Assessing educational effectiveness: the impact of a specialist course on the delivery of care

PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

Many medications are prescribed and administered PRN (pro re nata, as needed). However, there are few integrative reviews to inform PRN psychotropic medication use in long-term care facilities and nursing or care homes. Accordingly, this integrative systematic review aimed to improve our understanding of PRN medicines management with a focus on psychotropic medications (antipsychotics, sedatives, anxiolytics, and hypnotics) in long-term care settings. Keywords relating to PRN in English, Norwegian, and Spanish were used, and articles published between 2009 and 2019 were retrieved. Based on the inclusion criteria, eight articles were used for data analysis and synthesis. This review offers a description of PRN prescription and administration of psychotropic medications in long-term care. Variations were observed in the management of PRN psychotropic medications based on residents’ underlying health conditions and needs, duration of use, and changes between medications and doses. Neither the reasons for PRN prescription and administration nor the steps taken to identify and manage any associated adverse reactions or adverse drug events were reported. Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities.

Nurse-led medicines' monitoring in care homes study protocol: a process evaluation of the impact and sustainability of the adverse drug reaction (ADRe) profile for mental health medicines

INTRODUCTION

Improved medicines' management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes.

METHODS AND ANALYSIS

This process evaluation will use interviews and observations with the participants of all five homes involved in earlier research, and five newly recruited homes caring for people prescribed mental health medicines. The ADRe profile is implemented by nurses, within existing resources, to check for signs and symptoms of ADRs, initiate amelioration and share findings with pharmacists and prescribers for medication review. Outcome measures are the numbers and nature of problems addressed and understanding of changes needed to optimise clinical gain and sustain implementation. Data will be collected by 30 observations and 30 semistructured interviews. Clinical gains will be described and narrated. Interview analysis will be based on the constant comparative method.

ETHICS AND DISSEMINATION

Ethical approval was conferred by the National Health Service Wales Research Ethics Committee. If the ADRe profile can be sustained in routine practice, it has potential to (1) improve the lives of patients, for example, by reducing pain and sedation, and (2) assist in early identification of problems caused by ADRs. Therefore, in addition to peer-reviewed publications and conferences, we shall communicate our findings to healthcare professionals, policy-makers and sector regulators.

TRIAL REGISTRATION NUMBER

NCT03110471.

Nurse-Led Medicines' Monitoring for Patients with Dementia in Care Homes: A Pragmatic Cohort Stepped Wedge Cluster Randomised Trial

BACKGROUND

People with dementia are susceptible to adverse drug reactions (ADRs). However, they are not always closely monitored for potential problems relating to their medicines: structured nurse-led ADR Profiles have the potential to address this care gap. We aimed to assess the number and nature of clinical problems identified and addressed and changes in prescribing following introduction of nurse-led medicines' monitoring.

DESIGN

Pragmatic cohort stepped-wedge cluster Randomised Controlled Trial (RCT) of structured nurse-led medicines' monitoring versus usual care.

SETTING

Five UK private sector care homes.

PARTICIPANTS

41 service users, taking at least one antipsychotic, antidepressant or anti-epileptic medicine.

INTERVENTION

Nurses completed the West Wales ADR (WWADR) Profile for Mental Health Medicines with each participant according to trial step.

OUTCOMES

Problems addressed and changes in medicines prescribed.

DATA COLLECTION AND ANALYSIS

Information was collected from participants' notes before randomisation and after each of five monthly trial steps. The impact of the Profile on problems found, actions taken and reduction in mental health medicines was explored in multivariate analyses, accounting for data collection step and site.

RESULTS

Five of 10 sites and 43 of 49 service users approached participated. Profile administration increased the number of problems addressed from a mean of 6.02 [SD 2.92] to 9.86 [4.48], effect size 3.84, 95% CI 2.57-4.11, P <0.001. For example, pain was more likely to be treated (adjusted Odds Ratio [aOR] 3.84, 1.78-8.30), and more patients attended dentists and opticians (aOR 52.76 [11.80-235.90] and 5.12 [1.45-18.03] respectively). Profile use was associated with reduction in mental health medicines (aOR 4.45, 1.15-17.22).

