Nursing Update 7 September 2022

Clinical

Evidence-Based Summary

A narrative review of the epidemiology and economics of chronic wounds.
Graves N. British Journal of Dermatology 2022;187(2):141-148.
Chronic wounds have a debilitating effect on the quality of life of many individuals, and the large economic impact on health system budgets warrants greater attention in policy making and condition management than is currently evident. The aim of this narrative review is to summarize the nature and extent of the chronic wound problem that confronts health systems across the world.

Challenges in the diagnosis and management of wound infection.
Malone M. British Journal of Dermatology 2022;187(2):159-166.
In this review article we will provide a brief overview of the current challenges clinicians face in diagnosing wound infections, how chronic infections caused by biofilms are a major challenge, and how there have been minimal advancements in developing new diagnostics or therapeutics in the identification and management of wound infections.

Inflammatory skin diseases and wounds.
Dissemond J. British Journal of Dermatology 2022;187(2):167-177.
Inflammatory wounds of the skin can be caused by many different diseases. Of particular importance here are the very heterogeneous groups of vasculitides and vasculopathies. These are usually interdisciplinary relevant diseases that require extensive diagnostics in specialized centres. Clinically, these inflammatory wounds present as very painful ulcers that develop from necrosis and are surrounded by erythematous livid borders.

The importance of exercise in the older person: motivational interviewing advice for nurses and other healthcare staff.
Palmer SJ. British Journal of Healthcare Assistants 2022;16(7):322-326.
The importance of exercise for health and wellbeing in the older person is well documented. Physical exercise also plays a part in falls prevention, thus reducing fear of injury when exercising. Motivational interviewing should be assertive and kind, and consider the provision of appropriately trained staff members, fitness facilities and cost. Facilitators and barriers affect motivation to engage. Barriers include cost, physical barriers, fear of injury, low motivation, dislike of exercise etc
Contact the library for a copy of this article

The vital role of healthcare assistants in pressure ulcer prevention: learning from research in practice.
Hayes C. British Journal of Healthcare Assistants 2022;16(8):370-378.
This article reports on the impact of an educational intervention to raise awareness of the prevention of pressure ulceration as an integral part of the PROACT project. This initiative took place in the north east of England in residential and non-residential care homes from May 2017 to March 2020, with a training programme on the need to raise awareness of the prevention of pressure ulceration delivered between January 2018 and September 2019.
Contact the library for a copy of this article

Wound healing: potential therapeutic options.
Bosanquet DC. British Journal of Dermatology 2022;187(2):149-158.
This review highlights the range of therapeutic options available to clinicians treating difficult-to-heal wounds. While certain treatments are established in daily clinical practice, most therapeutic interventions lack robust and rigorous data regarding their efficacy, which would help to determine when, and for whom, they should be used. The purpose of this review is to give a broad overview of the available interventions, with a brief summary of the evidence base for each intervention.

COVID-19 vaccines and medicines: updates for August 2022.
Medicines and Healthcare products Regulatory Agency (MHRA); 2022.
https://www.gov.uk/drug-safety-update/covid-19-vaccines-and-medicines-updates-for-august-2022
Drug Safety Update. Recent information relating to COVID-19 vaccines and medicines that has been published since the July 2022 issue of Drug Safety Update, up to 19 August 2022.
Freely available online

New UK guidance updates recommendations for the timing of initial investigation and antimicrobial treatment of sepsis.
BMJ Best Practice; 2022.
https://bestpractice.bmj.com/topics/en-gb/3000098
The Academy of Medical Royal Colleges (AOMRC), which represents all medical colleges in the UK, has issued guidance to help prioritise management of patients who are critically ill and most likely to benefit from rapid treatment. The guidance also allows patients with possible sepsis identified as less severely ill to benefit from a longer period of investigation and more accurate treatment, while reducing the burden of antimicrobial resistance.
Available with an NHS OpenAthens password

