The discourse of delivering person-centred nursing care before, and during, the COVID-19 pandemic: Care as collateral damage

The global COVID-19 pandemic challenged the world-how it functions, how people move in the social worlds and how government/government services and people interact. Health services, operating under the principles of new public management, have undertaken rapid changes to service delivery and models of care. What has become apparent is the mechanisms within which contemporary health services operate and how services are not prioritising the person at the centre of care. Person-centred care (PCC) is the philosophical premise upon which models of health care are developed and implemented. Given the strain that COVID-19 has placed on the health services and the people who deliver the care, it is essential to explore the tensions that exist in this space. This article suggests that before the pandemic, PCC was largely rhetoric, and rendered invisible during the pandemic. The paper presents an investigation into the role of PCC in these challenging times, adopting a Foucauldian lens, specifically governmentality and biopolitics, to examine the policies, priorities and practical implications as health services pivoted and adapted to changing and acute demands. Specifically, this paper draws on the Australian experience, including shifting nursing workforce priorities and additional challenges resulting from public health directives such as lockdowns and limitations. The findings from this exploration open a space for discussion around the rhetoric of PCC, the status of nurses and that which has been lost to the pandemic.

Nurse Navigators - Champions of the National Rural and Remote Nursing Generalist Framework: A solution

INTRODUCTION

Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person-centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high-care needs to self-management. Nurse Navigators are a working model in rural and remote areas of Queensland.

OBJECTIVE

To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice.

DESIGN

Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020.

FINDINGS

Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work.

DISCUSSION

This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework.

CONCLUSION

The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill.

How are the Dietary Needs of Pregnant Incarcerated Women Being Met? A Scoping Review and Thematic Analysis

INTRODUCTION

The number of incarcerated pregnant women is increasing globally. With many having complex health and social backgrounds, incarceration provides opportunities for health interventions, including the chance to have their nutritional needs met. Despite the additional nutritional requirements of pregnancy being well documented, how these are being met within the correctional setting is currently poorly understood.

METHODS

A scoping review of the literature was conducted to identify the literature published between January 2010 and April 2023 related to the provision of nutrition for pregnant women in the international prison systems. Sixteen papers met the criteria for inclusion in the review. The relevant key findings were charted and thematically analysed.

RESULTS

Two themes were identified: 'the inconsistent reality of food provision' and 'choice, autonomy and food'. There is a clear disparity in the way in which diet is prioritised and provided to pregnant incarcerated women across several countries.

DISCUSSION

The findings highlight the need for a consistent approach to diet on a macro, global level to ensure the health of women and their infants in context.

Front-line health professionals' recognition and responses to nonfatal strangulation events: An integrative review

AIM

The aim of this study was to determine how front-line health professionals identify and manage nonfatal strangulation events.

DESIGN

Integrative review with narrative synthesis was conducted.

DATA SOURCES

A comprehensive database search was conducted in six electronic databases (CINAHL, Wed of Science, DISCOVER, SCOPUS, PubMed and Scholar) resulting in 49 potentially eligible full texts, reduced to 10 articles for inclusion after exclusion criteria were applied.

REVIEW METHODS

An integrative review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Data were extracted, and a narrative synthesis using Whittemore and Knafl (2005) framework was undertaken to determine how front-line health professionals identify and manage nonfatal strangulation events.

RESULTS

The findings identified three main themes: an overall failure by health professionals to recognize nonfatal strangulation, a failure to report the event and a failure to follow up on victims after the event. Stigma and predetermined beliefs around nonfatal strangulation, along with a lack of knowledge about signs and symptoms, were the salient features in the literature.

CONCLUSION

Lack of training and fear of not knowing what to do next are barriers to providing care to victims of strangulation. Failure to detect, manage and support victims will continue the cycle of harm through the long-term health effects of strangulation. Early detection and management of strangulation are essential to prevent health complications, particularly when the victims are exposed to such behaviours repeatedly.

IMPACT

This review appears to be the first to explore how health professionals identify and manage nonfatal strangulation. It identified the significant need for education and robust and consistent screening and discharge policies to assist health providers of services where victims of nonfatal strangulation attend.

NO PATIENT OR PUBLIC CONTRIBUTION

This review contains no patient or public contribution since it was examining health professionals' knowledge of identifying nonfatal strangulation and the screening and assessment tools used in clinical practice.