CONCLUSION

The WWADR Profile for Mental Health Medicines can improve the quality and safety of care, and warrants further investigation as a strategy to mitigate the known adverse effects of prescribed medicines.

TRIAL REGISTRATION

ISRCTN 48133332.

Factors that condition the spontaneous reporting of adverse drug reactions among nurses: an integrative review

AIM

To describe and synthesise previous research on factors conditioning the spontaneous reporting of adverse drug reactions among nurses.

BACKGROUND

Spontaneous reports of adverse drug reactions by health-care providers, are a main instrument for the continuous evaluation of the risk-benefit ratio of every drug. Under-reporting of adverse drug reactions by all health-care providers, in particular by nurses, is a major limitation to this system.

EVALUATION

An integrated review of the literature was conducted using MEDLINE, CINAHL, Embase, Scopus databases and Google Scholar. After evaluation for appropriateness related to inclusion/exclusion criteria, 16 studies were included in the final analysis and synthesis.

KEY ISSUES

Two factors emerged from the study: (1) intrinsic factors related to nurses' knowledge and attitudes; (2) extrinsic factors related to nurses' interaction with health-care organisations and to the relationship between nurses and physicians. Nurses' attitudes that hinder reporting include ignorance, insecurity, fear and lethargy.

CONCLUSIONS

Nurses are not fully aware of their role in adverse drug reaction reporting. Nurses must acquire greater knowledge to implement specific skills into their daily clinical practice.

IMPLICATIONS FOR NURSING MANAGEMENT

To improve nurses' reporting of adverse drug reactions, it is necessary to develop management approaches that modify both intrinsic and extrinsic factors.

Medication monitoring in a nurse-led respiratory outpatient clinic: pragmatic randomised trial of the West Wales Adverse Drug Reaction Profile

Objective

To assess the clinical effect of medication monitoring using the West Wales Adverse Drug Reaction (ADR) Profile for Respiratory Medicine.

Design

Single-site parallel-arm pragmatic trial using stratified randomisation.

Setting

Nurse-led respiratory outpatient clinic in general hospital in South Wales.

Participants

54 patients with chronic respiratory disease receiving bronchodilators, corticosteroids or leukotriene receptor antagonists.

Intervention

Following initial observation of usual nursing care, we allocated participants at random to receive at follow up: either the West Wales ADR Profile for Respiratory Medicine in addition to usual care (‘intervention arm’ with 26 participants); or usual care alone (‘control arm’ with 28 participants).

Main Outcome Measures

Problems reported and actions taken.

Results

We followed up all randomised participants, and analysed data in accordance with treatment allocated. The increase in numbers of problems per participant identified at follow up was significantly higher in the intervention arm, where the median increase was 20.5 [inter-quartile range (IQR) 13–26], while that in the control arm was −1 [−3 to +2] [Mann-Whitney U test: z = 6.28, p<0.001]. The increase in numbers of actions per participant taken at follow up was also significantly higher in the intervention arm, where the median increase was 2.5 [1]–[4] while that in the control arm was 0 [−1.75 to +1] [Mann-Whitney U test: z = 4.40, p<0.001].

Conclusion

When added to usual nursing care, the West Wales ADR Profile identified more problems and prompted more nursing actions. Our ADR Profile warrants further investigation as a strategy to optimise medication management.

Trial Registration

Controlled-trials.com ISRCTN10386209

Medication monitoring for people with dementia in care homes: the feasibility and clinical impact of nurse-led monitoring

OBJECTIVES

People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring.

DESIGN

Feasibility "before-and-after" intervention study.

SETTING

Three care homes in Wales.

PARTICIPANTS

Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine.

INTERVENTION

West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines.

OUTCOME MEASURES

(1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later.

RESULTS

Nurses recruited and retained 11 of 29 eligible service users. The profile took 20-25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation.

CONCLUSIONS

Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.