Guideline / Policy

COVID-19: testing during periods of low prevalence.
UK Health Security Agency (UKHSA); 2022.
https://www.gov.uk/guidance/covid-19-testing-during-periods-of-low-prevalence
Explains the purpose of ongoing testing and sets out who is currently eligible for access to testing and when tests should be used.
Freely available online

National protocol for inactivated influenza vaccine.
UK Health Security Agency (UKHSA); 2022.
https://www.gov.uk/government/publications/national-protocol-for-inactivated-influenza-vaccine
This protocol is for the administration of inactivated influenza vaccine to individuals in accordance with the national influenza vaccination programme (25 August 2022: Added version 04.00, see page 3 for change history)
Freely available online

Women’s Health Strategy for England.
Department of Health and Social Care (DHSC); 2022.
https://www.gov.uk/government/publications/womens-health-strategy-for-england
Details the government’s 10-year ambitions and the actions we are taking now to improve the health and wellbeing of women and girls in England.
Freely available online

Original Research

Chlorhexidine (di)gluconate locking device for central line infection prevention in intensive care unit patients: a multi-unit, pilot randomized controlled trial.
Pook M. British Journal of Nursing 2022;31(14):S36-S46.
Intensive care unit (ICU) patients are at risk for central line-associated bloodstream infection (CLABSI) with significant attributable mortality and increased hospital length of stay, readmissions, and costs. Chlorhexidine (di)gluconate (CHG) is used as a disinfectant for central line insertion; however, the feasibility and efficacy of using CHG as a locking solution is unknown.

Epidemiology and management of abdominal injuries in children.
Chaudhari PP. Academic Emergency Medicine 2022;29(8):944-953.
Most children with IAI are managed nonoperatively, and most children’s hospitals manage children with IAI similarly. These data can be used to inform future benchmarking efforts across hospitals to assess concordance with guidelines for the management of children with IAI.

Understanding approaches to continence care for people living with dementia in acute hospital settings: an ethnographic study.
Featherstone K. Health Services and Delivery Research 2022;10(14):https://doi.org/10.3310/QUVV2680.
This study found continence care was often deprioritised to reduce interruptions to ward timetables, establishing ‘pad cultures’ negatively impacting individuals and reliant on placing incontinence pads on continent older people.
Freely available online

Professional Development

The influence zone: a critical performance measure for negative pressure wound therapy systems.
Gefen A. British Journal of Nursing 2022;31(15):S8-S12.
This article provides an introduction to the theory of, what is termed, the ‘influence zone’ in the context of negative pressure wound therapy (NPWT). It is a quantitative bioengineering performance measure for NPWT systems, to indicate their effectiveness, namely, how far from the wound bed edges a specific system is able to deliver effective mechano-stimulation into the periwound, and at which intensity.

Report

The impact of dementia on women: how women are disproportionately affected across their lives and what needs to change.
Alzheimer’s Research UK; 2022.
https://www.alzheimersresearchuk.org/about-us/our-influence/policy-work/reports/the-impact-of-dementia-on-women/
The report highlights how women are disproportionately affected by dementia across their lives, including that dementia is the leading cause of death for women; the UK has the largest difference in male and female healthcare experiences in the G20 countries; most clinical trials do not report sex-specific outcomes; 2/3 of unpaid dementia carers are women; the majority of dementia researchers are female (60%) but only 39% hold senior research positions.
Freely available online

Statistics

National Obesity Audit: Bariatric surgical procedures, 2021/22 (provisional).
NHS Digital; 2022.
https://digital.nhs.uk/data-and-information/publications/statistical/national-obesity-audit/bariatric-surgical-procedures-2021-22-provisional#highlights
This is the first release of data to form part of the National Obesity Audit (NOA). Data on NHS funded bariatric surgical procedures delivered in England, are presented in an interactive dashboard. All data is currently sourced from Hospital Episode Statistics (HES), NHS Digital. As more data starts to be submitted by other weight management services, the dashboard will develop to provide a comprehensive picture of commissioning, access and outcomes of weight management services across England.
Freely available online

