Tuesday, 3 July 2018

A NICE Future is One with Fewer Surgical Site Complications

Author of report Dr Vicki Strugala,
Smith & Nephew Professional Education
 – AWM; Europe.
Complications from surgical incisions are a significant economic and human burden, costing an approximate £1 billion[i] to the NHS each year and contributing to significant morbidity and mortality in the UK and globally. A recent World Union of Wound Healing Societies consensus guidelines reports that up to 60% of surgical site infections (SSIs) are preventable[ii] in the first place, which suggests that more needs to be done to reduce this figure.

One such medical innovation that is helping reduce the wound care burden is Negative Pressure Wound Therapy. A recent meta-analysis which included 16 studies, demonstrated the prophylactic application of PICO on surgical site incisions significantly reduced surgical site infections (SSIs) by 58%, wound dehiscence (wound rupturing along a surgical incision) by 26%, and length of stay by 0.5 days when compared to standard care[iii]*.

The meta-analysis evaluated results from 16 peer-reviewed publications (including 10 RCTs), involving 1863 patients and 2202 incisions. It assessed the average effect of the PICO Single Use Negative Pressure Wound Therapy System application across a wide variety of surgical indications.

This study is the latest body of evidence which adds to the literature and research supporting PICO as an effective prophylactic treatment option for SSIs. In addition, it helps provide important insights into optimising clinical management strategies for preventing SSIs, which are an increasing concern for healthcare providers and their patients around the world.

This week, NICE announced its first Medtech Innovation Briefing (MIB) for PICO, which is the first MIB awarded for a Negative Pressure Wound Therapy device, in relation to the prevention of surgical site complications. It is hoped that this latest announcement is expected to provide healthcare professionals with the confidence to treat at-risk patients and procedures with PICO, improving clinical and cost savings.

For example, in patients undergoing primary hip and knee arthroplasties, it was estimated that care with PICO enabled cost savings of more than £7,000 per high-risk patient (BMI ≥35 or ASA ≥3) compared with care with standard dressing[iv]**.

Pioneering medical technologies are therefore key to providing solutions that continue to improve current standards of care and economic outcomes, and most importantly, better patient outcomes.


Rachel Cunningham
Account Director
ROAD Communications
Email: Rachel@roadcommunications.co.uk

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[i] Guest J et al, Health economic burden that different wound types impose on the UK’s National Health Service. Int Wound J 2016; doi: 10.1111/iwj.12603

[ii] World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT. Wounds International, 2016

[iii] Strugala, V. and Martin, R. Meta-analysis of comparative trials evaluating a prophylactic single-usenegative pressure wound therapy system for the prevention of surgical site complications. Surgical Infections (2017). DOI 10.1089/ sur.2017.156 * Meta-analysis included 10 RCT & 6 observational studies. Reduction in SSI (16 studies included): 1839 patients (2154 incisions): PICO 5.2%; control group 12.5%; p<0.0001. Mean reduction in hospital length of stay 0.47 days (8 studies included): p<0.0001

[iv] Nherera LM, Trueman P, Karlakki SL. Cost-effectiveness analysis of single-use negative pressure wound therapy dressings (sNPWT) to reduce surgical site complications (SSC) in routine primary hip and knee replacements. Wound Repair Regen. April 2017. doi:10.1111/wrr.12530

   * 50-patient study; length of stay reduced: PICO 6.1 days; control group 14.7 days; p<0.019

   ** Calculations based on a 220-patient RCT

Sunday, 17 June 2018

Care-giving by family members

Roger Watson, Editor-in-Chief

Caring by family caregivers for family members is a considerable commitment and takes time away from work, leisure and life in general. But how much time do family caregivers spend on caregiving and how much time do they think they spend on it? This was the focus on an article from Spain by Timonet‐Andreu et al. (2018) titled: 'Overestimation of hours dedicated to family caregiving of persons with heart failure' and published in JAN which aimed to: 'profile the family caregivers of people living with heart failure, to determine the perceived and real time devoted to daily care and to identify the factors associated with caregivers’ overestimation of time dedicated to care'.

Nearly 500 patient-family caregiver dyads were involved in the study for three years. Caregivers overestimated the time spent on caring to be twice as much as the time they actually spent on caring. The factors which led them to overestimate caregiving time included the age of the caregiver and the length of the caregiving relationship. In conclusion, the authors say:

'The overestimation of time dedicated to care seems to be related to people living with heart failure and caregivers’ characteristics, such as functional status, caregiver burden, age and cohabitation. These patterns should be taken into account by nurses when carrying out assessments and care planning with these types of patients and their caregivers.

Moreover, objective measures to determine the real amount of time dedicated to caregiving should be developed to facilitate a comprehensive assessment of the caregiver’s situation. If this were done, specific interventions could be designed for caregivers with a strongly distorted perception of the time dedicated to care to detect underlying clinical or social circumstances that could be producing this misconception. This issue could then be addressed by means of educational or behavioural interventions.'

You can listen to this as a podcast

Reference

Timonet‐Andreu, E. , Canca‐Sanchez, J. C., Sepulveda‐Sanchez, J. , Ortiz‐Tomé, C. , Rivas‐Ruiz, F. , Toribio‐Toribio, J. C., Mora‐Banderas, A. and Morales‐Asencio, J. M. (2018), Overestimation of hours dedicated to family caregiving of persons with heart failure. J Adv Nurs. doi:10.1111/jan.13727


What affects clinical nurse educator’s perception of confidence in their role?

Van Nguyen, PhD 
Research officer, Alfred Health Clinical School, La Trobe University, Australia.

Associate Professor Helen Forbes, PhD
School of Nursing and Midwifery, Deakin University, Geelong, Australia.

Alfred Deakin Professor Maxine Duke, PhD
School of Nursing and Midwifery, Deakin University, Geelong, Australia.

Our article “The effect of preparation strategies, qualification and professional background on clinical nurse educator confidence” provides an insight into the factors that assist clinical educators of nursing in Vietnam to develop confidence in their role. According to World Health Organisation (2013), there is a lack of evidence for the most effective preparation and support strategies for health educators. This study provides important evidence for the orientation and preparation of future nurse educators and other health professional educators. The results of this study will appeal specifically to current clinical nurse educators, those who are considering taking on this role or those who supervise clinical nurse educators.

This article is the third publication in our series about nursing education. The first article describes the development and validation of psychometric properties of the Clinical Nurse Educator Skill Acquisition Assessment tool (CNESAA) (Nguyen, Forbes, Mohebbi, & Duke, 2017b) which was used to identify preparation and support strategies for clinical nurse educators. The second article focuses on how confident Vietnamese clinical nurse educators were to undertake their role in the context of numerous restructures to professionalise nursing in Vietnam (Nguyen, Duke, & Forbes, 2017a). In these articles, the CNESAA was used not only to measure clinical nurse educator’s confidence but to explore important aspects related to the preparation of human resources for nursing education. Such use of the tool can also be applied in other contexts as well as other disciplines of health sciences.

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References

Nguyen, V. N. B., Forbes, H., Mohebbi, M., & Duke, M. (Accepted for publication). The effect of preparation strategies, qualification and professional background on clinical nurse educator confidence. Journal of Advanced Nursing.

Nguyen, V. N. B., Duke, M., & Forbes, H. (2017a). Nurse educator confidence in clinical teaching in Vietnam: A cross-sectional study. Collegian. doi:10.1016/j.colegn.2017.09.008

Nguyen, V. N. B., Forbes, H., Mohebbi, M., & Duke, M. (2017b). Development and validation of an instrument to measure nurse educator perceived confidence in clinical teaching. Nursing & Health Sciences, 19(4), 498-508. doi:doi:10.1111/nhs.12373

World Health Organisation. (2013). Transforming and scaling up health professionals’ education and training: World Health Organization guidelines 2013. Retrieved from Geneva: http://apps.who.int/iris/bitstream/10665/93635/1/9789241506502_eng.pdf