Integrating an evidence-based intervention into clinical practice: 'transitional relationship model'

The transitional relationship model (TRM) facilitates the discharge process by providing peer support and hospital staff involvement until a therapeutic relationship has been established with a community care provider. A quasi-experimental, action-oriented research design was employed in which psychiatric wards at six hospital sites implemented the model in three waves. Helpful strategies were identified by each wave of wards for consideration by subsequent wards. Using an ethnographic approach, qualitative data were examined to uncover experiences and perceptions of TRM implementation and to help identify key issues that were supporting or hampering implementation. Specific strategies that facilitate the implementation of TRM include: (1) the use of educational modules for on-ward hospital staff training and peer training; (2) presence of on-site champions; and (3) supportive documentation systems. Issues identified as barriers to implementation included: (1) feeling drowned, swamped and overwhelmed; (2) death by process; (3) team dynamics; and (4) changes in champions. Staged large-scale implementation of the TRM allowed for iterative improvements to the model leading to positive outcomes. This study highlights the need to address work environment issues, particularly interprofessional teams.

The New Zealand nurse specialist framework: clarifying the contribution of the nurse specialist

Maximizing the contribution that nurses can make to the health care outcomes is the focus of health workforce planners and funders worldwide. New Zealand, along with many other countries, faces significant taxonomical challenges in developing specialist nursing workforce as nurse specialists and specialty areas of practice are inconsistently defined. Clearly defining and capturing data on current workforces is a challenge shared by many countries impacting on the ability to understand current supply and plan for anticipated increased demand. This article presents an overview of the New Zealand Nurse Specialist Framework (NZNSF) developed through a consensus approach as part of a doctoral study. The NZSNF has already been adopted by some national nursing groups in New Zealand and provides an overarching structure to support coherence, clarity and consistency for nurse specialists. The framework aims to support workforce policy makers in planning effective utilization of the nurse specialist in health care delivery.

The impact of an integrated pharmacology and medicines management curriculum for undergraduate adult nursing students on the acquisition of applied drug/pharmacology knowledge

AIMS

To investigate the efficacy of a 14-month integrated pharmacology and medicines management curriculum for undergraduate nursing students on the acquisition of applied drug/pharmacology knowledge.

BACKGROUND

Despite considerable debate regarding nurses' ability to be able to fulfill their medication management responsibilities, little is known about how nurses should be educated in medicines management.

METHODS

Two groups of nursing students were compared. The first group were exposed to the usual curriculum (control group), whilst a second group experienced a new integrated pharmacology and medicines management curriculum (intervention group) (N=120). The impact of the curriculum on applied drug knowledge was assessed using a 69 item short answer questionnaire relating to a vignette. Students also undertook a 42 item on-line test exploring principles of pharmacokinetics. Students were also asked to self-rate their knowledge using a four point likert scale which asked how confident they were in relation to the prescribed medication regime. The data were collected in July 2008. The intervention group was exposed to an integrated curriculum approach, whilst the control group undertook periods of supervised practice within a clinical environment supported with a workbook and practice assessment learning outcomes.

RESULTS/FINDINGS

Students exposed to an integrated approach to pharmacology and medicines management demonstrated superior pharmacokinetic knowledge and were more able to apply drug knowledge to the patient vignettes than the control group.

CONCLUSION

An early introduction of an integrated approach to the teaching and assessing of pharmacological processes improves students' drug knowledge prior to qualification. A sound preparation will help to ensure safe and effective medicines management care for patients and will prepare nurses for post graduate education and further training.

Does specialist respiratory education make a difference to practice?

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) poses a huge burden to society. Continued professional development can be regarded as a requisite for implementing quality care. Within the literature the effectiveness of COPD care is evident, yet it is seldom attributed to the educational attainment of healthcare professionals. This study aimed to examine whether a nationally delivered COPD module is perceived to impact on clinical practice.

METHODS

As part of a mixed methods study (Cresswell et al., 2003), qualitative data were gathered post-intervention from 68 students utilising a semi-structured, self-completed questionnaire. Data were analysed using a themed content analysis and a quasi-statistical approach.

RESULTS

The major themes that emerged from the analysis were: changes in personal practice, evidence of changes implemented and changes in participants' personal views regarding disease management. These findings suggest that when students gain knowledge they use it to the benefit of patients.

