Journal of Clinical Nursing

Ski, Chantal F; Thompson, David R

doi: 10.1111/j.1365-2702.2010.03435.xpmid: 21320216

Holmes, Susan; Padgham, Nigel D

doi: 10.1111/j.1365-2702.2010.03585.xpmid: 21507089

Aim and objectives. To provide an overview of vertigo and its management and identify its impact on individuals to offer strategies for managing the condition. Background. Dizziness and vertigo are symptoms common to many pathologies/dysfunctions ranging from the benign to the potentially serious; many are poorly understood. Although rarely life‐threatening, vertigo is debilitating and significantly affects quality of life; it may be as disabling as paralysis or loss of a limb. Although 40–80% of cases remain unexplained, referral for specific investigation is rare. Design. A narrative literature review including descriptive, theoretical and empirical material reliant on the keywords ‘dizziness’ and ‘vertigo’ and the phrase ‘vestibular disorders’. This provided diverse information that was used to address the research questions. Results. Vertigo is a widespread and potentially distressing symptom that may arise at any age and be acute or chronic. For most, it resolves spontaneously; for others, dizziness persists, causing significant distress. Its management is challenging, especially when the underlying cause is unclear. Pharmacological interventions, physiotherapy, psychotherapy or, rarely, surgery can be used in its management. Few nursing studies are available, suggesting that nursing knowledge may be limited. Relevance to clinical practice. Although nurses may frequently encounter patients with vertigo, there are few relevant nursing studies in this area; few consider appropriate nursing interventions or approaches to patient care. The information provided reveals that understanding the full impact of the condition and identification of patients’ needs are essential to effective care. Some strategies to help affected patients are outlined. Conclusions. Vertigo, a widespread, often intractable condition, affects significant numbers of people; diagnosis and management can be challenging. Treatment, care and support must be selected on an individual basis taking individuals into account. The primary goals are to maintain physical status, psychosocial interaction and quality of life.

Morse, Megan; Procter, Nicholas

doi: 10.1111/j.1365-2702.2010.03574.xpmid: 21435054

Aims and objectives. The aim of this paper is to examine high‐level evidence in early intervention in psychosis and scope the potential role of the mental health nurse‐practitioner in the treatment of management of early psychosis. Background. Psychosis imposes complex symptoms that impact on the individual and their social network, often resulting in long‐term disability. As specialised early intervention in psychosis is emerging, the nurse‐practitioner role in mental health is also gaining momentum. The background literature highlights several critical synergies between nurse‐practitioners’ scope of practice and needs of patients with early psychosis. Design. Literature review. Method. Electronic databases including Cochrane Library, CINAHL, Medline, TRIP and EMBASE. Searching was limited to articles published between 1988–2009. Eligible studies were limited to systematic reviews and randomised controlled trials. Results. Two systematic reviews and five randomised controlled trials met the inclusion criteria. No studies were located which specifically addressed the nurse‐practitioner role in early psychosis. Conclusions. Specific interventions require further research but there is emerging evidence that specialised intervention for people in the early phase of psychotic illness is achievable and possibly essential. It is within the scope of practice of mental health nurse‐practitioners to ensure patient and carer education and support, adherence to medication and other treatments, promotion of social inclusion and social connectedness. Relevance to clinical practice. Mental health nurse‐practitioners have the potential to provide specialist support to meet the needs of this complex group. Central to this is an ability to build an evidence‐base around the treatment and management of people with early psychosis and deliver effective education and leadership across clinical, inter‐professional and organisational domains. The paper concludes by positing a set of recommendations for nurse‐practitioners in the field of early psychosis in the Australian mental health setting.

Luk, Andrew L

doi: 10.1111/j.1365-2702.2010.03622.xpmid: 21507090

Aims and objectives. This is a follow‐up study to investigate the long‐term effects of a holistic care programme for the rehabilitation of persons with serious mental illness. Perception of help from the programme and factors relating to the outcomes of the programme will also be studied. Background. This psychiatric rehabilitation programme in Hong Kong adopts a self‐help group (SHG) approach with holistic care emphasising on the physical, psychological, social and spiritual functioning of the programme participants. Design. A quantitative approach using a set of self‐administered questionnaires was adopted. Method. Data were compared with a quasi‐experimental study conducted in 2003 by Luk and Shek involving an experimental group and a control group. Results. All the outcome measures of participants were similar to that of the experimental group found in last study. When compared with the control group, it was found that participants had more hope than the control subjects. Help perceived from the programme included support, encouragement, enhancement of self‐confidence, spiritual assistance and reflection of values. Having a job is found to be a key factor relating to the outcomes of the programme participants. Conclusions. The programme is effective to provide some positive changes to its participants. Help is perceived by most participants and the programme is also useful to provide mutual support to participants in maintaining a job in the community, which is a paramount factor for rehabilitation. Relevance to clinical practice. A partnership model in SHG seems to be successful in providing support for the rehabilitation of persons with serious mental illness. Spiritual element should be incorporated into psychiatric rehabilitation programme to instil hope and meaningfulness of life. Nurses should be better educated in providing holistic care to individual clients and to a group.