Systematic Review / Meta-Analysis

Effects of tranexamic acid treatment in severely and non-severely injured trauma patients.
Ageron F-X. Transfusion 2022;62 Suppl 1:S151-S157 .
Early tranexamic acid treatment improves survival in both severely and non-severely injured trauma patients. Its use should not be restricted to the severely injured.
Available with an NHS OpenAthens password for eligible users

Update Alert 8: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings.
Annals of Internal Medicine 2022;:L22-0272.
This is the eighth update alert for a living rapid review on the use of masks for the prevention of respiratory virus infections, including SARS-CoV-2, in health care and community settings. The evidence for benefits of mask use versus no use for prevention of SARS-CoV-2 infection in the community remains low to moderate.
Freely available online

professional

Evidence-Based Summary

Role of discharge coordinators in community intermediate care teams
Carried out by Andrew Hughes from Sussex Health on 17/8/2022
https://www.knowledgeshare.nhs.uk/index.php?PageID=literature_search_request_download&RequestID=36250
This Evidence Search found communication and information sharing is crucial both on admission and when taking a proactive approach to discharge. Self-care and the significance of carers is highlighted.
Available with an NHS OpenAthens password

Why diversity in the general workforce matters: reading list (August 2022)
South London and Maudsley Trust Library; 2022.
https://slamonline-my.sharepoint.com/:w:/g/personal/plee1_slam_nhs_uk/Ef5N7CSP-ERBsr5qsHrQo8wBsYqCbqOHK2McK0ZrPmjS_A?e=cYRyoF
This list of key reports, books, literature reviews and other articles has been put together by South London and Maudsley Trust Library. Please contact the library to request documents or to request a different literature search to support your work in the trust: [email protected]
Freely available online

Guideline / Policy

NHS Prevent training and competencies framework.
Department of Health and Social Care (DHSC); 2022.
https://www.gov.uk/government/publications/nhs-prevent-training-and-competencies-framework
Guidance for healthcare professionals about safeguarding vulnerable individuals from being drawn into terrorism.
Freely available online

Opinion

Beyond black and white: an inclusive reciprocal mentoring model to promote diversity, engagement and understanding.
Sarsah H. British Journal of Healthcare Management 2022;28(8):1-5.
The NHS is the largest employer of Black, Asian and minority ethnic staff in the UK. However, 15% of staff from these ethnic backgrounds have reported experiencing discrimination at work. This article explores how a programme based on reciprocal mentoring could be an effective means of creating a more inclusive NHS culture, with discussion of a pilot reciprocal mentoring programme that was implemented at Chelsea and Westminster Hospitals NHS Foundation Trust from September 2020 to May 2021.
Available with an NHS OpenAthens password for eligible users

Can restorative clinical supervision positively impact the psychological safety of midwives and nurses? Comment
Carter V. British Journal of Nursing 2022;31(15):818-820.
Restorative clinical supervision (RCS) and the introduction of professional midwife and nurse advocates (PMAs/PNAs) have gained validation and momentum since the process was introduced via the A–Equip (Advocating and Educating for Quality Improvement) model for midwifery supervision and support (NHS England, 2017; 2018). The RCS model is multifunctional and has been identified has having widespread benefits for both those providing health care and those using services.

Is nurse education too focused on acute care? Comment
Lavery J. British Journal of Nursing 2022;31(15):822.
Even before the COVID-19 pandemic there was a shortfall in the community nursing workforce and an increasingly ageing population. The motto in the pandemic was to ‘stay at home, save lives and protect the NHS’. Media images were of NHS staff at full capacity in the acute sector, with weekly clapping for NHS heroes outside emergency departments. The media portrayal of the NHS at this time arguably favoured acute services, but perhaps created a disservice to frontline staff in the community.