DISCUSSION

Overall students reported an increase in knowledge and confidence regarding COPD management and an impact on practice was reported. The findings will add to a mounting body of evidence that supports the value of continuing professional learning and will aim to satisfy consumers of education of the efficacy of knowledge in terms of direct patient impact.

Perioperative nurses' perceptions and experiences of continuing professional education

This article presents an overview of perioperative nurses' perceptions and experiences of continuing professional education (CPE). Four themes emerged from 23 interviews: attitudes and culture (background); deciding to study (going in); student experience (process); and outcomes (going out). My findings indicate transferability of other studies to perioperative nursing, and suggest that CPE is associated with increased social status and doctor-nurse collaboration. My work also illuminates the concept of 'secret study'.

A systematic review evaluating the impact of post-registration nursing and midwifery education on practice

Given the current focus on evidence-based practice, it is surprising that there is a dearth of systematic evidence of the impact on practice of post-registration nursing and midwifery education. The systematic review presented here formed part of a national review of post-registration nursing and midwifery education in Ireland [Health Service Executive, 2008. Report of the Post-registration Nursing and Midwifery Education Review Group: Changing practice to support service delivery. Health Service Executive, Dublin]. The review focuses specifically on the impact on practice from the perspective of nurses, midwives, patients, carers, education and health service providers. Sixty-one (61) studies met the criteria set. These studies were mainly of a retrospective and descriptive nature, often with small cohorts, set within one educational setting. The findings indicate that students benefit from post-registration programmes in relation to changes in attitudes, perceptions, knowledge and in skill acquisition. There is also some evidence that students apply their newly acquired attitudes, knowledge and skills. There is however limited evidence of the direct impact on organisational and service delivery changes, and on benefits to patients and carers. It can be concluded that the impact of post-registration nursing and midwifery education on practice has yet to be fully explored through a more systematic and coherent programme evaluation approach.

Evaluation of a pilot study day for healthcare assistants and social care officers

This report evaluates a pilot study day, which provided an introduction for healthcare assistants and social care officers into the causes, incidence and impact of symptoms encountered when providing palliative care for people with advanced disease.

AIM

To demonstrate whether the study day facilitated an increase in confidence and knowledge in key areas of symptom control, the degree of satisfaction with the study day and whether participants were able to use information from the study day in practice.

METHOD

Both qualitative and quantitative methods were employed in the evaluation process. Data were collected using satisfaction questionnaires, pre- and post-test questionnaires, and a telephone follow-up for self-selected participants.

RESULTS

There was a high degree of satisfaction with the study day. The results demonstrated statistically significant increases in both knowledge and confidence in helping to manage key symptoms encountered in palliative care patients.

CONCLUSION

All participants reported that the aims of the day were met and agreed that the topics were relevant to practice.

A competency based educational programme for research nurses: an Italian experience

BACKGROUND

the EU Directive states the requirement of staff working in trials to be qualified by education, training and experience [14]. This includes the research nurse; however, in the transition from ward nurse to research nurse, new and highly developed skills and knowledge are required in order to work effectively.

METHODS

an educational programme was developed, which included a review of current knowledge and baseline practice, development of competencies related to the role of research nurse, haemato-oncology and clinical trial education to support this advanced practice for nurses in clinical trials.

RESULTS

overall, the feedback on the course by the nurses was very positive, and the nurses were able to undertake the role of research nurse within specified clinical trials.

Implementation and evaluation of a pilot education programme in colorectal cancer management for nurses in Scotland

