Tuesday, 20 January 2015

Pregnant and in prison

Roger Watson, Editor-in-Chief


Being pregnant can be a difficult time for some women; being in prison must be a difficult time for anybody but can you imagine being pregnant and in prison with the prospect of giving birth there?

A recent UK study by Shaw et al. (29014) and published in JAN titled 'Systematic mixed-methods review of interventions, outcomes and experiences for imprisoned pregnant women' investigates, using a literature review, the experiences of women who are pregnant and give birth in prison.  This is against a background of an increasing number of women who are pregnant and in prison worldwide; estimated, for example, to be 600 annually in the UK.  Studies were only obtained from the UK or USA and there were bot quantitative and qualitative studies.

The qualitative studies, emanating from interviews with pregnant prisoners are heart-rending; for example:

'...knowing it’s coming to an end. Picturing myself leaving my baby at the hospital. How lonely will it be...it’s tearing me up inside...I’m going to feel empty. Words just cant describe how bad it hurts. I don’t want to let him go.'

Sadly there is little good research in the area; in the words of the authors: 'There is very limited published data on the experiences and outcomes of childbearing women in prison. There appear to be no good quality intervention studies examining the effectiveness of interventions to improve well-being in the short or longer term for these women and their babies.'



Reference

Shaw J Downe S Kingdon C. (2014) Systematic mixed-methods review of interventions, outcomes and experiences for imprisoned pregnant women. Journal of Advanced Nursing. DOI: 10.1111/jan.12605

Wednesday, 14 January 2015

Can nursing handovers be more effective?

Roger Watson, Editor-in-Chief

Nursing handovers are a routine, a ritual almost, between nursing shifts. I recall many different patterns during my time in clinical practice. At one end of the spectrum there was the the mass exodus of the majority of nursing staff  to the ward office for a long and quite boring summary of each patient; aimed at everyone at once and nobody in particular with a great deal of irrelevant information included. At the other end of the spectrum - and exemplified on intensive care - one-to-one handovers in considerable detail, all of it easily obtained at a glance form the patient chart.  There were varying philosophies about writing things down during handover: some saw this as a potential breach of patient confidentiality if the notes became lost; others expressed surprise that you were not capturing their words of wisdom on a scrap of paper. In any case, questions were discouraged. Whatever model was in operation I felt that they were all a considerable waste of time.

However, nursing handovers are potentially valuable and some modes of conductung them may be safer than others as a recent study published in JAN shows (Drach-Zahavy and Hadid 2015).  The study comes from Israel and is titled: 'Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift'.  The authors studied 200 randomly selected handovers, including the accompanying documentation, and found a great deal of inaccuracy in terms of medication dosage and missing information. The best model for handover was one that was face-to-face and where an open and questioning attitude was adopted. In the words of the authors: 'Our study presents opportunities for interventions aimed to improve communication during handover. The findings, which support the association between specific handover strategies, errors and handover quality, suggest the integration of flexibility alongside standardized procedures.'

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Reference

Drach-Zahavy A, Hadid N (2015) Nursing handovers as resilient points of care: linking handover strategies to treatment errors in the patient care in the following shift Journal of Advanced Nursing doi: 10.1111/jan.12615

Staffing levels and patient outcomes

Roger Watson, Editor-in-Chief

Does it matter how many staff you have in a clinical area? Of course it does - we can all recall shifts with fewer than expected staff, where corners had to be cut and care delivery prioritised. But what effect does understaffing really have on the things that nurses do, or are supposed to do, and can these be measured?

In an article from Australia by Twigg et al. (2015) titled 'The impact of understaffed shifts on nurse-sensitive outcomes', the authors claim that it does.  They define nurse sensitive outcomes as 'adverse patient outcomes that can be used as indicators of the quality of nursing care' and they conducted a secondary analysis of data on a sample of over 30,000 admissions over two years. The outcomes studied were: surgical wound infection, urinary tract infection, pressure injury, pneumonia, deep vein thrombosis, upper gastrointestinal bleed, sepsis and physiological metabolic derangement.  In all cases understaffing had an adverse impact. These findings are very important and the authors are looking to expand the outcomes that could be linked to understaffing; in their own words: 'The methods developed for this study could be used to add other variables of interest at the patient level, for example patient turnover or nurse skill mix, to aid understanding of nurse staffing and the context of care and their impact on patient outcomes.'

Listen to this post as a podcast:



Reference

Twigg DE, Gelder L, Myers H (2014) The impact of understaffed shifts on nurse-sensitive outcomes Journal of Advanced Nursing doi:10.1111/jan.12616

Thursday, 8 January 2015

What happens to my manuscript after submission to JAN?

Roger Watson, Editor-in-Chief

This podcast explains what happens to a manuscript after submission and covers screening by the Editor-in-Chief, the Managing Editor and the Editors.