The grounded theory of Coalescence of Perceptions, Practice and Power: An understanding of governance in midwifery practice

AIMS

This study aimed to understand midwifery care during labour, particularly decision-making processes, within Australian health systems.

BACKGROUND

Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision-making contributes to understanding governance of practices.

METHOD

Straussian grounded theory using semi-structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour.

RESULTS

Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged.

CONCLUSIONS

Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates.

IMPLICATIONS FOR MIDWIFERY MANAGERS

Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance.

PROMOTING NURSES' AND MIDWIVES' ETHICAL RESPONSIBILITIES TOWARDS VULNERABLE PEOPLE: AN ALIGNMENT OF RESEARCH AND CLINICAL PRACTICE

AIM

To stimulate discussion and debate about inclusion of vulnerable populations in primary research to inform practice change and improve health outcomes.

BACKGROUND

Current research practices to safeguard vulnerable people from potential harms related to power imbalances, may in fact limit the generation of evidence-based practice.

EVALUATION

The authors draw on their experience working and researching with a recognised group of vulnerable people, incarcerated pregnant women, to provide insight into the application of ethics in both research and clinical practice. In a novel approach, the ethical principles are presented in both contexts, articulating the synergies between them. Suggestions are presented for how individuals, managers and organisations may improve research opportunities for clinical practitioners and enhance the engagement of vulnerable people to contribute to meaningful practice and policy change.

KEY ISSUES

Ethical practice guidelines may limit the ability to create meaningful change for vulnerable populations, who need authentic system change to achieve good health outcomes.

CONCLUSION

Inclusive research and practice are essential to ensuring a strengths-based approach to healthcare and addressing health needs of the whole population. Health systems and models of care recognising the diverse lives and health needs of the broader population, demand practical, sustainable support from clinical managers.

IMPLICATIONS FOR NURSING MANAGEMENT

Practical suggestions for clinical managers to support point of care research is provided, embedding vulnerable voices in policy, practice development, and care provision.

Lost voices: Using a case study to illustrate narrative inquiry: Research brief

INTRODUCTION

In this study, we tested the feasibility of using a narrative inquiry - three-dimensional space inquiry to elicit the experiences of an adult family member who shared her journey of care and advocacy for her husband situated in a dementia care unit.

BACKGROUND

The voices of family members are rarely heard in relation to their experiences about being included in or making decisions about their loved one's care. Shared decision-making has been an important patient-centred approach to nursing care since the 1990s; however, it is often not a reality in aged care facilities.

METHOD

An interview was conducted with one adult family member using the three-dimension space that is inspired by narrative theorists to analyse the narrative.

RESULTS

Three themes were identified in the responses: communication between staff and family, staffing in the dementia care unit, and loss of voice and shared decision making.

CONCLUSION

Results of this study indicate that narrative inquiry supports the telling of personal experiences around a problem and then using that information to raise awareness of those issues that are not always heard but which are essential for change in health care policy and practice.

Cognitive effects of chemotherapy: An integrative review

PURPOSE

An estimated 18.1 million new cancer cases (excluding nonmelanoma skin cancers) were diagnosed worldwide in 2020. Despite a rising incidence of cancers worldwide, in developed countries with strong healthcare systems, survival rates are improving as a result of early detection, improved treatments and survivorship care (World Health Organisation (WHO), 2021). Whilst living longer, cancer survivors are often living with side effects of treatment, including chemotherapy related cognitive impairment, often termed "chemobrain".

METHOD

An integrative review of contemporary literature answering the research question how does chemotherapy affect cognitive function? was undertaken utilising three computerised databases CINAHL, Medline and PUBMED, between 2015 and 2021. Data was thematically analysed to identify themes within published literature.

RESULTS

Thematic analysis identified four broad themes within the literature regarding chemotherapy induced cognitive impairment. Identified themes included; cognition as part of a complex scenario, proof of existence and searching for the cause, learning to play the game and timing of cognitive impairment.

CONCLUSIONS

Aggressive treatment with chemotherapy in the adjuvant setting has drastically improved the survival of cancer patients. Subsequent to aggressive treatments, side effects such as cognitive impairment have presented, which may persist in the long term. Despite the exact aetiology of chemotherapy induced cognitive impairment being largely unknown, the consequences of the condition are impacting cancer survivors and their quality of life.