This paper describes the results of an evaluation of a nursing education programme for nurses caring for patients with colorectal cancer. A sample of 67 registered nurses from 6 location sites within the 3 Regional Cancer Networks in Scotland were recruited to the pilot. The programme was adapted from an evidence-based education manual for nurses in the management of colorectal cancer developed by the European Oncology Nursing Society as part of a Nursing in Colorectal Cancer Initiative (NICCI) [Hawthorn, J., Redmond, K., 1999. A Guide to Colorectal Cancer. AstraZeneca Oncology, UK]. The format for evaluating the programme was based on the TELER method of treatment evaluation [Le Roux, A.A., 1995. TELER: the concept. Physiotherapy 79 (11), 755-758] that had previously been developed along side the training manual [Grocott, P., Richardson, A., Ambaum, B., Kearney, N., Redmond, K, 2001a. Nursing in colorectal cancer initiative--the audit phase. Part 1. Development of the audit tool. European Journal of Oncology Nursing 5 (2), 100-111; Grocott, P., Richardson, A., Ambaum, B., Kearney, N., Redmond, K., 2001b. Nursing in colorectal cancer initiative: the audit phase. Part 2. Content validity of the audit tool and implications of the standards set for clinical practice. European Journal of Oncology Nursing 5 (3), 165-173] for cytotoxic chemotherapy to provide the NICCI Audit Tool (Le Roux, 2003). This model was developed further in the current study to include the domains of: Disease, Diagnosis and Staging, Treatment, Nursing Issues and General Issues. Data were analysed descriptively and are discussed. Overall the results from this study demonstrate a statistically significant improvement in disease-related knowledge (p=<0.001) and in the best practice statements for nursing issues (p=<0.001) and general issues (including attitudes) (p=0.023) that were maintained at four months post completion of the course.

The effect of education on hypothetical and actual oxygen administration decisions

AIM

This study examined the effect of an education intervention on emergency nurses' decisions related to oxygen administration.

METHOD

A controlled pre-test/post-test quasi-experimental design was used. The intervention was a written self directed learning package. Outcome measures were (i) factual knowledge measured using parallel form multiple choice questions (MCQs) and (ii) clinical decisions measured using parallel form MCQs, parallel form patient scenarios and clinical practice observation.

RESULTS

Eighty-eight nurses from 4 Melbourne EDs participated in the study (control group: n=37 and experimental group: n=51). Subgroups of nurses from the experimental group also participated in the patient scenarios (n=20) and clinical practice observation (n=10). Emergency nurses' knowledge increased as a function of education. Both patient scenario data and clinical practice observation showed decreased selection of nasal cannulae, increased selection of air entrainment masks and a trend towards selection of higher oxygen flow rates following education.

CONCLUSIONS

Evaluation of educational interventions in nursing should focus on identifying strategies that enhance learning in a clinical environment, are valid in terms of the clinical context and culture in which they are being used and most importantly, produce sustained improvements in actual clinical practice.

The impact of oncology education on practice—A literature review

Cancer care currently enjoys a high national profile in the UK, with a growing emphasis on cancer education for nurses and allied health professionals, however, there is dearth of research into the effectiveness and impact of cancer education on practice. This paper explores the context of cancer care and education and reviews the literature regarding the relationship between the two. It explores the assumption that education positively influences practice and contributes to the health care agenda by supporting the need for further research in this area.

How do participants of a post registration oncology nursing course perceive that the course influences their practice?—A descriptive survey

The high incidence of cancer necessitates informed and skilled cancer care, a concept highlighted in a number of Government reports. However, there is little research, which explores the relationship between cancer education and practice. This paper reports a descriptive survey to explore the perceived impact of a post registration oncology-nursing course on practice. It aimed to determine how much the oncology nursing course impacted on practice and what aspects impacted the most. Postal questionnaires, using primarily closed questions, were sent to all post-registration nurses (n=171) who had undertaken an oncology-nursing course at one cancer centre between 1996 and 2003. The course was perceived to have a positive impact on practice and the subjects perceived to be most beneficial included those relating to communication skills, attitudes to cancer and psychological support. In conclusion, the study suggested that there is a positive relationship between oncology education and practice. This research may be used to inform discussions to support current and future investment in oncology education.

Evaluation of Clinical Ladder Participation in Norway

PURPOSE

To evaluate nurses' reasons for joining a clinical ladder program, their experiences during participation, and how they use their new competence in practice.

DESIGN AND METHODS

Cross-sectional survey design. Sample was 541 nurses who participated in clinical ladder programs at four hospitals in Norway. Data were analysed with descriptive and inferential statistics.

