bluuebunny/crossref_metadata_2025_split huggingface dataset:
Working with resistance, tension and objectivity: Conducting a randomised controlled trial of a nursing intervention for breathlessness
Authors: Plant Hilary , Bredin Mary , Krishnasamy Meinir , Corner Jessica 
Published: March 2006

It is vital that nurses wishing to recommend or introduce new strategies are able to provide supporting evidence that is acceptable to their colleagues. The methodology from which to derive such evidence remains to be clearly defined, as the research process is complex, demanding and, to a certain extent, uncharted. This paper examines the experience of nurses collaborating in a multi-centre randomised controlled trial which evaluated a nursing intervention for the management of breathlessness in patients with lung cancer. The study raised several important methodological issues: resistance among colleagues to innovative nursing practice; the difficulty of measuring well-being in patients whose physical condition is deteriorating; maintaining uniformity of practice within a diverse group of collaborating nurse researchers; and the tension between the nursing role and the necessity of an ethically demanding research design. Analysis of the process of conducting a randomised controlled trial produced valuable insights which indicated the kind of support required to undertake research and successfully implement a new intervention into clinical practice. The study also highlighted the problems associated with asking ill people to complete standard measurement tools, particularly when such instruments might not be sensitive to the reality of the patient(s) problem, in this case, the experience of breathlessness.
Older patients' experiences of pre-treatment discussions: An analysis of qualitative data from a study of colorectal cancer
Authors: Bailer Christopher 
Published: March 2006

It has been suggested that cancer in the elderly is badly treated and that criteria other than chronological age should form the basis for treatment decisions. A study was conducted to discover whether there were age-related differences in the treatment received by a sample of older people with colorectal cancer, and to determine whether any differences were related to patterns of functional status. It was recognised that involvement in treatment decisions may be influenced by contextual factors, therefore additional qualitative data were collected from patients themselves. Responses to semi-structured questions from 337 patients aged 58-95 years were analysed in the light of previous research, which suggests that only a minority want to share equally in medical decision-making with clinicians. Our aim was to determine whether a similar pattern was apparent in patients' responses, and to develop understanding of the determinants of involvement in treatment decision-making. The analysis suggests that patients often lack a sense of agency in the face of disease- and treatment-related events, and that many do not believe they possess the relevant knowledge or authority to act positively in these circumstances. Concerns remain about the losses involved in taking a dependent approach and about the extent to which resisting dependency is possible.
Clinical guidelines in community hospitals
Authors: Anthony Denis , Brooks Nicola 
Published: March 2006

Nineteen F and G grade nurses, one practice development nurse, two physiotherapists and two occupational therapists working in 11 community hospitals in Leicestershire and Rutland were interviewed about their use of clinical guidelines and their attitude towards them. They were asked questions about sources of clinical guidelines, and a simple gap analysis was carried out. The interviewees were able to identify clinical guidelines that were used locally, and human and organisational resources of guidelines: resource rooms, practice development nurses, link nurses and study days. The use of link nurses, and regular study days, both of which provide cascade learning, work well. Furthermore, in the opinion of the ward nurses, the practice development nurse has a useful role in making nurses aware of guidelines. Generally, the responses about the use of clinical guidelines were positive, although some reservations were noted. There was agreement that regular professional meetings and ward hand-overs provide a natural and effective dissemination route. The interviewees were not aware of any national clinical guidelines. Despite many of the interviewees having access to the internet (generally from home rather than from the hospitals), none could identify any online resources for clinical guidelines or knew that they existed.
Young people and alcohol
Authors: Plant Martin , Plant Moira 
Published: March 2006