Health (il)literacy: Structural vulnerability in the nurse navigator service

Health literacy is a contemporary term used in health services, often used to describe individuals requiring additional support to access, understand and implement health service information. It is used as a measure of self-efficacy in chronic disease models of care such as the nurse navigator service. The aim of the research was to investigate the concept of health literacy in the nurse navigator service, particularly in relation to the defined role objective of person-centred care. Fairclough's critical discourse analysis was used to analyse the experiential, relational and expressive elements of texts, investigating the hidden truths which are represented in discourse. Texts from a variety of health service micro-, meso- and macro-hierarchical sources were selected for analysis using the nurse navigator evaluation data set and other associated texts. Health literacy in the nurse navigator service is a technology of government used to increase participation of individuals in their own health and well-being. The discourse suggests that health literacy responsibilises both individuals and nurses and is discursively formed within a matrix of rational choice. In this context, health literacy contributes to structural vulnerability.

807 A Review of The Applications of Autologous Fascia Lata Grafts in Reconstructive Surgery

Background

We sought to review current applications of fascia lata autografts and update the original collection of uses proposed almost a century ago, thereby revealing the full extent of uses available to the contemporary reconstructive surgeon.

Method

A comprehensive literature search of peer-reviewed articles listed within PubMed and Medline was performed.

Results

The properties of autologous fascia lata grafts are presented, a technique for its harvest and the numerous uses of this material in reconstructive surgery. Specifically, its applications in head and neck surgery, surgery of the limbs, abdominal wall reconstruction and penile reconstruction are reviewed.

There is limited data on donor site morbidity, but complications appear to be uncommon. However, it was established that the reported risk of muscle herniation varies greatly in the available literature from 0-36% and appears to be related to the width of tissue harvested.

Conclusions

Autologous fascia lata grafts are a viable and versatile material in the armamentarium of a reconstructive surgeon, that, with careful planning, can be used with minimal donor site morbidity. This is especially true in lower resource settings where a surgeon may not have access to allogenic material and autologous grafts can provide an easily accessible, cheaper, and practical alternative.

783 Brachial Plexopathy Secondary to Prone Position Used in The Treatment of a Ventilated Patient With COVID-19: A Case Report and Service Improvement Recommendations

Introduction

Prone position has been recommended by many authorities as part of the management of ventilated patients with COVID-19. However, proning with concurrent use of sedation and muscle relaxants carries the hypothetical risk of brachial plexus injuries, thought to be due to stretch and compression of the abducted shoulder.

Case

Recommendations

Conclusions

We present this as a pathology to consider in patients proned during the COVID-19 pandemic; and recommend checking for signs of focal neurological deficits of the upper limb upon removal of paralysis and sedation, with early referral of suspected cases.

798 Improving Foundation Doctors’ Confidence and Knowledge of Free Flaps and Their Possible Complications: A Closed-Loop Quality Improvement Study

Introduction

To assess confidence and knowledge of managing free flaps in foundation doctors’, who, whilst working on a general surgery rota, are expected to intermittently manage plastic surgery patients, and introduce a simple tool to support them.

Method

A single-centre closed-loop quality improvement project, using the ‘Plan, Do, Study, Act’ methodology, was conducted. Initially, a prospective, baseline audit assessing foundation doctors’ confidence and knowledge was carried out. This utilised images and clinical scenarios to assess understanding of complications.

Results were analysed, and a simple poster was designed and distributed for reference. Two months later the questionnaire was repeated to reassess confidence and knowledge.

Results

Pre- and post- intervention surveys were completed by all general surgery foundation doctors (n = 11). Mean confidence was significantly improved following intervention (p = <0.0001). Baseline ability to spot a healthy flap and venous congestion was good. Ability to identify arterial occlusion and a healthy muscle flap, with concurrent split-thickness skin graft, significantly improved (p = <0.0001 and p = 0.0091, respectively)

Conclusions

Foundation doctors lack confidence and knowledge of managing free flaps, despite some being expected to do so whilst on a general surgery rota. This can be improved through a simple, informative resource to refer to when dealing with these patients.

Nurse navigators and person-centred care; delivered but not valued?

Positioning the individual at the centre of care (person-centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long-standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well-being of the individuals utilising the services.

Examining the hurdles in defining the practice of Nurse Navigators

BACKGROUND

Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care.

PURPOSE

A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident.

DISCUSSION

Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance.

CONCLUSION

Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide.