FINDINGS AND CONCLUSIONS

Internal motivational factors were most important reasons for joining a clinical ladder. Nursing leaders were lacking in their engagement with the clinical ladder project and its participants. Perceived learning effect, use of competence, and intent to stay increased as nurses progressed in the ladder.

Effectiveness of continuing education programmes in nursing: literature review

AIM

The aim of this paper is to review the literature on what facilitates or inhibits continuing education in nursing and to identify ways to make continuing education more effective.

BACKGROUND

[corrected] Healthcare professionals have always been encouraged to update their knowledge and maintain clinical competence. The rapid changes currently taking place within healthcare systems have increased the pressure from direct care providers, professional bodies and the general public for nurses to engage in continuing education programmes. Despite a growing body of empirical research on this topic, the effectiveness and impact of continuing education remains underexplored.

METHOD

A literature search was conducted in January 2005 using CINAHL, Medline, the Cochrane databases and the Internet. Keywords used were: 'continuing education', 'professional development', 'viability of continuing education/professional development programmes', 'evaluation of continuing education/professional development programmes' and 'effectiveness of continuing education/professional development programmes'. No date restrictions were imposed.

RESULTS

Factors that facilitate the implementation of continuing education in nursing arise from individual, professional and organizational perspectives. While the philosophy behind continuing education is to encourage nurses to become lifelong learners, the learning method chosen for such programmes is often didactic in nature, as opposed to encouraging nurses to take initiative and direct their own learning. Continuing education is intended to ensure healthcare practitioners' knowledge is current, but it is difficult to determine if those who attend these courses are implementing what they have learnt.

CONCLUSION

To make continuing education programmes more effective, nurses need to have a more participatory role in their learning. A concerted effort should be made to make continuing education attainable and realistic.

The effects of specific educational preparation on emergency nurses' clinical decisions regarding supplemental oxygen administration

The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes.

Effect of a self-directed learning package on emergency nurses' knowledge of assessment of oxygenation and use of supplemental oxygen

Emergency nurses frequently and independently make decisions regarding supplemental oxygen. The importance of these decisions for patients is highlighted by the well documented association between respiratory dysfunction and adverse events. This study aimed to: (i) examine the effect of educational preparation on emergency nurses' knowledge of assessment of oxygenation, and the use of supplemental oxygen; (ii) explore the impact of existing knowledge on decisions related to the implementation of supplemental oxygen; and (iii) explore nurses' characteristics that were associated with effectiveness of the educational preparation. A pretest/post-test, controlled, quasi-experimental design was used in this study. Educational preparation was effective in increasing emergency nurses' knowledge. Baseline level of knowledge was predictive of reports of independent decisions regarding the implementation of oxygen. There was a significant positive relationship between postgraduate qualification in emergency nursing and the effect of education, and significant negative relationships between effect of education and baseline level of knowledge and daily decisions to implement supplemental oxygen.

Impact of a course on community nurses' practice: an evaluation

An evaluation of a community course for nurses working in primary care was undertaken to ascertain whether it made an impact on the students' clinical practice. The course was undertaken by 16 nurses working within community nursing teams that included intermediate care, health visiting, school nursing and district nursing. Three quarters of the nurses had worked in the community for less than one year and half of these were newly qualified nurses. The evaluation consisted of semi-structured questionnaires, which were completed after the course and by the student and their mentor after 3 months. The assessment of practice document submitted by the students for assessment was also scrutinized for examples of changes students had made to their practice. The results demonstrate that the students felt that the community course made an impact on their practice and encouraged them to develop some of the key skills identified for community nurses.

Monitoring adverse drug reactions: scales, profiles, and checklists

BACKGROUND

Globally, adverse drug reactions (ADRs) make a substantial contribution to ill health. Introducing a systematic approach to patient surveillance could mitigate these problems. Formalized medication monitoring schedules have been proposed as one strategy to diagnose and action side-effects and the problems emanating from adverse drug reactions. To date, most developments have been linked to antipsychotic medications. Several scales, checklists, and side-effect profiles are available, including the West Wales ADR (adverse drug reaction) profile. However, relatively little work has been undertaken on the clinical validity, reliability, and sensitivity of these instruments.

