UCLan Open Journals (University of Central Lancashire)
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A multi-modal approach to promoting hand hygiene to reduce hospital acquired infection: A change management proposal for an intensive care unit
Full text linkAim: Using evidence from a previous literature review, a proposed plan was developed to promote hand hygiene and reduce the prevalence of hospital-acquired infections within an intensive care unit in the North-West of England.
Methodology: The RE-AIM framework structured the implementation of the proposed plan with Lewin’s force field theory applied. The proposed plan was peer-reviewed for feedback on the change management plan. Finally, Gibbs’s model was used to reflect on the lead author’s independent learning journey undertaking a 3-year degree programme in adult nursing to reflect and identify opportunities for future development.
Results: A multimodal change plan was developed with guidance from the evidence and identified themes. The peer review process highlighted areas for improvement and provided valuable feedback. The reflective process identified opportunities for professional development and developing nurse leadership skills.
Discussion: The proposed plan was based on three hand hygiene themes identified in a previous literature review; education and understanding, direct observation, and reminders/ prompts. The change management phase highlighted important barriers to be addressed for the proposal to be successful. The peer review process facilitated innovative ideas and reflecting on the feedback given. The improvement process reinforced a need to listen to feedback throughout the negotiated change.
Conclusion: A proposed plan focused on hand hygiene and healthcare acquired infections offers valuable insights related to change management plans in nursing
Specialist domestic abuse training for emergency department clinical staff: A review of the literature
Full text linkAim: Emergency departments are often the first point of contact for women suffering from domestic abuse and identifying how healthcare staff can support women is important to tackle missed opportunities for timely intervention.
Method: A review of research studies was undertaken between 2012 and 2024 using electronic databases AMED, CINAHL Ultimate, MEDLINE, EBSCO, and the RCNi. The search words “emergency department, ED, accident and emergency, A & E, domestic abuse, domestic violence, intimate partner violence, family violence, staff- training education, development, learning” were used and retrieved n=93, reduced n=18, and finally n=7.
Findings: The findings identify a training and role-specific issue related to emergency department nursing, and the need to have a supportive environment for positive action to be taken on behalf of the victim and their families. Four themes were identified; “don’t ask,” “stereotyping,” moral distress” and “systemic support.” In ‘don’t ask’ the thread of conscious incompetence ensures staff reluctance to talk to women in case it opens a ‘can of worms.’
Discussion: The difficulties experienced by emergency nurses were compounded by staff being unaware of their departments policy on dealing with domestic abuse. Contrary to WHO recommendations, the evidence identified domestic abuse screening in most emergency departments happens on an ad-hoc basis and is subject to the experience and confidence of the individual clinician.
Conclusion: Training is required to myth bust the factors related to domestic abuse, yet training is not enough, there needs to be a shift in attitudes toward domestic abuse, and in an institutional context, staff should feel supported and empowered to respond to women appropriately
Prescriptive language in NMC nursing standards
Full text linkThis paper examines imperative language in the professional Code of conduct in Nursing and Midwifery (NMC, 2018), using the philosophical arguments of moral ethics through the lens’ of Immanuel Kant (1785) and Richard Hare (1952). A professional code is used in many high-risk professions to set industry standards and parity across the workforce. Professions usually adopt a code of standards, ethics, or conduct (Crystal & Giesel, 2024). It is argued here that the equivocation is a key indicator that sets nursing and midwifery apart from other professions. Codes of standards and ethics align more readily with how a person behaves in practice; whereas codes of conduct govern beyond the workplace and include personal attributes (Aibar-Guzmán et al., 2023). The shift, from principles that adopt characteristics of performance, to attributes which espouse essential behaviours, suggests the differences becomes functional as the language used to ascribe behaviour has to perform differently (alongside those adhering to it). Used in an unchecked way, a code can neutralise autonomy and creativity and, in the extreme, can neutralise the professional’s career entirely (Mishra & Aithal, 2023). Any code is predicated on language and Kant (1785) and Hare (1952) were interested in the language that accompanied everyday life in what is more formally recognised as the logical study of the language of morals (Hare, 1952). Some of the separate positionalist critiques of Kant and Hare are used here to support an analysis of the Code and its use of language in determining professional character and behaviour. It is argued that while a code is needed, the NMC rests on the axle of good and bad which challenges the writings of Kant and Hare, who open moral language to one that tries to work out the tension between that dialectic
Effective methods of promoting hand hygiene to reduce hospital acquired infections: A literature review
Full text linkAim: A literature review aimed to explore the most effective methods of promoting hand hygiene in nursing to reduce the prevalence of hospital acquired infections (HAIs).
Methodology: A literature search was conducted using AMED, British Education Index, CINAHL Ultimate, ERIC and MEDLINE with the search terms “hand hygiene, hospital acquired infection, reduction, and promotion” between 2014 and 2024. A PICO framework helped to create a search hypothesis and a PRISMA flowchart used. The search was later repeated between 2017 and 2024 to be relevant post Covid 19 pandemic.
Results: n=9 research studies were retrieved, reduced to n=6. The research studies were critically appraised to identify themes and relevant discussion.
Findings: The reviewed research studies had a variety of methodologies used, sample size and time periods. Three key themes were first, education and knowledge; second, direct observation, and third, reminders/ prompts. All research studies demonstrated a correlation between promoting hand hygiene and a reduction in hospital acquired infections.
Discussion: The cost of HAIs was an issue in terms of a negative effect on hospital resources (beds, staffing costs, equipment) and positive patient outcomes. Despite WHO (2020) and organisational guidelines of best practice, education and training, hand hygiene frequency had improved at the beginning of the Covid 19 pandemic, with healthcare staff being key to reduce HAIs but hand hygiene later became less observed due to high staff workload and burnout. The research findings reinforce WHO guidelines, and indicate a need for regular training, reminders, and updates in clinical practice to promote hand hygiene to reduce the incidence of HAIs.