Person-centred rhetoric in chronic care: a review of health policies

PURPOSE

The purpose of the paper is to explore how the national, state and organisational health policies in Australia support the implementation of person-centred care in managing chronic care conditions.

DESIGN/METHODOLOGY/APPROACH

A qualitative content analysis was performed regarding the national, state and organisational Queensland Health policies using Elo and Kyngas' (2008) framework.

FINDINGS

Although the person-centred care as an approach is well articulated in health policies, there is still no definitive measure or approach to embedding it into operational services. Complex funding structures and competing priorities of the governments and the health organisations carry the risk that person-centred care as an approach gets lost in translation. Three themes emerged: the patient versus the government; health care delivery versus the political agenda; and health care organisational processes versus the patient.

RESEARCH LIMITATIONS/IMPLICATIONS

Given that person-centred care is the recommended approach for responding to chronic health conditions, further empirical research is required to evaluate how programs designed to deliver person-centred care achieve that objective in practice.

PRACTICAL IMPLICATIONS

This research highlights the complex environment in which the person-centred approach is implemented. Short-term programmes created specifically to focus on person-centred care require the right organisational infrastructure, support and direction. This review demonstrates the need for alignment of policies related to chronic disease management at the broader organisational level.

ORIGINALITY/VALUE

Given the introduction of the nurse navigator program to take up a person-centred care approach, the review of the recent policies was undertaken to understand how they support this initiative.

Evaluation of a nursing and midwifery exchange between rural and metropolitan hospitals: A mixed methods study

Introduction

This paper reports on the findings of the Nursing and Midwifery Exchange Program, initiated to promote rural and remote nursing and midwifery, and to facilitate clinical skills development and clinical collaboration between health services in Queensland, Australia. The project was undertaken over an 18-month period in one state of Australia, offering structured, temporary exchange of personnel between metropolitan and rural health services.

Background

Globally, there is an increasing awareness of nursing shortages, and with it, the need to ensure that nurses and midwives are prepared for specialist roles and practice. This is particularly important in rural and remote areas, where there are pre-existing barriers to access to services, and difficulties in attracting suitably qualified, permanent staff.

Methods

A mixed methods approach to the evaluation was undertaken with two cohorts. One cohort was the nurses and midwives who participated in the exchange (n = 24) and the other cohort were managers of the participating health services (n = 10). The nurses and midwives who participated in the exchange were asked to complete a questionnaire that included questions related to embeddedness and job satisfaction. The managers participated in a Delphi series of interviews.

Results

Those who participated in exchange reporting a higher score on the reported degree of understanding of rural client, which was accompanied with a moderate-to-large effect size estimate (d = 0.61). Nurses/midwives in the exchange group reported higher scores on their perceptions of aspects of their home community that would be lost if they had to leave, which was accompanied with a large effect size (d = 0.83). Overall, NMEP was reported by the participants to be a positive way to improve professional development opportunities for nurses and midwives. The findings also show the program supported practical collaboration and raised the profile of nursing and midwifery in rural areas.

Conclusion

Exchange programs support clinical and professional development, raising the awareness of different contexts of practice and related skills requirements, and thereby supporting a greater understanding of different nursing roles. In the light of increasingly complex care required by patients with chronic conditions being managed in community-based services, programs such as NMEP provide the opportunity to build collaborative networks between referring and referral centres as well as contribute to the ongoing skills development.

Whose centre is it anyway? Defining person-centred care in nursing: An integrative review

AIM

The aims of this literature review were to better understand the current literature about person-centred care (PCC) and identify a clear definition of the term PCC relevant to nursing practice.

METHOD/DATA SOURCES

An integrative literature review was undertaken using The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Scopus and Pubmed databases. The limitations were English language, full text articles published between 1998 and 2018 within Australian, New Zealand, Canada, USA, Europe, Ireland and UK were included. The international context off PCC is then specifically related to the Australian context.

REVIEW METHODS

The review adopted a thematic analysis to categorise and summarise themes with reference to the concept of PCC. The review process also adhered to the Preferred Reporting System for Meta-Analysis (PRISMA) and applied the Critical Appraisal Skills Programme (CASP) tools to ensure the quality of the papers included for deeper analysis.

RESULTS

While definitions of PCC do exist, there is no universally used definition within the nursing profession. This review has found three core themes which contribute to how PCC is understood and practiced, these are People, Practice and Power. This review uncovered a malalignment between the concept of PCC and the operationalisation of the term; this misalignment was discovered at both the practice level, and at the micro, meso and micro levels of the healthcare service.