AIM

This paper describes the development of the monitoring schedule approach to medication management. It also reviews and compares the instruments available for monitoring the adverse drug reactions of antipsychotic medications. The UKU (Udvalg for Kliniske Undersogelser) scale and the West Wales ADR profile assess a broader range of physiological parameters and potential problems than other instruments. However, to be adopted in practice, such instruments must achieve a balance between clinical gain and practical cost, including the time spent in administration.

CONCLUSION

Further work is needed to explore the translation of formalized ADR surveillance programmes into clinical gains and improved outcomes for clients.

Asssessment of practice in intensive care: students' perceptions of a clinical competence assessment tool

Part I of this paper (literature review) identified some of the challenges around the development of suitable assessment tools to measure clinical competence. The lack of research on competence assessment, especially within an intensive care environment was also high lighted. In this, part 2, findings from a qualitative study aimed at exploring student nurses' perceptions of a new clinical competence assessment tool, recently introduced into a postgraduate intensive care nursing course are presented. Semi- structured interviews and a focus group interview were used to collect the data. Eleven students were involved in the study. The findings are presented in narrative form and in the context of literature on assessment and competence. Although the clinical competence assessment tool was in its infancy at the time of this study, the findings suggest that students not only had difficulty interpreting the language of the tool, but considered that because of its generic nature, it failed to capture the specialist skills required for intensive care nursing.

A test instrument for palliative care

This article describes a methodological study concerning the development of a test instrument that can be used for measuring the effects of a course in palliative care on registered nurses and licensed practical nurses. This test instrument is comprised of two parts: an expertise and insight test and a self-efficacy instrument and is tested in three panels. The expertise and insight test appears to be usable for measuring the effects of a course in palliative care. The reliability and validity of the test were found to be adequate for evaluation of the effects of a post-basic palliative care course. The generality of the self-efficacy instrument was reduced because high-scoring items in the area of communication had to be removed. Moreover, the scores of the various categories of respondents discriminate less than expected on the basis of their previous education and the test results. Many respondents, regardless of their background, believed themselves to have a high level of competency. The self-efficacy instrument must therefore be used cautiously.

The impact on work-related stress of mental health teams following team-based learning on clinical risk management

Risk management is viewed as a systematic process based on multiprofessional and multi-agency decision-making. A learning pack was developed as part of a team-based learning project aiming to encourage and develop collaborative working practice. This brought different professionals and agencies working in mental health together to learn. There is little doubt that mental health practice is a source of stress for practitioners. Apart from the stress associated with managing 'risky' situations, risk management is also a relatively new concept. This can increase stress around ability to cope, both on an individual practitioner level and in teams. This article reports the impact that the learning pack had on team members' stress, specifically work-related stress. A range of scales were used to measure change in stress and results demonstrated reduced work-related pressure in a number of areas following the learning. The implications for team learning in relation to clinical risk management are discussed in light of the findings.

An evaluation of a palliative care course for generic nurses

The case for palliative care training for generic nurses is supported in this article, and the results of an evaluation of a generic palliative nursing course are explored. Evaluation of the participants' knowledge base was undertaken using the Palliative Care Quiz for Nurses, and more subjective evaluation of changes in practice was achieved through a short questionnaire that was sent out to participants 3 months after completion of the course. The need for educators and clinicians to develop more evaluation models based on clinical evidence is highlighted.

Managing adverse drug reactions: an orphan task

BACKGROUND

Nurse prescribing initiatives have potential to impact on medication management for long-term conditions. Over time, the adverse effects of medications become increasingly onerous. This 'side-effect burden' is particularly heavy for users of antipsychotic medication. Although consensus exists that strategies are needed to alleviate these problems, currently, they are not clearly the responsibility of any one professional group.

AIM

This paper explores the introduction of nurse-administered evaluation checklists, in relation to nurse prescribing initiatives and division of professional responsibilities for medication management.

METHODS

This was an observation study, with a quasi-experimental comparator group design, undertaken with clients receiving long-term antipsychotic medication. In both intervention and comparator groups, before and after introduction of evaluation checklists in the intervention group, 20 nurse-client interactions were observed. Problems actioned by the nurses, with and without the checklists, were compared. Stakeholders' views were sought concurrently.