Poor leaders feed on illusory insecurity.
Foster S. British Journal of Nursing 2022;31(14):761.
Although I believe that it is important to consider the evidence base of what great leadership looks like, I think that it is equally important to learn from the negative impact of poor leadership. A powerful quote that made me reflect on workplace culture recently came from Robson (2017). She cited US author Tim Ferriss, who stated that, as a teenager, he was advised: ‘You are the average of the five people you most associate with.’

When is criticism constructive? Comment
Grainger A. British Journal of Nursing 2022;31(14):730.
The giving and taking of constructive criticism are integral components of continuing professional development for Nursing and Midwifery Council (NMC) registrants. Petress (2000) defined constructive criticism as judgemental feedback given to help its receivers view their professional performance through the eyes of others.

Original Research

A model of empathic reflection based on the philosophy of Edith Stein: a discussion paper.
Jack K. Nurse Education in Practice 2022;63:103389.
Empathy supports person-centred care provision by aiding effective communication and promoting feelings of wellbeing by helping people feel understood. The development of empathy in nursing students is best facilitated through experiential learning and reflective practice, although to date, there are no reflective models specifically designed for this purpose. It is the aim of this paper to present a model designed to promote reflection on the development of empathy.
Available with an NHS OpenAthens password for eligible users

A student coaching in practice (SCiP) approach: the impact on adult field pre-registration nursing students.
Norman K. British Journal of Nursing 2022;31(15):800-806.
A ‘student coaching in practice’ (SCiP) approach, based on the OSCAR and GROW model of coaching, was implemented across three UK NHS trusts in the West Midlands, involving seven placement areas that consisted of both acute and community hospital settings. The study aimed to explore the impact of a SCiP approach on preparing students for their next stage of learning and perceived confidence.

Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort descriptive study.
Rizk E. British Journal of Nursing 2022;31(14):S6-S16.
Despite the increasing popularity of midline catheters, data on the use of alteplase for restoring midline catheter patency is scarce. This study aimed to evaluate off-label use of alteplase for midline catheter occlusions. Adults who received alteplase into a midline catheter between January 2015 and May 2018 within a multi-hospital health system were included in this study.

An exploration of undergraduate nursing students’ experiences of mentorship in an Irish hospital.
Baxter G. British Journal of Nursing 2022;31(15):812-817.
Mentorship is the support model of choice for nursing practice in Ireland and although it follows a similar approach to that provided thus far in the UK, there is little available evidence about the students’ lived experience of mentorship and the extent to which it facilitates their development. This study aimed to explore undergraduate nursing students’ experiences of mentorship in hospital.

Bachelor nursing students´ and their educators´ experiences of teaching strategies targeting critical thinking: a scoping review.
Westerdahl F. Nurse Education in Practice 2022;63:103409.
The objective of this scoping review was to review the published literature on existing teaching strategies targeting bachelor nursing students’ critical thinking and explore how these strategies are described by students and educators. The research questions were: (i) Which teaching strategies are described in the literature targeting critical thinking among nursing students? and (ii) How are these teaching strategies described and experienced by students and/or nurse educators?
Available with an NHS OpenAthens password for eligible users

Developing and evaluating an educational web-based tool for health professions education: the Flipped Classroom Navigator.
Youhasan P. BMC Medical Education 2022;22(1):594.
Flipped classroom pedagogy is a blended learning approach applied in undergraduate health professions education. However, teachers and students may require training to effectively engage in flipped classroom pedagogy. Thus, this study aimed to design, develop, and evaluate a web-based tool for fostering flipped classroom pedagogy in undergraduate health professions education.
Freely available online

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: an integrative review.
Inocian E. Nurse Education in Practice 2022;63:103391.
The aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students. Caring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.
Available with an NHS OpenAthens password for eligible users

Improving patient understanding on discharge from the short stay unit: an integrated human factors and quality improvement approach.
Cook JLE. BMJ Open Quality 2022;11(3):e001810.
We used a systems approach to improve patient understanding on discharge from the adult acute medicine short stay unit (SSU). Patient understanding was assessed across five domains: diagnosis, medication changes, follow-up care, return instructions and knowing who their consultant was. The aim of this approach was that at least 90% of patients achieved near-complete understanding (score >4) on questionnaire across all five discharge domains.