CONCLUSION

The concept of PCC is well known to nurses, yet ill-defined and operationalised into practice. PCC is potentially hindered by its apparent rhetorical nature, and further investigation of how PCC is valued and operationalised through its measurement and reported outcomes is needed. Investigation of the literature found many definitions of PCC, but no one universally accepted and used definition. Subsequently, PCC remains conceptional in nature, leading to disparity between how it is interpreted and operationalised within the healthcare system and within nursing services.

The use of telephone communication between nurse navigators and their patients

Background

Hospitals and other health care providers frequently experience difficulties contacting patients and their carers who live remotely from the town where the health service is located. In 2016 Nurse Navigator positions were introduced into the health services by Queensland Health, to support and navigate the care of people with chronic and complex conditions. One hospital in Far North Queensland initiated an additional free telephone service to provide another means of communication for patients and carers with the NNs and for off-campus health professionals to obtain details about a patient utilising the service. Calls made between 7am and 10pm, seven days per week are answered by a nurse navigator.

Aim

To report utilisation of the service by navigated clients and remotely located clinicians compared to use of navigators’ individual work numbers and direct health service numbers. We report the reason for calls to the free number and examine features of these calls.

Methods

Statistical analysis examined the call reason, duration of calls, setting from where calls originated and stream of calls. Interactions between the reasons for calls and the features of calls, such as contact method, were examined.

Results

The major reason for calls was clinical issues and the source of calls was primarily patients and carers. Clinical calls were longer in duration. Shorter calls were mainly non-clinical, made by a health professional. Setting for calls was not related to the reason. The most frequent number used was the individual mobile number of the NN, followed by the hospital landline. Although the free number was utilised by patients and carers, it was not the preferred option.

Conclusion

As patients and carers preferred to access their NN directly than via the 1800 number, further research should explore options best suited to this group of patients outside normal business hours.

Balancing the scales-Nurses' attempts at meeting family and employer needs in a work-intensified environment

AIMS

This paper describes findings from a survey conducted in New Zealand exploring nurses' decision-making about when to delay care, delegate care, hand care over or leave care undone. Unanticipated findings identified processes that nurses go through when deciding to take planned/unplanned leave when wards are constrained through budget limitations.

BACKGROUND

Missed/rationed care is increasingly the focus of attention in international studies, identifying a complex interplay of organisational, professional and personal factors affecting nurses' decision-making when faced with limited organisational time, human and material resources to provide care.

METHODS

The survey presented nurses with Likert-scale questions with option for free text comments. This paper reports on the commentaries about work-life balance.

RESULTS

Nurses described workload pressures that lead to rationing care affected them, and the long-term effect on them as individuals. Nurses verbalized the difficulties and associated guilt about taking leaving and sick leave when wards were short staffed.

CONCLUSIONS

Nurses consider how their absence will affect the workspace and their home first, considering the impact on themselves last.

IMPLICATIONS

The findings may provide valuable insights for nurse managers in relation to workforce allocations and resources where acknowledgement of work-life balance is considered.

The evaluation of nurse navigators in chronic and complex care

AIM

With increasing age and chronicity in populations, the need to reduce the costs of care while enhancing quality and hospital avoidance, is important. Nurse-led co-ordination is one such model of care that supports this approach. The aim of this research was to assess the impact that newly appointed Navigators have on service provision; social and economic impact; nurses' professional quality of life and compassion fatigue; and analysis of the change that has occurred to models of care and service delivery.

DESIGN

A concurrent mixed-method approach was selected to address the research aims.

METHODS

The research project was funded in July 2018 and will conclude in December 2020. Several cohorts will be studied including; patients assigned to a navigator, patients not assigned to a navigator, family members of patients assigned a navigator; and a sample sized estimated at 140 navigators.

DISCUSSION

This study provides a comprehensive international longitudinal and mixed method framework for evaluating the impact of nurse navigators on quality of care outcomes for patients with chronic conditions. IMPACT-WHAT PROBLEM WILL THE STUDY ADDRESS?: Even with specialty focused co-ordinated care, patients get lost in the system, increasing the incidence of non-compliance and exacerbation of condition. Navigators work with patients across service boundaries allowing for care that is patient responsive, and permitting variables in clinical, social and practical elements of care to be addressed in a timely manner. This novel nurse-led approach, supports hospital avoidance and patient self-management, while encouraging expansion and opportunity for the nursing and midwifery workforce.