The topic of young people drinking, and its related problems, continues to foster concern and controversy. This review highlights some of the main psychological, social and behavioural evidence related to the formation of children's attitudes to alcohol, the acquisition of drinking habits by young people and factors associated with patterns of alcohol consumption and its consequences. Some of the implications of this evidence are highlighted, and recommendations are suggested to curb levels of heavy/inappropriate drinking among youth. Many children are hostile to alcohol consumption by adults. The onset of adolescence generally reverses such negative attitudes and drinking is widely viewed by teenagers and young adults in a positive light as a symbol of being adult and sociable. Many young people drink to intoxication as part of the process of learning how to drink. Recent studies show that rates of heavy drinking, intoxication and negative consequences among teenagers vary considerably in different countries. Teenagers in north west Europe (including Denmark, Finland, Iceland, Ireland and the UK) report the highest rates, while those in the Mediterranean area report much lower ones. It is concluded that a sensible approach by parents should involve teaching their children to drink in moderation at home and that parents should set boundaries to control and protect their children from harm associated with periodic heavy drinking. School-based alcohol education has generally produced disappointing results and it is suggested that harm minimisation policies should be devised that are relevant to young people.
Nursing and midwifery research in England: Working towards establishing a dedicated fund
Authors: Rafferty Anne-Marie , Newell Rob , Traynor Michael 
Published: March 2006

This paper considers the case for establishing a strategic fund for research in nursing, midwifery and health visiting, and for building capacity in the field. It reviews the key policy documents and staging posts in the process and argues that both professional push and policy pull factors have provided the key catalyst for change. The role and responsibilities of nurses, midwives and health visitors are increasing in the light of government policies and professional aspirations. An appropriate evidence base is essential to understanding, undertaking, commissioning and implementing research. Research capacity-building needs to be integrated into wider strategic plans for the profession, as well as R&D policy per se. Establishing a fund to develop high-calibre research is only the beginning of a much longer process to give nursing research greater influence. Researchers, educators, managers and clinicians need to join forces to build strong communities and strengthen their links with patient and user groups. However, the investment in nursing and midwifery R&D will have failed if it benefits the professional community only. Patient care needs to be part of what could be termed 'payback' for investment and it is essential to develop an evaluation strategy capable of measuring a range of impacts from the outset.
Facilitating practitioner research through critical companionship
Authors: Titchen Angie , McGinley Maeve 
Published: March 2006

The investigation of practice by practitioners themselves is growing in nursing. It is now expected of many nurses that they will carry out research as part of their everyday practice, for example, in the case of consultant nurses. Nurses are also expected today to provide evidence-based care for their patients and their carers. Researching one's own practice, providing care based on rigorously gained knowledge of many types and giving a professional account of that practice are challenging activities for which many nurses need support. Based on that premise, this paper explores 'critical companionship' (Titchen, 2000; RCN, 2003), which can be described as a helping relationship based on trust, high challenge and high support, in which an experienced practitioner accompanies a less experienced practitioner on a learning journey. It is a means of enabling nurses to acquire, experientially, the knowledge and skills required for patient care and its development. The concept of critical companionship is described within the context of a practitioner learning to investigate the nature and development of her own professional knowledge base and to transform her findings into potentially transferable ones. Findings relating to therapeutic use of self and its impact on patients are offered as an exemplar of this transformation process. In addition, a new conceptual framework for blending all types of knowledge through professional artistry is described. Collaborative testing of this framework within a critical companionship relationship is shown. It is concluded from this piece of practitioner research that professional artistry is essential for genuinely evidence-based, person-centred care, and that it can be facilitated through critical companionship. The conclusion is also made, based on our own and others' work, that critical companionship is effective in enabling practitioners to gather, analyse and critique evidence from their own practice and to articulate this evidence to peers for critical scrutiny, public review and knowledge creation. The benefits of critical companionship for patients and carers are described.
An exploration of the possible causes of occlusion problems in skin-tunnelled catheters used in paediatric oncology
Authors: Gordon Kim , Lloyd Andrew 
Published: March 2006

Occlusion in children's skin-tunnelled catheters throughout the course of treatment for malignant disease can lead to increased physical and psychological stress. A two-phase study at a paediatric oncology centre aimed to identify the factors associated with occlusion in children's skin-tunnelled catheters. The statistical findings show that occlusion problems were significantly more likely to occur in two groups of patients: those receiving dexamethasone as part of their treatment protocol, and children whose parents did not flush the line at home. In addition, the survey indicated that occlusion in skin-tunnelled catheters is a far more frequent problem than had been previously recognised. Further work is needed both to verify which factors are important and to guide future care of children with these catheters.
An evaluation of nurses' record-keeping skills and knowledge of using patient group directions for antibiotics at a walk-in centre
Authors: Brooks Nicky , Darmnng Frank , Bell Ian , Charles Joanne 
Published: March 2006