Keskin, Gülseren; Engin, Esra

doi: 10.1111/j.1365-2702.2010.03669.xpmid: 21545572

Aim. This study aimed at evaluating depression and suicidal ideation and coping strategies with stress in patients receiving haemodialysis replacement therapy. Background. Patients undergoing haemodialysis treatment may often experience depression and accompanying suicidal ideation. Coping strategies with depression‐related suicidal ideation may require regular evaluation of the patient and the support of nurses. Design. A cross‐sectional descriptive study. Method. The sample consisted of 92 adults with an age range of 19–65 who had chronic renal failure and consecutively admitted to the Dialysis Center of Kadiköy and Dialysis Center of Kahraman in Turkey. Four instruments were used: Socio‐demographic Form, Beck Depression Inventory, Suicide Behaviors Questionnaire and Coping Strategies with Stress Inventory. Results. The points obtained from Beck Depression Inventory were above 17 (the cut‐off point) in 40·2% of the patients. There were positive correlations between depression and Suicide Behaviors Questionnaire (r = 0·469, p = 0·001), between patients’ age and depression (r = 0·43, p = 0·00) and suicidal ideation (r = 0·27, p = 0·01). Depression and behavioural disengagement had a positive correlation (p = 0·001, r = 0·410). Depression and suicidal ideation increased with lower education status (F = 7·42, p = 0·001; F = 4·51, p = 0·014). Conclusion. Haemodialysis patients frequently experience depression. This study demonstrated that suicidal ideation increased as the severity of depression increased. Depression and suicidal ideation were increasing with age in patients with chronic renal failure. Therefore, it is considered necessary for dialysis patients to be under regular psychiatric evaluation with risk assessment. Relevance to clinical practice. It is vitally important that nurses in dialysis centres evaluate the psychosocial conditions of patients with renal failure undergoing haemodialysis treatment so as to enhance the quality of nursing care. It is also fundamental for the success of holistic care that nurses properly assess the possibility of depression and suicide as well as coping strategies. This study sheds light on the holistic evaluations of dialysis patients.

Lee, Regina LT; Loke, Alice Yuen

doi: 10.1111/j.1365-2702.2011.03737.xpmid: 21702862

Aims. To describe and compare the lifestyle behaviours and psychosocial well‐being of Chinese adolescents aged 10–19 in the two cities of Hong Kong and Guangzhou and to identify the factors that most influence adolescents’ lifestyle patterns in these two cities. Background. Health‐promoting lifestyle behaviours of adolescents are influenced by economic growth and societal changes. Design. A cross‐sectional comparative survey. Methods. The Chinese version of the Adolescent Lifestyle Questionnaire was used to measure the adolescents’ lifestyle behaviours and psychosocial well‐being in the primary and secondary schools. Results. A total of 2014 adolescents aged 10–19 responded to the survey in Hong Kong (n = 1008) and Guangzhou (n = 1006). Adolescents in Guangzhou practised healthier lifestyle behaviours and psychosocial well‐being than adolescents in Hong Kong, with statistically significant differences in all the seven dimensions. Adolescents in Guangzhou, when compared with those in Hong Kong, obtained higher mean scores in ‘physical participation’ (9·6 vs. 8·9, p < 0·001), ‘nutrition’ (20·2 vs. 17·6, p < 0·001), ‘social support’ (19·6 vs. 18·9, p = 0·001), ‘stress management’ (9·6 vs. 9·3, p = 0·022), ‘identity awareness’ (25·7 vs. 23·5, p < 0·001), ‘health practices awareness’ (9·2 vs. 8·3, p < 0·001) and ‘safety’ (21·6 vs. 20·6, p < 0·001). Demographic factors that contributed to adolescents’ lifestyle behaviours were living in Guangzhou (OR = 1·92, 95% CI 1·56, 2·44), being in the younger age group (10–14 years old) (OR = 2·44, 95% CI 2·00, 3·03) and living with both parents (OR = 1·92, 95% CI 1·12, 3·27). Conclusions. Socio‐economic disparities, family composition and age group are the key factors associated with adolescents’ healthy lifestyle behaviours. Further research is needed to understand the complex causal pathways between ethnicity, social environment and health behaviours. Relevance to clinical practice. Parental lifestyles inevitably influence the lifestyles of their young. Therefore, nurses should emphasise the health education of both parents and youth as future parents and support parents in modelling health‐promoting lifestyles.

