A model to advance nursing science in trauma practice and injury outcomes research

Aims: This paper presents a model to advance nursing science and practice in trauma care. Background: The continuum of clinical care provided to trauma patients extends from the time of injury through to long-term recovery and final outcomes. Nurses bring a unique expertise to meet the complex physical and psychosocial needs of trauma patients and their families to influence outcomes across this entire continuum. Data Sources: Literature was obtained by searching CINAHL, PubMed and OvidMedline databases for 1990 – 2010. Search terms included trauma, nursing, scope of practice and role, with results restricted to those published in English. Manual searches of relevant journals and websites were undertaken. Discussion: Core concepts in this trauma outcomes model include environment, person/family, structured care settings, long term outcomes and nursing interventions. The relationships between each of these concepts extend across all phases of care. Intermediate outcomes are achieved in each phase of care and influence and have congruence with long term outcomes. Implications for Policy and Practice: This model is intended to provide a framework to assist trauma nurses and researchers to consider the injured person in the context of the social, economic, cultural and physical environment from which they come and the long term goals that each person has during recovery. The entire model requires testing in research and assessment of its practical contribution to practice. Conclusion: Planning and integrating care across the trauma continuum, as well as recognition of the role of the injured person’s background, family and resources, will lead to improved long term outcomes

Structures, processes and outcomes of specialist critical care nurse education: An integrative review

Objectives: The objective of this study was to review and synthesise international literature to reveal the contemporary structures, processes, and outcomes of critical care nurse (CCN) education. Method: An integrative review on specialist critical care education was guided by Whittemore and Knafl's integrative review steps: problem identification; literature search; and data evaluation, analysis, and presentation. Donabedian's Quality Framework (Structure-Process-Outcome) provided a useful analytical lens and structure for the reporting of findings. Results: (1) Structures for CCN education incorporated transition-to-practice and ongoing education programs typically offered by hospitals and health services and university-level graduate certificate, diploma, and masters programs. Structural expectations included a standard core curriculum, clinically credible academic staff, and courses compliant with a higher education framework. Published workforce standards and policies were important structures for the practice learning environment. (2) Processes included incremental exposure to increasing patient acuity; consistent and appropriately supported and competent hospital-based preceptors/assessors; courses delivered with a flexible, modular approach; curricula that support nontechnical skills and patient- and family-centred care; stakeholder engagement between the education provider and the clinical setting to guide course planning, evaluation and revalidation; and evidence-based measurement of clinical capabilities/competence. (3) Outcomes included articulation of the scope and levels of graduate attributes and professional activities associated with each level. The role of higher degree research programs for knowledge creation and critical care academic leadership was noted. Conclusions: Provision of high-quality critical care education is multifaceted and complex. These findings provide information for healthcare organisations and education providers. This may enable best practice structures and processes for critical care specialist training that meets the needs of industry and safely supports developing CCN expertise. There is an acknowledged tension between the expectations of governing bodies for policies, standards, and position statements to enhance quality and reduce care variance and the availability of high-quality evidence to underpin these across international contexts

Family presence during resuscitation: a narrative review of the practices and views of critical care nurses

Background The option of family presence during resuscitation was first presented in the late 1980s. Discussion and debate about the pros and cons of this practice has led to an abundant body of international research. Aim To determine critical care nurses’ experiences of, and support for family presence during adult and paediatric resuscitation and their views on the positive and negative effects of this practice. Methods A narrative literature review of primary research published 2005 onwards. The search strategy comprised an electronic search of three bibliographic databases, supplemented by exploration of a web-based search engine and hand-searching. Results Twelve studies formed the review. Research primarily originated from Europe. The findings were obtained from a moderately small number of nurses, and their views were mostly based on conjecture. Among the factors influencing family presence during resuscitation were dominant concerns about harmful effects. There was a noticeable absence of compliance with recommended guidelines for practice, and the provision of a unit protocol or policy to assist decision-making. Conclusion A commitment to family-centred care, educational intervention and the uptake of professional guidance are recommended evidence-informed strategies to enhance nurses’ support for this practice in critical care.Published versio

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

How can we meet the support needs of LGBT cancer patients in oncology? A systematic review

Objectives Approximately 3.6 million people in the UK identify as lesbian, gay, bisexual and transgender (LGBT). Fear of discrimination and lack of sexual orientation and gender identity recording suggests LGBT people are invisible to health services. A systematic review was conducted to critically analyse primary research investigating psychosocial support needs for LGBT cancer patients during and after treatment. Key findings Twenty studies were included in the review; of which ten were qualitative, seven quantitative and three mixed methods. The main themes highlighted include health care professional knowledge and education, negative impact on mental health, lack of inclusive support groups, prevalence of discrimination within healthcare services and the disclosure or non-disclosure of sexual orientation and gender identity. Conclusion The review highlights how healthcare providers are failing LGBT cancer patients in psychosocial support resulting in unmet needs. Recommendations have been made to ensure an LGBT inclusive environment within cancer services, as well as the need to develop support services for LGBT cancer patients. Implications for practice Training should be provided for HCP staff in LGBT health and awareness. Sexual orientation and gender identity recording and monitoring is important to ensure LGBT people are not ‘invisible’ in oncology, radiotherapy and in future research. LGBT cancer support groups and resources should be created, as the review evidence suggests LGBT patients are actively looking for these resources