Pregnant in prison: An integrative literature review

BACKGROUND

Pregnant women in prisons are recognised as a marginalised group. However, there is a limited understanding of the women's unique maternity needs and how correctional institutions and maternity service providers respond to these needs.

AIM

The aims of the review are threefold.

METHOD

An integrative literature review was undertaken. A comprehensive search strategy using seven electronic databases resulted in the retrieval of 363 articles. Of them, 32 peer-reviewed studies met the final selection criteria and were included in this review which utilised the Critical Appraisal Skills Program tools and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart. Thematic analysis identified universal themes.

FINDINGS

Three dominant themes emerged related to the experience of pregnant women in prison: (1) risks and vulnerability factors; (2) prison enablers and supports; and (3) prison barriers. Extant research on risks and vulnerability factors is disproportionate to research examining how prisons can enable or obstruct responding to the women's perinatal needs. Limited research on the midwifery support available to the women in prison is available. Significantly, only two out of 32 reviewed papers include research directly conducted with the pregnant women in prison.

CONCLUSION

Pregnant women in prisons have complex needs. More research is required to understand how prisons can enhance the pregnancy experience by engaging pregnant women in prisons as research participants.

From the Ground Up: Improving Pregnancy and Birth Experiences Through the Provision of Extraordinary Learning Opportunities in Australia

A collaborative project formally titled "Working together to improve pregnancy and birth experiences for women and provide extraordinary learning opportunities for midwifery students" was launched in April 2017, after several years of consultation and planning. The opportunity to adopt an integrated response to the needs of incarcerated pregnant women and the learning needs of midwifery students was identified and supported by the university offering a graduate-entry midwifery program, a women's correctional center, and a health service in a regional area of Australia. Incarcerated women who are pregnant require pregnancy, birth, and postnatal support distinct from their clinical care, while at the same time, midwifery students need to recruit pregnant women for continuity-of-care experiences. This article presents an overview of the implementation of the pilot project. It also discusses the project team and the challenges and successes of and unanticipated opportunities for practice modification and change.

Reconciling professional identity: A grounded theory of nurse academics' role modelling for undergraduate students

Role modelling by experienced nurses, including nurse academics, is a key factor in the process of preparing undergraduate nursing students for practice, and may contribute to longevity in the workforce. A grounded theory study was undertaken to investigate the phenomenon of nurse academics' role modelling for undergraduate students. The study sought to answer the research question: how do nurse academics role model positive professional behaviours for undergraduate students? The aims of this study were to: theorise a process of nurse academic role modelling for undergraduate students; describe the elements that support positive role modelling by nurse academics; and explain the factors that influence the implementation of academic role modelling. The study sample included five second year nursing students and sixteen nurse academics from Australia and the United Kingdom. Data was collected from observation, focus groups and individual interviews. This study found that in order for nurse academics to role model professional behaviours for nursing students, they must reconcile their own professional identity. This paper introduces the theory of reconciling professional identity and discusses the three categories that comprise the theory, creating a context for learning, creating a context for authentic rehearsal and mirroring identity.

Publisher's Note: JLab Measurements of the ^{3}He Form Factors at Large Momentum Transfers [Phys. Rev. Lett. 119, 162501 (2017)]

This corrects the article DOI: 10.1103/PhysRevLett.119.162501.

JLab Measurements of the ^{3}He Form Factors at Large Momentum Transfers

The charge and magnetic form factors, F_{C} and F_{M}, respectively, of ^{3}He are extracted in the kinematic range 25  fm^{-2}≤Q^{2}≤61  fm^{-2} from elastic electron scattering by detecting ^{3}He recoil nuclei and scattered electrons in coincidence with the two High Resolution Spectrometers of the Hall A Facility at Jefferson Lab. The measurements find evidence for the existence of a second diffraction minimum for the magnetic form factor at Q^{2}=49.3  fm^{-2} and for the charge form factor at Q^{2}=62.0  fm^{-2}. Both minima are predicted to exist in the Q^{2} range accessible by this Jefferson Lab experiment. The data are in qualitative agreement with theoretical calculations based on realistic interactions and accurate methods to solve the three-body nuclear problem.

