British Journal of Nursing最新文献

Advanced clinical practitioners (ACPs) are integral to modern healthcare, providing high-quality, evidence-based care to patients. While ACPs show some development in clinical practice, leadership, and education, challenges persist in the research pillar. Trainee and qualified ACPs often have difficulties initiating their research journey and may feel uncertain about where to start. Existing studies have explored and emphasised the importance of ACPs developing and maintaining their research skills, yet there remains a gap in understanding how they can effectively demonstrate their research capabilities. Therefore, this article aims to help trainees and qualified ACPs on how to evidence their research pillar capabilities.

Background: Patients admitted on the day of surgery are asked to arrive fasted, and they often fast for longer than necessary. Although pre-assessment supports patients to prepare for surgery, little is known about how they make fasting decisions.

Aims: To explore factors influencing the fasting decisions of day-case patients and how to provide information pre-operatively.

Methods: A qualitative descriptive study design was used. Semi-structured telephone interviews were carried out with 10 patients recruited from a single day-case unit. Data were analysed using thematic analysis.

Findings: Three themes provided context for fasting decisions: the operation as a serious event; the patient as an active partner; and the patient as a rule follower. Length of fast is determined by fasting decisions and practicalities.

Conclusion: Patients approach fasting decisions according to their knowledge and experience and their individual preferences for information. Pre-assessment nurses should tailor information to the patient and explain the rationale for fasting.

Background: The significance of vascular access devices for patients in the emergency department (ED) is undeniable. When it comes to evaluating the effectiveness of interventions, randomised controlled trials (RCTs) stand out as the most reliable sources of evidence compared with other study designs.

Aim: To explore and synthesise the findings from RCTs related to vascular access devices in the ED setting.

Methods: A systematic search will be conducted in electronic medical databases including the Cochrane Central Register of Controlled Trials, Pubmed, CINAHL and Embase databases. All RCTs focusing on peripheral intravenous catheters, central venous catheters and intraosseous catheters, published in English and Chinese in peer-reviewed journals within the past decade, will be included.

Conclusion: This scoping review will summarise the current state of evidence for vascular access devices in the ED setting. This will identify gaps in the literature and, in turn, assist clinicians and researchers in pinpointing areas for future exploration and provide a valuable guide for future research.

Background: Poor access to lymphoedema specialists and communication between them and patients prevents appropriate lymphoedema management. Therefore, development and dissemination of remote systems is necessary to improve care in rural areas with limited medical personnel or access to medical coordination.

Aims: The authors evaluated the elements required for providing patient education on conservative therapy for lymphoedema, to determine the feasibility of remote management.

Methods: The study involved connecting a health professional in a local clinic (point A) treating a patient with lymphoedema, who was present alongside the clinician, with a specialist certified lymphoedema therapist (CLT) located remotely in a university (point B).

Findings: The CLT was able to greet, interview and provide guidance to the patient on conservative therapy. Direct contact with the patient was not possible, which limited visualisation, palpation, leg circumference measurement, and lymphatic drainage management.

Conclusion: The findings suggest that remote a lymphoedema management approach involving conservative therapy benefits both patients and health professionals, particularly in rural regions. Future studies are needed to confirm the effectiveness of this approach to confirm adequate treatment.

Reliance on digital technology may have implications for our social and economic wellbeing, including factors such as health, environmental quality, social interaction, and educational levels. Although there may be concerns, it is important to acknowledge that digital technology also offers immediate, cost-effective and accessible solutions that are transforming various services. The COVID-19 pandemic, through the disruption of educational systems worldwide, has accelerated the transformation of higher education, leading to changes in the way it is perceived. However, there is a lack of understanding regarding the relationship between digital poverty, digital literacy, and students' online experiences. This article aims to explore the engagement of nursing students in online learning post COVID.

Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, describes how compassionate leadership results in engaged and motivated staff, in turn leading to high-quality care.

Background: Young people receiving cancer treatment in the South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network usually receive care across two or more NHS trusts, meaning transition into adult services can be challenging.

Aim: To develop a planned, co-ordinated approach to transition across the network that meets National Institute for Health and Care Excellence guidance recommendations for transition and the cancer service specifications.

Methods: A 2-year, nurse-led quality improvement (QI) project, using the principles of experience-based co-design.

Outcomes: The QI project resulted in the development of six key principles of practice; refining and testing of a benchmarking tool; initiatives to facilitate first transition conversations; and the launch of an information hub.

Conclusion: Robust QI processes, cross-network collaboration and wide stakeholder involvement required significant resource, but enabled deeper understanding of existing pathways and processes, facilitated the establishment of meaningful objectives, and enabled the testing of interventions to ensure the project outcomes met the needs of all stakeholders.

Clinically assisted nutrition and hydration (CANH) decision-making in adult patients presents complex ethical dilemmas that require careful consideration and navigation. This clinical review addresses the multifaceted aspects of CANH, emphasising the importance of ethical frameworks and the role of advanced clinical practitioners (ACPs) in guiding decision-making processes. The pivotal role of ACPs is highlighted, from their responsibilities and challenges in decision-making to the collaborative approach they facilitate involving patients, families and multidisciplinary teams. The article also explores ethical principles such as autonomy, beneficence, non-maleficence, and justice, elucidating their application in CANH decision-making. Legal and ethical frameworks covering CANH are examined, alongside case studies illustrating ethical dilemmas and resolutions. Patient-centred approaches to CANH decision-making are discussed, emphasising effective communication and consideration of cultural and religious beliefs. End-of-life considerations and palliative care in CANH are also examined, including the transition to palliative care and ethical considerations in withdrawal or withholding of CANH. Future directions for research and implications for clinical practice are outlined, highlighting the need for ongoing ethical reflection and the integration of ACPs in CANH decision-making.