Eveillard, Matthieu; Raymond, Françoise; Guilloteau, Véronique; Pradelle, Marie‐Thérèse; Kempf, Marie; Zilli‐Dewaele, Marina; Joly‐Guillou, Marie‐Laure; Brunel, Patrick

doi: 10.1111/j.1365-2702.2011.03704.xpmid:

Reid‐Searl, Kerry; Eaton, Anne; Vieth, Lea; Happell, Brenda

doi: 10.1111/j.1365-2702.2011.03795.xpmid: 21831109

Aim and objective. To explore undergraduate nursing students’ experiences of High Fidelity Patient Silicone Simulation. Background. Use of simulation as an educational tool is rapidly gaining popularity. Simulation provides a safe learning environment and helps overcome difficulties securing sufficient clinical placements. However, several limitations have been identified with this approach, particularly in relation to cost and authenticity. Design. Exploratory qualitative methodology informed the development of knowledge in this under‐researched area. Methods. Focus group interviews were conducted with 21 nursing students and first year graduates. Participants had experienced High Fidelity Patient Silicone Simulation during the program. This involved their lecturer simulating a patient by adopting mannerisms and behaviours of a person, based on a predeveloped character and using masks and appropriate clothing to establish the visual image of a simulated patient. Thematic analysis was undertaken to identify main areas of interest to participants. Results. Two main themes are reported in this paper: ‘realism of the character’ and ‘skills of the teacher’. Characters presented to students were viewed as realistic which enabled participants to engage with the character and take the process seriously. Knowledge and skill of the teacher was used to direct student learning experience and maximise learning benefits to be gained. Conclusion. High Fidelity Patient Silicone Simulation was perceived by student participants as a highly effective teaching tool. Participants found the experience positive and believe it impacted on the quality of learning experiences. Relevance to clinical practice. Clinical experience is necessary for the development of safe and competent registered nurses. Simulation has been acknowledged as a useful adjunct to clinical experience, particularly when placements are limited. High Fidelity Patient Silicone Simulation may be used to promote realism, enhance student learning and contribute to an increase in clinical competence and confidence in nursing students.

van Harten‐Krouwel, Diny; Schuurmans, Marieke; Emmelot‐Vonk, Mariëlle; Pel‐Littel, Ruth

doi: 10.1111/j.1365-2702.2011.03801.xpmid: 21801255

Aims and objectives. This study examined the feasibility of nursing falls prevention advice and factors influencing feasibility. Background. The frequency and seriousness of falls in hospitalised patients are underestimated, and such falls should be preventable because of the presence of professionals. A best practice‐based falls prevention advice was developed to decrease the incidence of secondary falls and the incidence of primary falls in the long term and to increase the knowledge of nurses about falls prevention and the seriousness of falls. Design. A descriptive, explorative study. Methods. Feasibility of the advice for 30 patients was assessed 82 times (theoretically, three times per patient) by observation and by interviewing nurses, patients and their families. Results. The falls prevention advice was used in 48% of the assessments. There was a difference in use between interventions. Interventions that required more knowledge, communication and extra activities were implemented the least. The absence of materials and knowledge about falls prevention were important determinants of the non‐implementation of certain interventions. Conclusion. Before falls prevention advice is implemented, it is important to educate nurses about falls, communication skills and implementation of the advice. Relevance to clinical practice. The falls prevention advice might help nurses to prevent falls and increase their knowledge about falls prevention.

Kwong, Enid W‐Y; Lau, Ada T‐Y; Lee, Rainbow L‐P; Kwan, Rick Y‐C

doi: 10.1111/j.1365-2702.2011.03827.xpmid: 21854474

Aim. The aim of this study was to evaluate a pressure ulcer prevention programme for nursing homes to ascertain the feasibility of its implementation, impact on care staff and outcomes for pressure ulcer knowledge and skills and pressure ulcer reduction. Background. No pressure ulcer prevention protocol for long‐term care settings has been established to date. The first author of this study thus developed a pressure ulcer prevention programme for nursing homes. Design. A quasi‐experimental pretest and post‐test design was adopted. Methods. Forty‐one non‐licensed care providers and eleven nurses from a government‐subsidised nursing home voluntarily participated in the study. Knowledge and skills of the non‐licensed care providers were assessed before, immediately after and six weeks after the training course, and pressure ulcer prevalence and incidence were recorded before and during the protocol implementation. At the end of the programme implementation, focus group interviews with the subjects were conducted to explore their views on the programme. Results. A statistically significant improvement in knowledge and skills scores amongst non‐licensed care providers was noted. Pressure ulcer prevalence and incidence rates dropped from 9–2·5% and 2·5–0·8%, respectively, after programme implementation. The focus group findings indicated that the programme enhanced the motivation of non‐licensed care providers to improve their performance of pressure ulcer prevention care and increased communication and cooperation amongst care staff, but use of the modified Braden scale was considered by nurses to increase their workload. Conclusion. A pressure ulcer prevention programme for nursing homes, which was feasible and acceptable, with positive impact and outcome in a nursing home was empirically developed. Relevance to clinical practice. The study findings can be employed to modify the programme and its outcomes for an evaluation of effectiveness of the programme through a randomised controlled trial.