Investigation into the predictive capability for mortality and the trigger points of the National Early Warning Score 2 (NEWS2) in emergency department patients.
Masson H. Emergency Medicine Journal 2022;39(9):685-690.
NEWS2 is an effective predictor of mortality for patients presenting to the ED. Findings suggest that maximum NEWS2 of 4 and over may be the best trigger point for escalation of treatment. Findings also suggest a NEWS2 of 0-1 can identify a very low-risk group within the ED.

Nurses’ recognition and response to unsafe practice by their peers: a qualitative descriptive analysis
Blair W. Nurse Education in Practice 2022;63:103387.
Unsafe practice is an important issue for the nursing profession however few studies have sought to identify how nurses recognise and respond to unsafe practice. This study aimed to identify the behaviours and cues that registered nurses recognise as indications of unsafe practice, perceived factors that contribute to unsafe practice and action nurses take in response.
Available with an NHS OpenAthens password for eligible users

Seeking autonomy: grounded theory of clinical reasoning processes during simulation based experiences.
Mohamed E. Nurse Education in Practice 2022;63:103408.
To conceptualize how undergraduate nursing students’ reason and think during Simulation-Based experiences (SBE) and explore the indicators of sound clinical judgment. Nursing students’ clinical reasoning processes during Simulation Based Experiences (SBE) are not well understood and underexplored. The purpose of this study is to conceptualize how undergraduate nursing students’ reason and think during SBE.
Available with an NHS OpenAthens password for eligible users

STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis.
Gangannagaripalli J. Health Services and Delivery Research 2021;9(23):doi.org/10.3310/hsdr09230.
Current evidence indicates that no STOPP/START intervention in the community, hospitals or nursing homes works better than any other.
Freely available online

The influence of patient gender in healthcare professional decision-making: an interaction analysis of simulation debriefings
Andrea Amato Gauci. International Journal of Healthcare Simulation 2022;:DOI 10.54531/IIVD1435.
The authors of this study are from Maudsley Learning, the IOPPN and KCL.
Previous research suggests that gender bias is pervasive in health care and has deleterious effects on treatment outcomes for patients. The aim of this study is to analyze the influence of patient gender in HCP decision-making by analyzing how they surface, discuss and manage topics around gender.
Freely available online

The role of ePortfolios in supporting learning in eight healthcare disciplines: a scoping review.
Janssens O. Nurse Education in Practice 2022;63:103418.
This scoping review aims at providing a summary of available knowledge about the role of ePortfolios in scaffolding learning in eight healthcare disciplines to identify main concepts, best practices, and knowledge gaps. ePortfolios are well established in scaffolding learning in many healthcare disciplines. Yet, an overview of the ePortfolio literature in the context of healthcare education doesn’t exist.
Available with an NHS OpenAthens password for eligible users

Professional Development

Improving patient communication through the duty of candour and shared decision-making.
Tingle J. British Journal of Nursing 2022;31(14):758-759.
Many lawyers in healthcare law strongly argue that if nurses and doctors improved their communication practices between each other and with the patient then there would be less litigation and fewer complaints. The cases involving communication failures are various and can have fatal consequences (as we see in the reports of Never Events).

Virtual reality: the next step in nursing education?
Thomas S. British Journal of Nursing 2022;31(14):756-757.
With the emergence of the COVID-19 pandemic, the way in which student nurses and other trainee health professionals develop knowledge and skills for practice rapidly changed. There was already a move towards the use of simulation within nursing education, with some arguing that high-quality simulation could replace some elements of practice learning. The Nursing and Midwifery Council (NMC) faced calls to consider a reduction of clinical hours required for nursing registration.

