were gathered from publicly available sources, including social media, and from English-speaking users. In total, 117 accounts from 103 participants were identified from films, autobiographical books, blogs, websites, videos, Twitter and Instagram. Data analysis followed narrative and multimodal analysis with a focus on rehabilitation needs. Results: Younger adult stroke survivors make sense of their experience by reflecting on how stroke has impacted their lives. Accounts reflected an emotional journey between the past self, the present self and evolving self, as well as associated challenges such as the impact on relationships and careers. The majority of accounts presented transitions as problematic, including the receipt of the initial diagnosis, or sometimes misdiagnosis, to returning home and achieving long-term rehabilitation goals. Specialist stroke nurses were considered essential in the rehabilitation process. Conclusion: A complex process of recovery follows stroke for younger adult stroke populations. Challenges to the rehabilitation process need to be better understood and the role of nursing highlighted in future service provision. A series of age-related challenges were highlighted that require attention to improve the care and support offered. Impact: This article informs clinicians, educators, and policymakers of the age-related needs of young adult stroke survivors. Focusing on the individual and the development of age-appropriate person-centred stroke care is important. The study highlights the role of stroke nursing and challenges the current policy focus on older stroke populations as well as arguing for greater awareness of age-appropriate stroke rehabilitation in younger adults following stroke.

Background: A skilled, knowledgeable, and compassionate nurse workforce is pivotal to caring well for older people living in care homes. This requires the provision of continuing professional development and career planning for nurses, which are key also for nurse recruitment and retention. Continuing professional development and career planning strategies and interventions should be evidence-driven. Objective: To identify the extent, range and nature of contemporary evidence regarding professional development and career planning for nurses caring for older people living in care homes. Methods: The methodological framework used was the Joanna Briggs Institute guidance for scoping reviews. The PRISMA extension for scoping reviews was used as the reporting framework. Four databases were searched from January 2010 to July 2021. Results were screened independently by two reviewers using eligibility criteria. Full texts and the reference lists of eligible articles were reviewed. Data were extracted for key elements from the 25 articles included. Results: Of the 25 articles, the majority were authored in the United States (n = 10) and UK (n = 8) with the remaining from Australia (n = 3), Canada (n = 3) and the Netherlands (n = 1). Four articles reported on professional development programmes. Three literature reviews addressed challenges for nurse participation in professional development, experiences of care home nurses as clinical leaders and managers, and leadership. Two expert commentaries reported on the challenges related to professional development and career planning for care home nurses. Sixteen empirical studies investigated a range of topics including: competencies, roles, intention to stay and leave, continuing professional development, and leadership. Key emergent factors that support professional development and career planning were as follows: access to structured learning opportunities addressing knowledge and skills specific to nursing frail older adults, a supportive working environment including adequate staffing, study time and flexible working, and integration of leadership development. Conclusions and implications for practice: This scoping review has highlighted factors that support and challenge professional development and career planning for nurses working in the care home sector. There remain important gaps in the opportunities for professional development and career planning for care home nurses that warrant attention.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of interventions for treating or managing faecal incontinence (FI) in older people living in care homes; and to critically appraise and summarise current evidence on the associated resource use, costs and cost‐effectiveness. Note: we are covering treatment (interventions aiming to cure or improve symptoms) and management (interventions aiming to contain symptoms, such as pads or anal plugs, or reduce effects of symptoms, such as skin protection) of FI. Prevention of FI in those who do not currently have the symptom is beyond the scope of this review.