Conclusion: HAIs have a negative impact on patients’ treatment outcomes, cost, and resource implications and despite WHO (2020) guidelines, continue to have a negative impact on patients’ health outcomes. Nurses dealing with a high workload and burnout are at risk of forgetting the importance of hand hygiene and evidence-based practice, yet hand hygiene is most cost-effective method of reducing HAIs
A literature review on the effectiveness of prophylactic foam dressings and pressure ulcer prevention in intensive care nursing
Full text linkAim: This article reviews the literature on the strategies for mitigating pressure ulcers through the formulation and execution of minor modifications within hospital settings.
Methodology: A search of the University’s e-databases Cumulative Index, Nursing and Allied Health Ultimate, CINHAL Ultimate and Medline retrieved n=37 research studies and n=2 found to meet the inclusion and exclusion criteria. A hand search identified a further n=6 to total n=8 research studies.
Findings: Each research study aimed to reduce the incidence of hospital acquired pressure ulcers in intensive care units, improve routine practice and compare the effectiveness of multi layered foam dressings for prevention. Three common themes were identified: first, evaluating the effectiveness of prophylactic sacral dressings. Second, educating nurses on improving clinical outcomes and third, the use of various interventions to prevent hospital acquired pressure ulcers in intensive care units.
Discussion: Intensive care unit patients are at significant risk of developing pressure ulcers due to a variety of contributing factors such as vulnerability, lack of movement, a need to physically examine skin, medical device use, managing continence, poor nutrition, repositioning and applying prophylactic multi layered foam dressings.
Conclusion: Properly addressing risk factors and harmonising preventive protocols is essential in minimising pressure ulcer development and improving overall patient care in an intensive care unit and other cases involving at risk patients
Common factors affecting quality of life scores for patients with newly formed stomas: A review of the literature
No full textIntroduction: Nurses have a key role in promoting and optimising the quality of life of patients adapting post-operatively to newly formed stomas. There are common factors negatively impacting on nursing care such as inconsistent Government strategy, poor evidence-based care informing organisations and inadequate resource allocation in localised care. Due to the number of patients living with stomas expected to rise to impact on service provision, this literature review aims to identify key factors nurses should be aware of when promoting health-related quality of life care post-operatively.
Methodology: A search was conducted using CINAHL Ultimate and Medline to identify key factors affecting the quality of life of patients with newly formed stomas. n=66 papers were identified using search-specific criteria between 2014 and 2024. n=26 research studies were retrieved, and after inclusion and exclusion criteria were considered, n= 7 papers were critically appraised.
Findings: Common factors identified were the importance of quality-of-life assessment tools used to assess health related quality of life, peristomal skin issues (inflammation, injury or damage to surrounding), and a lack of available suitable facilities affecting privacy.
Discussion: It is important to understand the difficulties ostomates face post-operatively and follow evidence-based guidelines irrespective of national pandemic emergencies.
Conclusion: This paper highlights a significant research gap into the facilities available for people living with a stoma; and the evidence identifies negative factors impacting on quality-of-life scores for both male and female ostomates
What UK career guidance counsellors in high schools and further education think about nursing as a career for men
Full text linkAim: To identify why men in Western societies consistently make up between 9-11% of the nursing workforce and viable solutions to this Global recruitment issue.
Methods: A review of the literature was undertaken using Cinhal Ultimate, Embase and Nursing and Allied Health search engine databases. n=490 studies were retrieved, reduced to n=65 with a final n=21 appraised.
Findings: The identified themes were; promoting nursing in secondary school, and for career counsellors to suggest nursing as a career choice to adolescent boys.
Discussion: Significant others such as family members, and friends influence on adolescent boys had a positive impact on the choice of career, and exposure as a patient or visitor to what nurses do, and outreach work in schools help to support an interest in nursing as a career. Adult partners were found to be instrumental in supporting a change of career later in life. The issue of job security, promotional prospects, and leaning towards more technical roles in nursing were motivational themes when choosing a career path, with friendliness, feeling included, and low pay, considered key factors. Lastly, the specific role of career guidance counsellors (CGS’s) was found to be instrumental in widening the choices for a career in nursing, with differences in attitudes and expectations for boys seen in private and public education.
Conclusion: CGC’s can play a vital role in informing their male and female students about career opportunities in the caring profession although may need further support from industry experts. In addition, schools and colleges should be following benchmarks for good career guidance
Exploring the importance of daily weights for patients diagnosed with chronic heart failure: A review of the literature
No full textAim: The importance of recording the daily weight of hospital in-patients suffering with congestive heart failure is reinforced in the European Society of Cardiology and NICE (2021) guidelines, yet inconsistencies in nursing care remain in the United Kingdom. Identifying the reasons and barriers for inconsistency is important to promote optimal fluid management and up-titrating therapy.
Methods: A review of the literature using the electronic database CINAHL Ultimate searched for research studies between 2013 and 2024, and from n=505 research studies, n=62 were reduced and n=11 appraised.
Findings: Three themes were found: first, recording congestive heart failure patients’ daily weights correlates to the effectiveness of congestive heart failure decongestion because it is a biomarker or measurable indicator to inform diuretic protocols and accurately titrate diuretics. Second, barriers and obstacles in obtaining daily weights relate to training and knowledge, poor task delegation and insufficient or broken equipment. Third, daily weighing and optimal fluid management reduces 30-day re-admissions, attendance at an emergency department and improved mortality rates.
Conclusion: The recording of a patient’s daily weight enables nurses to determine accumulated fluid retention, inform a multi-disciplinary treatment response, predict mortality, accurately titrate medications, and reduce 30-day re-admissions