Report

Past cases provide basis to improve patient safety education and training.
Tingle J. British Journal of Nursing 2022;31(15):824-825.
To provide safe and good quality health care nurses and doctors need to reflect on past cases where adverse events have occurred and to learn lessons. Trend analysis should take place, which should inform policy, and the information obtained cascaded down the management chain to frontline staff. It is imperative that this happens, but the all-too-familiar story in the NHS is that it does not to the extent that it should. Many safety lessons from past adverse healthcare events go unlearnt.

Ambitious for change: Research into NMC processes and people’s diversity characteristics.
Nursing and Midwifery Council (NMC); 2022.
https://www.nmc.org.uk/about-us/equality-diversity-and-inclusion/edi-research/ambitious-for-change-research-into-nmc-processes-and-peoples-protected-characteristics/
This report outlines the findings from research into why some professionals have different experiences of NMC’s processes. The report aims to understand why these differences exist and the impact they have on the workforce. The findings highlight opportunities to improve regulatory activities and ensure processes are fair. They also draw attention to how inequalities that cut across the health and social care sector and exist in wider society are contributing to the disparities.
Freely available online

Integrated care systems explained: making sense of systems, places and neighbourhoods.
The King’s Fund; 2020.
https://www.kingsfund.org.uk/publications/integrated-care-systems-explained
Integrated care services represent a fundamental shift in the way the health and care system is organised. This explainer looks at how these bodies are structure and the progress made before the Covid-19 (Coronavirus ) outbreak took hold.
Freely available online

Mental Capacity Report: July 2022.
Thirty Nine Essex Street LLP; 2022.
https://1f2ca7mxjow42e65q49871m1-wpengine.netdna-ssl.com/wp-content/uploads/2022/07/Mental-Capacity-Report-July-2022-Compendium.pdf
Highlights this month include: In the Health, Welfare and Deprivation of Liberty Report: Injunctions against family members; Draft LPS forms published; and serious medical treatment applications; In the Practice and Procedure Report: Remote observations of hearings and new SRA guidance on vulnerable clients; In the Wider Context Report: Mental Health Bill Update; Archie Battersbee case in the Court of Appeal; Posthumous use of embryos; and CAMHS gatekeeping.
Freely available online

Patient-initiated follow-up: does it work, why it matters, and can it help the NHS recover?
Nuffield Trust; 2022.
https://www.nuffieldtrust.org.uk/resource/patient-initiated-follow-up-does-it-work-why-it-matters-and-can-it-help-the-nhs-recover
The NHS’s elective recovery strategy includes a target of moving 5% of outpatient attendances to patient-initiated follow-up (PIFU) pathways by March next year. But what exactly is PIFU? As the NHS prepares to scale it up nationally, Sarah Reed and Nadia Crellin explain more about what it is, the problems it could solve, and what is known so far about how well it works.
Freely available online

Patient-initiated follow-up: will it free up capacity in outpatient care?
Nuffield Trust; 2022.
https://www.nuffieldtrust.org.uk/research/patient-initiated-follow-up-will-it-free-up-capacity-in-outpatient-care
This NIHR rapid service evaluation team (RSET) briefing explains what we know from the available evidence and earlier evaluations of patient-initiated follow-up (PIFU) about how personalising follow-up impacts service use and patient experience and outcomes. We also discuss key implementation considerations for the NHS as it seeks to mainstream this approach.
Freely available online

Systematic Review / Meta-Analysis

Effectiveness of Digital Simulation on Student Nurses’ Knowledge and Confidence: An Integrative Literature Review.
Gebreheat G. Advances in Medical Education and Practice 2022;:765—775.
Results suggest that digital simulation with realistic, immersive and interactive characters had a positive impact on students’ learning outcome in terms of knowledge acquisition and self-confidence. Therefore, combining digital simulation with face-to-face simulation will enhance learning.
Freely available online