Patient group directions (PGDs) are now an integral feature of walk-in centres (WiCs), enabling nurses to supply and administer drugs to the generalised direction of a doctor rather than by means of a patient-specific prescription. The aims of the study described here were to assess nurses' record-keeping and knowledge with regard to PGDs for antibiotics implemented at a local WiC. The study methods included undertaking a clinical audit of patient records between October 2000 and March 2001 and an assessment of nurses' knowledge using multiple-choice questionnaires, vignettes and shadowing consultations. A total of 1,169 patients was supplied antibiotics, 72% of which were provided by nurses using a PGD. Nearly 100% of patients were supplied antibiotics correctly according to drug and dose; however, in only 63% of cases was there recorded evidence that allergy or contraindications were checked before the antibiotic was supplied. The study found that 51% of the required assessment criteria were recorded on the computer records. Nurses' knowledge at baseline resulted in a median score of 70%, which rose to 79% following educational interventions. The study suggests that nurses are knowledgeable and supply antibiotics judiciously in terms of drug and dose, but that in terms of clinical governance there is room for improvement in record-keeping.
High, medium, and low security care: Does the type of care make any difference to the role of the forensic mental health nurse?
Authors: Dale Colin , Storey Les 
Published: March 2006

This paper describes a survey of the educational preparation of nurses working in high, medium and low security mental health settings. Data from focus groups and interviews were also content-analysed to yield a theory of nursing in secure environments comprising of statements of competency. The competences were translated into a questionnaire and distributed to nurses working in high, medium and low security mental health settings. Respondents stated whether individual competences were part of their current practice or supervisory involvement, and the degree of importance they accorded to each competency. The competence framework received widespread support from nurses at all levels of security in relation to their role description and level of importance. Results identified issues in relation to security and how procedures in parts of the system (notably in high security) militate against therapeutic care. Noticeable differences emerged between respondents working in high and medium secure environments in relation to involvement of the patient's family and preparation for discharge. Issues of concern common to all levels of security included teamwork, balancing security and therapy, boundaries of professional practice, and clinical supervision.
Safety and security procedures in psychiatric acute admission wards
Authors: Cowman Seamus , Walsh Jim 
Published: March 2006

Violence and assaultive behaviour is a serious and growing problem in psychiatric services across the world. Despite many concerns about violence and assault in healthcare, there is an alarming lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. This paper describes the safety and security measures in psychiatric acute admission wards in the Republic of Ireland and may be considered to be representative of acute psychiatric settings in other jurisdictions. A population study was undertaken, which included all psychiatric acute admission wards in the Republic. A descriptive survey research design was adopted, with the use of a questionnaire for data collection. The questionnaire was analysed using SPSS (version 11) and descriptive statistics were used to present the results. There was wide variation in safety and security practices across the wards. Measures aimed at ensuring staff security were also lacking, with no overall acceptable minimal standards discernible. It may be concluded that there is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards. One has to ask to what extent the disparate practices in safety and security revealed in the results of the study account for the escalation in violent episodes and assaultive behaviour in psychiatric services in recent years.
Pelvic Varices Mimnicking Placenta Percreta at Sonography
Authors: Russ Paul D. , Tomaszewski Garin , Coffin Carolyn 
Published: March 2006

Abnormal placentation refers to pathologic adherence of the placenta to the uterus.1-3 Three subtypes are defined based on depth of myometrial invasion by nonneoplastic chorionic villi. Superficial, deep, and transmural involvement are termed placenta accreta, increta, and percreta, respectively. Of the three, placenta percreta is the rarest type, occurring with a frequency of only 1:33,000-90,000 deliveries.3 The antepartum diagnosis of placenta percreta is crucial because the associated vascular involvement of the myometrium and surrounding pelvic structures can result in massive blood loss, fetal demise, and maternal death at delivery. An imaging feature of placenta percreta is the sonographic demonstration of abnormal vascularity within the placenta, subplacental complex, and adjacent organs such as the bladder.1,2,4-8 Pelvic varices are dilated veins (T 5 mm) that can occur during pregnancy or in non pregnant women.9'-5 These enlarged veins commonly involve the broad ligaments and parametrium, and, as a result, they often abut or surround the uterus, lower uterine segment, and cervix. Although pelvic varices can be prominent, they rarely cause obstetrical complications (Gibbs R, personal communication). We report a case of pelvic varices mimicking placenta percreta with bladder invasion. The antenatal diagnosis of placenta percreta radically altered the patient's management. Although only unusual pelvic varices were subsequently documented at cesarean hysterectomy, the extremely cautious care necessitated by the presumptive sonographic diagnosis of placenta percreta was warranted to avoid a potential obstetrical catastrophe.
Sonographic Evaluation of the Two Vessel Umbilical Cord
Authors: Bornemeier Shaun , Carpinito Lisa A. , Winter Thomas C. 
Published: March 2006