Prevalence of cervical cancer and associated mortality in Grenada, 2000-2010

Objective To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000-2010. Methods Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35-44 age group, with the second highest among 45-64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000-2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

A Brief Survey Of The Impact Of Restructuring Of Clinical Placement And Education Delivery For Medical Students In 5 Boroughs Partnership Nhs Foundation Trust

Introduction

In the United Kingdom, a drive has been initiated to duly attract and recruit medical student into career psychiatry. However, most medical students attending university find the psychiatry lacks structure and organised model in teaching delivery.

As a result, many medical students put off earlier on in their studies by psychiatry.

Aim

We wanted to test the above hypothesis with the introduction of structure by allocating de-centralised teaching and hands on clinical experience for medical students.

Method

The collective survey tool is devised to reflect the needs of medical students with de-centralised teaching separate but to complement university studies. This included introduction of induction package, set out syllabus, structured learning sessions. The results of the feedback from the medical students were collated and the results are discussed.

Discussion

The results indicate the success of the decentralized and borough based teaching, with improved interest in psychiatry and higher attendance rate. The feedback has been positive, and efforts of the tutors have been appreciated. Whether this will translate into higher recruitment rate number is to be seen.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Role modeling in undergraduate nursing education: an integrative literature review

The transition of nursing education from the hospital setting to the university sector over recent decades has opened dialog about who is guiding the development of nursing students' professional identity. In addition, there is ongoing debate over real or perceived gaps between nursing student learning in the university and the clinical area, how this translates into professional behaviors and how well students make the transition between the two settings. This paper presents the findings of an integrative literature review into the topic of role modeling in undergraduate nursing education. This review was conducted to identify and appraise research findings about role modeling of professional behaviors for undergraduate nursing students. Literature reviewed from 2000 onwards assesses what is currently known about role modeling of undergraduate nursing students. A systematic search of the databases of CINAHL, Scopus and PubMed from 2000 onwards resulted in the selection of 33 articles for deeper analysis. Two clear themes emerged from the literature, the first relating to nurse clinicians as role models for students during clinical placements and the second relating to nurse academics as role models in the academic setting. Findings from this integrative literature review show an imbalance in the recognition of the role modeling of professional behaviors in the clinical versus the academic setting. Nurses in academic settings have more contact with the students over their period of study and as such, the significance of nurse academics as student role models requires further investigation.

JLab measurement of the 4He charge form factor at large momentum transfers

The charge form factor of 4He has been extracted in the range 29  fm(-2) ≤ Q2 ≤ 77  fm(-2) from elastic electron scattering, detecting 4He recoil nuclei and electrons in coincidence with the high resolution spectrometers of the Hall A Facility of Jefferson Lab. The measurements have uncovered a second diffraction minimum for the form factor, which was predicted in the Q2 range of this experiment. The data are in qualitative agreement with theoretical calculations based on realistic interactions and accurate methods to solve the few-body problem.

Ultrasound-guided core biopsy in the diagnosis of lymphoma of the head and neck. A 9 year experience

OBJECTIVES

This retrospective study aimed to evaluate the diagnostic utility of ultrasound-guided core biopsy (USCB) in lymphoma of the head and neck, in particular whether core biopsy can provide sufficient diagnostic information for definitive treatment.

METHODS

All lymphomas diagnosed in the head and neck at Eastbourne General Hospital between January 2000 and June 2009 were identified. Radiology and pathology reports were reviewed and the diagnostic techniques recorded. The type of biopsy (fine needle aspiration, needle core, surgical excision biopsy) used to establish a diagnosis sufficient to allow treatment, i.e. the "index" diagnostic technique, was identified. Previous inconclusive or inadequate biopsies were noted. Pathology reports based on USCB were graded 0-3 according to diagnostic completeness and ability to provide treatment information.

RESULTS

Of 691 overall cases of lymphoma diagnosed over the 9 year period, 171 different patients presented with lymphoma in the head and neck. Of these 171, 83 had USCB biopsy during diagnostic work up. 60 were regarded as grade 3 where a confident diagnosis of lymphoma was made. In seven patients, clinical management proceeded on the basis of a suggestive (grade 2) pathology report without surgical excision, and these were therefore also included as "index" biopsies. Overall therefore, 67/83 core biopsies (81%) provided adequate information to allow treatment. Surgical excision biopsy was the index modality in 104 cases.

CONCLUSION

In the majority of cases USCB is adequate for confident histopathological diagnosis avoiding the need for surgical excision biopsy in cases of suspected head and neck lymphoma.