SUMMARY A woman aged 40 who had given birth to seven mentally retarded children was diagnosed as having phenylketonuria. Her blood phenylalanine was 18mg/100ml. All the children were microcephalic and retarded in growth, and characteristic facies, skeletal and ear abnormalities were found. Two of the children had Fallot's tetralogy, and one of these two had infantile spasms. Mild diffuse abnormalities were present in the electroencephalograms of four of the children. The findings reinforce the need for careful dietary treatment of pregnant women with phenylketonuria. RESUME Chez une femme de 40 ans ayant donne naissance a sept enfants arrieres mentaux, on a pu porter le diagnostic de phenylcetonurie. Son taux sanguin de phenylalanine etait de 18mg/100ml. Tous les enfants etaient microcephaliques, retardes dans leur croissance, et presentaient un facies caracteristique, des anomalies du squelette et de l'oreille. Deux des enfants avaient une tetralogie de Fallot et chez l'un de ces deux derniers, on notait des spasmes infantiles. Des anomalies diffuses moderees etaient presentes sur les eeg de quatre des enfants. Ces fails renforcent la necessite d'un traitement dietetique soigneux chez les femmes enceintes presentant une phenylcetonurie. ZUSAMMENFASSUNG Eine Frau im Alter von 40 Jahren, die sieben geistig retardierte Kinder geboren hatte, wurde als Phenylketonurikerin diagnostiziert. Ihr Blutphenylalaninspiegel betrug 18mg/100ml. Alle Kinder waren mikrocephal, mindenvuchsig und hatten eine charakteristische Facies und Skelett-und Ohrmisbildungen. Zwei der Kinder hatten eine Fallot'sche Tetralogie und eines davon hatte Neugeborenenkrampfe. Leichte diffuse Veranderungen im eeg fanden sich bei vier Kindern. Die Befunde machen erneut sehr deutlich, das eine sorgfaltige diatetische Uberwachung einer schwangeren Frau mit einer Phenylketonurie erforderlich ist. RESUMEN Una mujer de 40 anos que habia dado a luz siete ninos mentalmente retardados fue diagnosticada de fenilcetonuria. La fenilalanina de su sangre era de 18mg/100ml. Todos los ninos eran microcefalicos y con crecimiento retardado, con facies caracteristica y anomalias esqueleticas y de oreja. Dos de los ninos tenian tetralogia de Fallot y uno de estos dos tenia espasmos infantiles. Habian anomalias difusas ligeras en los eeg de cuatro de los ninos. Los hallazgos refuerzan la necesidad de un cuidadoso tratamiento dietetico de las gestantes con fenilcentonuria.

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

Chitosan is a natural polymer composed of randomly distributed -(1-4)-linked D-glucosamine (deacetylated unit) and Nacetyl-D-glucosamine (acetylated unit). It has been described as a non-toxic, biodegradable and biocompatible polymer with very interesting biological properties, such as permeation-enhancing and mucoadhesive properties, anticoagulant and antimicrobial activity and so on. Chitosan has been used in several areas such as biomedical, pharmaceutical and biotechnological fields as well as in the food industry. Recently, there has been a growing interest in the modification of chitosan to improve its solubility in physiological conditions, to introduce new applications or to improve chitosan biological properties. Research and development on a variety of amphiphilic copolymers containing hydrophobic and hydrophilic segments, have been very active due to their spontaneous self-assembly behaviour in aqueous media These smart transitions often lead to diverse functional compartment structures like micelles, vesicles and gels, which represent promising applications in the field of biotechnology and pharmaceutics. The aim of the present paper is to review the latest advances in the synthesis of chitosan amphiphilic derivatives with a special emphasis in their applications.

BACKGROUND: The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. This is an update of an earlier review published in The Cochrane Library in Issue 3, 2004. OBJECTIVES: To determine whether nursing‐led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. SEARCH METHODS: We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. The initial search was done in January 2001. The register search was updated in October 2006, the other database searches were updated in November 2006 and the citation search was run in January 2007. SELECTION CRITERIA: Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Ten random or quasi‐random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality (OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher quality studies showed a larger non‐significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI ‐0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to ‐6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. AUTHORS' CONCLUSIONS: There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.

Summary The literature concerning dementia and disintegrative psychosis in childhood is reviewed. Two cases with different neurodegenerative disorders presenting with late juvenile onset psychiatric symptoms arc described. There appears little point in retaining the eponymous syndromes of de Sanctis and Heller. The diagnostic category of Progressive Disintegrative Psychosis is appropriate to describe the clinical psychiatric picture in these children. Because of the rarity of such conditions further collaboration between child psychiatrists, paediatiric neurologists and neuropathologists is needed to delineate further the psychiatric syndromes associated with the neurodegenerative disorders.

SUMMARY A negative replication of Nuffield's (1961a, b) neuropsychiatric correlation study is presented. Of 946 patients seen over a twelve-year period in the EEG Department of The Maudsley Hospital, 350 had spike abnormalities in their EEGs; however, only 22 patients had “pure” EEG patterns (unilateral temporal lobe spike; generalized 3 c/sec spike and wave; generalized, irregular spike and wave). Of these, 11 had only had a single EEG and a further 2 patients had normal follow-up recordings. The authors conclude that previously reported neuropsychiatric correlations based upon “pure” EEGs may be the result of chance finding only.