Evaluation of the umbilical cord is an important part of a fetal ultrasound examination. The gold standard for documenting the umbilical cord has been an axial section of a free loop of umbilical cord within the amniotic fluid. There are normally two umbilical arteries and one umbilical vein, but in approximately 1% of pregnancies, only one umbilical artery is present. The presence of a two vessel umbilical cord or a single umbilical artery has been associated with an increase in other fetal abnormalities. When axial views of the umbilical cord are not obtainable, it is common practice to use color Doppler to determine the presence or absence of the umbilical arteries as they course adjacent to the fetal bladder. The three-vessel cord is confirmed by identifying the right and left umbilical arteries on each side of the bladder. This study compared axial views of free-floating two vessel umbilical cords with color Doppler evaluation of the umbilical arteries adjacent to the bladder and attempted to answer three questions regarding the single umbilical artery: 1) Does the presence of two umbilical arteries next to the fetal urinary bladder validate the documentation of a three vessel umbilical cord; 2) When one umbilical artery was absent, was there a prevalence as to which side was affected; and 3) Does the side of the absent umbilical artery correlate with an increase or decrease in risk for other anomalies? This study showed that there were three sonographic variations with respect to a two vessel umbilical cord when axial gray scale images of the umbilical cord were compared with color Doppler images of the umbilical arteries adjacent to the fetal urinary bladder. The most prevalent variation, occurring in 17 (49%) of 35 cases, was the two-vessel cord with the left umbilical artery absent. The right umbilical artery was absent in 13 (37%) of 35 cases. The third and least prevalent variation, occurring in five (14%) of 35 cases, was a two vessel umbilical cord with both umbilical arteries present adjacent to the fetal urinary bladder. Each of the single umbilical artery variations in the study were associated equally with other sonographically identifiable abnormalities. We conclude that a two vessel umbilical cord may be missed by relying solely on color Doppler views of the umbilical arteries adjacent to the bladder.
Emergency Department Visits for Injury in School‐aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment
Authors: Linakis James G. , Amanullah Siraj , Mello Michael J. 
Published: March 2006

Abstract
Objectives:
To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same‐aged children who were injured outside of school.
Methods:
Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury‐related ED visits were analyzed for patients who were 5 through 19 years of age.
Results:
There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school‐aged children (ages 5–19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school‐aged children when location of injury was known). Males accounted for 63% of injuries at school; middle‐school children (ages 10–14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary‐ (5–9 yr, 24%) or secondary‐school (15–19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary‐school children were injured most (40%), followed by middle‐ (32%) and primary‐aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school‐aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001).
Conclusions:
A significant proportion of injuries to school‐aged children occur at school. Notable differences exist between the epidemiology of in‐ and out‐of‐school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.
Screening for Adolescent Depression in a Pediatric Emergency Department
Authors: Scott Emily Gale , Luxmore Brett , Alexander Heather , Fenn Robin L. , Christopher Norman C. 
Published: March 2006

Abstract
Objectives:
To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms.
Methods:
The Beck Depression Inventory–2nd edition (BDI‐II) was used to screen all patients 13–19 years of age who presented to the ED during the period of study. The BDI‐II is a 21‐item self‐report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening‐program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health).
Results:
Four hundred eighty‐seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n= 192, 55%), mild (n= 52, 15%), moderate (n= 41, 11%), or severe depressive symptoms (n= 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI‐II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms.
Conclusions:
Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression.