Abstract: Lymphoedema is a chronic, incurable, debilitating condition, usually affecting a limb and causes discomfort, pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. However, there is a paucity of prevalence data on this condition. This study aimed to determine the prevalence of lymphoedema among persons attending wound management and vascular clinics in an acute tertiary referral hospital. Four hundred and eighteen patients meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n = 11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and broken skin, 64% (n = 7) had history of broken skin and 36% (n = 4) had undergone treatment for venous leg ulcers. The most common co-morbidities were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3), hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of life scores identified that physical functioning was the domain most affected among this group. This study has identified the need to raise awareness of this condition among clinicians working in the area of wound management.
Abstract: To incorporate an international and multidisciplinary consensus in the determination of the research and education priorities for wound healing and tissue repair.
Abstract: stroke is a leading cause of death and disability globally. The economic costs of stroke are high but not often fully quantified. This paper estimates the economic burden of stroke and transient ischaemic attack (TIA) in Ireland in 2007.
Abstract: Surgical patients are at particular risk of healthcare-associated infection (HCAI) due to the presence of a surgical site leading to surgical site infection (SSI), and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice; this was used to inform the development of a targeted educational initiative by surgeons specifically for surgical trainees. Parameters assessed during the initial audit and a further audit after the educational initiative were related to intra- and postoperative aspects of the prevention of SSIs, as well as care of peripheral venous catheters (PVCs) in surgical patients. The proportion of prophylactic antibiotics administered prior to incision across 360 operations increased from 30.0% to 59.1% (P<0.001). Surgical site dressings were observed in 234 patients, and a significant decrease was found in the percentage of dressings that were tampered with during the initial 48h after surgery (16.5% vs 6.2%, P=0.030). In total, 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVCs in situ (37.9% vs 24.4%, P<0.001), PVCs in situ for >72h (10.6% vs 3.1%, P<0.001) and PVCs covered with clean and intact dressings (87.3% vs 97.6%, P<0.001). Significant improvements in surgical practice were established for the prevention of SSI and CRBSI through a focused educational programme developed by and for surgeons. Potentially, other specific measures may also be warranted to achieve further improvements in infection prevention in surgical practice.
Abstract: BACKGROUNDL: Pressure ulcers are common, costly and impact negatively on individuals. Pressure is the prime cause, and immobility is the factor that exposes individuals to pressure. International guidelines advocate repositioning; however, there is confusion surrounding the best method and frequency required.
Abstract: Many countries are developing national audits of stroke care. However, these typically focus on stroke care from acute event to hospital discharge rather than the full spectrum from prevention to long-term care. We report on a comprehensive national audit of stroke care in the community and hospitals in the Republic of Ireland. The findings provide insights into the wider needs of people with stroke and their families, a basis for developing stroke-appropriate health strategies, and a global model for the evaluation of stroke services.
Abstract: Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency.
Abstract: Day surgery (DS) is viewed as the optimal environment for many surgical procedures. Yet, Irish DS rates are low compared to international figures.
Abstract: Honey has previously been shown to have wound healing and antimicrobial properties, but this is dependent on the type of honey, geographical location and flower from which the final product is derived. We tested the antimicrobial activity of a Chilean honey made by Apis mellifera (honeybee) originating from the Ulmo tree (Eucryphia cordifolia), against selected strains of bacteria.
Abstract: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty.
Abstract: The comparative element of this study is to describe safety and security measures in psychiatric acute admission wards in the Republic of Ireland and London; to describe differences and similarities in terms of safety and security patterns in the Republic of Ireland and London; and to make recommendations on safety and security to mental health services management and psychiatric nurses.
Abstract: Comparison of desloughing efficacy after four weeks and healing outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey (Woundcare 18+) vs. standard hydrogel therapy (IntraSite Gel).
Abstract: Eighteen per cent of patients in hospital have a pressure ulcer. These are often difficult to manage and are associated with significant morbidity and mortality. Wound cleansing is a routine part of managing these wounds. This article summarises the challenges associated with pressure ulceration and reviews evidence to guide nurses in selecting wound-cleansing fluids.
Abstract: Pressure, from lying or sitting on a particular part of the body, results in oxygen deprivation to the affected area. If a patient with an existing pressure ulcer continues to lie or bear weight on the affected area, the tissues become depleted of blood flow and there is no oxygen or nutrient supply to the wound, and no removal of waste products from the wound, all of which are necessary for healing. Patients who cannot reposition themselves require assistance. International best practice advocates the use of repositioning as an integral component of a pressure ulcer management strategy. This review has been conducted to clarify the role of repositioning in the management of patients with pressure ulcers.
Abstract: The political, professional and economic context in which mental health care is delivered has witnessed significant changes in recent times. The movement of psychiatric patients from institutions to community settings has seen the emphasis of the loci of care delivery shifting with increasing numbers presenting to general hospitals. The speciality of the Psychiatric Consultation Liaison Nurse (PCLN) has emerged as a bridge between mental health and general hospital services. A descriptive, non-experimental research approach was employed to establish patient profiles and to provide an overview of the depth of service provision. This design was selected as the most appropriate because of the limited information on the PCLN in an Irish setting and secondly, as the study was limited to one rural geographical location. A questionnaire was utilized to collate the details of patients who had received a mental health assessment. The findings presented here are the profiles of patients assessed by the PCLN during the 3-month study period. The results add further credence to the existing evaluative studies in presenting the characteristics of patients within the Irish context and further contribute to the unique body of evidence that defines the mental health nurse in an advancing role.
Abstract: Chronic non healing wounds have an elevated alkaline environment. The acidic pH of Manuka honey makes it a potential treatment for lowering wound pH, but the duration of effect is unknown. Lowering wound pH can potentially reduce protease activity, increase fibroblast activity and increase oxygen release consequently aiding wound healing. The aim of this study was to analyse the changes in surface pH and size of non healing ulcers following application of Manuka honey dressing after 2 weeks. The study was an open label, non randomised prospective study. Patients presenting consecutively with non healing chronic superficial ulcers, determined by aetiology and no reduction in wound size in previous 3 weeks. Single pH measurements recorded using Blueline 27 glass surface electrode and R 315 pH meter set (Reagecon/Alkem, Co. Clare Ireland). Area determined using Visitrak (Smith & Nephew, Mull, UK) digital planimetry. Apinate (Manuka honey) (Comvita, Slough, UK) applied to wounds for 2 weeks after which wounds re-evaluated. Eight males and nine females with 20 ulcers (3 bilateral) were included: venous, 50% (n = 10); mixed aetiology, 35% (n = 7); arterial, 10% (n = 2) and pressure ulcer, 5% (n = 1). Reduction in wound pH after 2 weeks was statistically significant (P < 0.001). Wounds with pH >or= 8.0 did not decrease in size and wounds with pH <or= 7.6 had a 30% decrease in size. A reduction in 0.1 pH unit was associated with an 8.1% reduction in wound size (P < 0.012). The use of Manuka honey dressings was associated with a statistically significant decrease in wound pH and a reduction in wound size. Elevated pH readings at the start were associated with minimal reduction in size. Surface wound pH measurements may contribute to objective wound assessments, but further research is necessary to determine its exact contribution.
Abstract: Pressure ulcer risk assessment is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. Use of a risk assessment tool is recommended by many international pressure ulcer prevention guidelines however it is not known whether using a risk assessment tool makes a difference to patient outcomes. A review was conducted to clarify the role of pressure ulcer risk assessment in clinical practice.
Abstract: To determine the qualitative bacteriological changes that occurred during a four-week treatment period with either manuka honey or a hydrogel dressing. This was the secondary outcome of a randomised controlled trial (RCT) that compared the efficacy of the two treatments in desloughing venous leg ulcers.
Abstract: The aim of this study was to use a Cochrane systematic review process to explore the effect of wound cleansing solutions and techniques on pressure ulcer healing.
Abstract: This article provides an overview of the European Wound Management Association's (2005) position document Identifying Criteria for Wound Infection and outlines its relevance and clinical applicability. The document is divided into four parts: understanding wound infection; clinical identification of wound infection--a Delphi approach; identifying criteria for pressure ulcer infection; and identifying surgical site infection in wounds healing by primary intention. Each part is discussed separately.
Abstract: There is evidence in the literature to suggest that mental health care staffs' attitudes towards clients with borderline personality disorder (BPD) are less than favourable. This study reports on a survey of psychiatric nurses' knowledge, experience and attitudes towards care received by clients with a diagnosis of BPD. The questionnaire was sent to all clinical nurses (n = 157) working in a psychiatric service in Dublin, Ireland and received a response rate of 41.4% (n = 65). The results indicate that the majority of nurses have regular contact with clients with BPD and nurses on inpatient units reported more frequent contact than nurses in the community. Eighty per cent of nurses view clients with BPD as more difficult to care for than other clients and 81% believe that the care they receive is inadequate. Lack of services was cited as the most important factor contributing to the inadequate care and the development of a specialist service is reported as the most important resource to improve care.
Abstract: In recent years, mental health services across Europe have undergone major organizational change with a move from institutional to community care. In such a context, the impact of change on the job satisfaction of psychiatric nurses has received little attention in the literature. This paper reports on the job satisfaction of psychiatric nurses and data were collected in 2003. The population of qualified psychiatric nurses (n = 800) working in a defined geographical health board area was surveyed. Methodological triangulation with a between-methods approach was used in the study. Data were collected on job satisfaction using a questionnaire adopted from the Occupational Stress Indicator. A response rate of 346 (43%) was obtained. Focus groups were used to collect qualitative data. Factors influencing levels of job satisfaction predominantly related to the nurses work location. Other factors influencing job satisfaction included choice of work location, work routine, off duty/staff allocation arrangements, teamwork and working environment. The results of the study highlight to employers of psychiatric nurses the importance of work location, including the value of facilitating staff with choices in their working environment, which may influence the recruitment and retention of nurses in mental health services.
Abstract: To determine the research priorities of oncology nurses in the Republic of Ireland, a descriptive survey study was undertaken at a national oncology specialist center. The center's nurses (N = 119) were invited to participate in the study, and a 66% (n = 79) response rate was obtained. The research priority areas identified were concentrated around nurse-led care and the effectiveness of nurse-led services in areas such as pain management. Communication, information, and continuity of care issues and stress and burnout in oncology nursing were also among the top priorities selected. Quality of life and radiotherapy were the most important themes that emerged in the open-question section of the questionnaire. The result of this study provides important insights and direction for the development of oncology nursing research in the Republic of Ireland. It also adds to the international literature on research priorities across different jurisdictions.
Abstract: This study, which forms part of a doctoral thesis, is derived from the increasing demand for economic models of nurse education as a process within a wider economic agenda which converts inputs (e.g. training costs) into outputs (e.g. registered nurses). In such a climate the pursuance and determination of quality in nurse education should be of fundamental concern to the nursing profession. The development of models for evaluation and measurement of quality must take due cognisance of the stakeholders' interests and concerns, and student nurses, as the consumers of nurse education, must be regarded as major stakeholders. This paper describes the use of the course experience questionnaire, an instrument designed to investigate the students' perspective on teaching and learning. The study incorporates a comparative analysis between Project 2000 students in Northern Ireland and students in the apprenticeship programme in the Republic of Ireland, from general, psychiatric, sick children's and mental handicap nursing. This comparative analysis does provide the nursing profession with a level of feedback on which to make decisions in the interest of quality. Nurse teachers should examine potential reasons why their programmes are poorly or highly rated and the actions that may be required to remedy imperfections on the one hand and the actions that may be taken to promote excellence on the other. As nurse education continues to forge links with universities, nurse teachers, by adopting student evaluation as a performance indicator, can maximize an essential element in the web of public accountability.
Abstract: Teaching and learning in all forms of education is being increasingly reviewed in a climate of educational accountability. The literature generally displays a certain irrationality about nurse education; on the one hand teachers are espousing student-centred ideologies while on the other hand, students are expressing preferences for teacher-structured approaches. The research on nurse education generally concludes that the roles of teacher and student operate around a mechanistic view of man with the teacher being viewed as the front of all knowledge and the students the passive recipients of that which was given. This paper reports on related background issues, and a study of the teaching/learning preferences of student nurses from general, psychiatric, sick children's and mental handicap nursing. Whilst students reflected preferences for more teacher-structured strategies, significant differences were identified between the preferences of the four groups of student nurses. It is concluded that any insistence on a doctrinaire approach to teaching and learning would be unnecessarily restrictive to the whole process of nurse education. Nurse tutors therefore need to reflect on what they do, particularly that which influences the relationship between the students and what they learn. It is then the responsibility of nurse tutors to act on what they have learned about that relationship and their part in it.
Abstract: The nursing profession has adopted many of its theoretical foundations, including research approaches, from other academic disciplines. This has resulted in the acceptance of one epistemological perspective to the exclusion of others. In this context, the evolution of nursing research reflects a rather conservative approach. The quantitative approach was the dominant paradigm of the 1950s, 1960s and during the 1970s and 1980s the research approach has been increasingly located in the qualitative paradigm. It is noted that each research perspective has several inherent differences which give rise to a specific type of research endeavour. Within the literature there is general support for the separateness of the quantitative qualitative paradigm. However in accepting the inherent differences between the two methods, nurse researchers have been concerned that neither method in isolation from the other will truly provide an understanding of human beings and of their health-related needs, problems or nursing care. Triangulation as a research strategy represents a means of integrating the two research approaches. Triangulation, first used in 1959, is defined as a combination of multi methods in a study of the same object or event to depict more accurately the phenomenon being investigated. The literature exploring the merits of triangulation is incomplete. However, it is reported that triangulation, by reconciling the paradigmatic assumptions inherent to quantitative and qualitative methods, provides rich and productive data. Triangulation does offer an alternative to the bi-polar quantitative and qualitative approaches and a means of reconciling the two methodological encampments.