Friday, 25 May 2018

It’s time to agree on author order

by Terence McCann

email: Terence.mcann@edu.au

Most of us have pondered the order of authors listed on a paper. Aside from our personal confusion about each author’s contribution, questionable authorship practices in leading peer-reviewed nursing and midwifery journals are a significant threat to the integrity of nursing and midwifery scholarship and research. Although broad guidelines regarding publishing practices exist, there appears to be a general absence of or adherence to regulatory guidance concerning authorship and author order. In addition, authorship trends differ across disciplines and countries, leaving the reader unable to determine which authorship convention has been followed. Hence, transparency in author attribution seems to be the exception rather than the rule. The confusion and contentiousness of author order are exacerbated by its potential influence on opportunities for employment, promotion, tenure and research funding. Although it is generally accepted that first and last authors receive the most credit – and the first author is almost always considered the most valuable position on a paper –there is little consistency in how author order is determined. Adoption of a set of principles to guide and justify author order is needed. In a forthcoming discussion paper, McCann and Polacsek (2018) recommend that the ‘first-last-author-emphasis’ be adopted uniformly internationally across nursing and midwifery research. The first author should have made the most significant contribution to the paper; the last author should have made the second most significant contribution to the study, or served as a senior academic or mentor on the study; and other authors should be listed in descending order of their contribution.
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McCann, T. V., & Polacsek, M. (2018). Addressing the vexed issue of authorship and author order: A discussion paper. Journal of Advanced Nursing. DOI: 10.1111/jan.13720

Monday, 14 May 2018

Reply to Hoeltzell

Reply to: http://journalofadvancednursing.blogspot.co.uk/2018/05/commentary-emotional-intelligence-or.html 

Austyn Snowden, PhD, RMN, FHEA

Thank you for commenting on our article, and for the opportunity to respond. To recap, our study found that there was a very small but positive correlation between ‘trait’ emotional intelligence and successful completion of a nursing degree at first attempt (Snowden et al., 2017). This was the finding from a three-year longitudinal study of a large cohort of Scottish student nurses who started training in 2013, and qualified in 2016. We also found that older females were more likely to complete the course, and that previous caring experience made absolutely no difference to whether students were successful or not, and in fact made it more likely for them to fail in year 1. 

We also found a slightly stronger correlation between ‘social connection’ and completion. Social connection was a factor we found in the Trait Emotional Intelligence Questionnaire- short form (TEIQue-SF) (Snowden et al., 2015), the questionnaire we used to measure trait EI in the study (Cooper and Petrides, 2010). ‘Social connection’ seemed to measure the ability to make connections between people, to apply EI. My interpretation is that it is this application of emotional intelligence that Ms Hoeltzell is referring to when arguing for ‘emotional competence’, the ability to express emotional intelligence in a social context. I’m not sure, but if my interpretation is correct, then we agree with her, because that’s what our research found.

However, I found the more interesting element of Ms Hoeltzell’s response to be the identification of emotional intelligence as ‘buzzword’. I couldn’t agree more with that. I think we have probably passed peak emotional intelligence, possibly even peak resilience, hence the need for related but extended concepts such as emotional competence. To me these less rigorous concepts simply signal that it’s time to move on, or at least look elsewhere. Our most recent data showed that in their first year of being qualified nurses, sickness/absence was associated with work experience, such that those with higher job satisfaction were less likely to go off sick. A bit obvious really, but still worth obtaining empirically. The relevant point to this response was that there was no relationship between emotional intelligence and sickness rates, or between resilience and sickness rates. Perhaps it’s time to stop blaming ourselves for lacking perfect personal attributes and instead consider a more practical analysis of the relationship between nurses and their work.

UK nursing has been through an unprecedented period of navel gazing as a consequence of care failings. Whilst it was right to reflect and repair, I think we have probably reached the end of the ‘attribute adventure’, and so I would personally consign emotional competence to history if I could, along with EI, compassion, and resilience. Instead, I would invite the social psychologists to have a go. John Paley’s critique of the compassion agenda (2013) was too early in the grief process for most to take at the time. I would urge another look.

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References

Cooper, A., Petrides, K. V, 2010. A psychometric analysis of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) using item response theory. J. Pers. Assess. 92, 449–57. doi:10.1080/00223891.2010.497426

Paley, J., 2013. Social psychology and the compassion deficit. Nurse Educ. Today 33, 10–11. doi:10.1016/j.nedt.2013.05.011

Snowden, A., Stenhouse, R., Marshall, S., Duers, L., Brown, N., Carver, F., Young, J., 2017. The relationship between emotional intelligence, previous caring experience, and successful completion of a pre-registration nursing/midwifery degree. J. Adv. Nurs. early view. doi:10.1111/jan.13455

Snowden, A., Watson, R., Stenhouse, R., Hale, C., 2015. Factor and Rasch Analysis of the Trait Emotional Intelligence Questionnaire Short Form. J. Adv. Nurs. 71, 2936–2949. doi:10.1111/jan.12746