FINDINGS

Implementation of evaluation checklists increased the numbers of adverse effects detected and actioned by nurses. They also served to apportion aspects of medication management between nurses and medical prescribers. Most actions taken by nurses to alleviate adverse effects concerned clients' physical health and advice on health-promotion. However, the nurses' interventions would have been more effective had they been able to supply clients with certain medicines either by prescribing from the Nurse Prescribers' Formulary or issuing under Patient Group Directions. For some clients, ameliorating the adverse effects of medication would have involved changes to prescribed antipsychotic medication; here decisions were more equivocal.

IMPLICATIONS

The identification of previously unattended problems, together with the views of service users, suggests that empowering nurses to address the 'care gaps' in medication management may benefit service users. The 'checklist evaluation' approach warrants further investigation, ideally in conjunction with nurse prescribing initiatives.

From ward-based critical care to educational curriculum 1: a literature review

There has been recent recognition in the literature, and a longer standing awareness amongst clinicians, that critically ill patients are to be found outside of intensive care units. These patients are not always well managed and some have concluded that their care is 'suboptimal' [Br. Med. J. 316 (1998) 1853] and that they die of preventable clinical problems [Extremes of Age: the 1999 Report of the National Confidential Enquiry into Perioperative Deaths (1999) NCEPOD]. Whilst the cause of this situation in the NHS probably involves a complex interplay of factors including failures in management, policy and the evidence/information base for practice, education failures have also been blamed. In response the government has mandated formal critical care education for ward nurses [Comprehensive Critical Care: a Review of Adult Critical Care Services (2000) Department of Health]. In this two-part paper, the literature around education for ward-based critical care is examined (Part 1) prior to a report of the findings (Part 2) of a case study exploring the everyday practices, context and culture of an acute surgical ward where seriously ill patients were cared for prior to the introduction of a critical care outreach service (Part 2). Implications for practice, education and future research are discussed.

The biological sciences in mental health nursing: stakeholders' perspectives

To date, relatively little attention has been paid to optimizing the development of education programmes to support safe and effective health care professionals. In particular, the wider stakeholders, particularly health service users, are rarely consulted on the knowledge base expected of practitioners. We report here on an evaluation, involving students, lecturers, nurses and service users, aimed at reviewing the bioscience component of the preregistration mental health nursing course. Students and lecturers agreed that the current common foundation course in bioscience was biased towards the adult branch students, and failed to meet the needs of mental health nurses. The mental health lecturers' solution to the 'bioscience problem' was to curtail the input. In contrast, service users described serious shortfalls in professionals' abilities to inform them of common side-effects of medication; these problems were attributable to inadequate educational preparation. The knowledge deficits identified could be rectified by making pharmacology an important part of the mental health education programme. However, for the curriculum to accommodate applied pharmacology, its supporting bioscience, and essential preparation in psychosocial interventions, some restructuring of the biological science programme for mental health nurses will be necessary. Our findings suggest that such restructuring should be informed by service users' views of their needs.

Educational input and patient outcomes: exploring the gap

Over the last two decades, the health care professions in the United Kingdom have seen an unparalleled expansion of continuing professional education (CPE) and development (CPD) programmes; however, there is little empirical evidence that these enhance the care delivered to patients. Further research is also needed to demonstrate that these initiatives are linked to improved patient outcomes. If health care educators are to move towards an 'evidence-based curriculum', some restructuring of courses may be needed. Priorities should be set and decisions made, based on the results of reliable and valid research into the clinical outcomes of CPE. To evaluate courses and demonstrate educational effectiveness solely in terms of student satisfaction is not enough; to survive in the world of evidence-based care, educators must also demonstrate their contribution to clinical effectiveness. However, the neoteric field of impact evaluation lacks not only validated research methods, but also an agreed agenda for future research. Drawing on interviews undertaken with nurses who have participated in education evaluations and the relevant literature, this paper discusses the available data collection instruments and the development of viable research designs and methods, which are urgently needed to assess the outcomes of professional education programmes.