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Stephen’s Student Nursing Experience

28 Aug, 15 | by Gary Mitchell, Associate Editor

On Wednesday 2nd September (8pm-9pm UK time) @EBNursingBMJ is co-hosting a twitter chat on student nursing and midwifery with @RCNStudents 

To celebrate the contributions our student nurses/midwives make – we are sharing blogs of their experiences in practice.  Today’s blog is from Stephen McKenna, a first year student nurse from the Queen’s University of Belfast.

Stephen3

Life Changing. Changing Lives.

Nursing was always a bit of a pipe dream, something I should have pursued a long time ago. Sometimes however, all you need is a push in the right direction and before you know it you’re a third of the way through a Nursing degree.

Heading back to the land of academia at 30 might not sound that daunting, but when you’ve been out of the loop for so long you start to question your sanity. Not normally a shrinking violet, I quickly became one on my first day. It didn’t help that there were only 12 males in a class of 370; that alone was pretty intimidating. If RCN statistics are anything to go by I better get used to working in a female dominated profession. By the end of the week the males in the class, perhaps through a sense of macho pride, had managed to commander an upper section of the lecture theatre, which we retained for the rest of the year. An unofficial ‘boy zone’ where lads could be lads and masculinity prevailed!

People say a Nursing degree is one of the toughest courses out there and if I’m honest they’re right. My first 6 weeks were a baptism of fire. They don’t call it ‘front-loaded learning’ for nothing! The topics are dished out raw for you to take away and digest. For me it was about keeping my head down and getting to grips with the basics. I quickly learned that I needed to be organized in order to stay on top of the demands. As much as study was important I also needed an excuse to get away from the books. With this in mind I joined the Rowing Club. At first the whole work/university/life balance thing was going fine, but then first placement kicked in and things were about to change.

Any nursing student will tell you that after 6 weeks in university they can’t wait to get the heck out of the place and onto their placement. Most of us have a deluded belief that we’ll have a bit more time to ourselves. Everyone’s placement experience is different though. We’ve all heard the horror stories of demonic Ward Sisters, absentee mentors and places you’re all but ignored. Thankfully my first placement was not like this and I learned a lot very quickly. On a busy surgical ward I saw a variety of complex conditions and procedures. You can read all the books under the sun, but in reality placement is where you learn the most. There were of course some sad cases. I found knowing someone was dying before they did a hard burden to carry. Dealing with death and dying is an intense experience. It’s hard to know what to say to a relative when a loved one dies, but in time I’m sure I’ll learn.

Juggling placement and part time work is a fine art. Unfortunately like everything in life; you can’t have it all. Something had to give. That something was the rowing. I couldn’t sustain the training required and by February I was already falling behind. After a lot of thought I decided it was time to hang the oars up for good. It’s fair to say everything in life is a trade-off. You give up one thing to get another and you can’t have it all. If I’m honest I was no Steve Redgrave anyway and a less demanding sport would have made more sense!

Before you know it 6 weeks of placement are up and you’re excited to get back to university, despite wishing 6 weeks previously you could escape it! University offers the chance to catch up with friends and have a bit of craic – something you don’t get much of on the wards for obvious reasons. The work continued to come in thick and fast in second semester. Social life became a distant memory.

Stephen2

Placement 2 was Health Visiting. I wasn’t really sure what to expect, but got my eyes well opened when I went into the community. They say you don’t know what goes on behind closed doors and that’s very true. I saw it all; deprivation, loneliness, neglect and domestic violence. Of course there is the pleasant side too. Brand new babies and happy homes to make you smile. It was an enjoyable placement, but health visiting isn’t for me – there are just some things a man doesn’t need to know about!

Final semester meant exams and essays. It was a pretty intense time, but I was determined to succeed – I’d made it this far and wasn’t going to fall at the final hurdle. I put a lot of work into revision and entered exams quietly confident. Thankfully the revision paid off and results were good.

The words ‘care home’ strike the fear of God into us Nursing Students. We imagine them as fusty old places with a bad reputation. An image not helped by the likes of the Winterbourne scandal. When I heard my final placement of year one was in a care home I was slightly dubious. Thankfully, I can report that good places still exist and this was one of them. Based in an Intermediate Care setting I found myself part of a fantastic team who really cared for the people they looked after. I had a brilliant mentor and learned a lot. In the end I left with a changed perception of care homes and was sad to leave the wonderful nursing staff and residents whom I had become so attached to.

Stephen1

With a year under my belt I am excited for what the next two will bring. Despite constantly being called ‘Doctor’ and asked why I’m not studying medicine, I am convinced Nursing is my calling. Determined to make the most of every opportunity I am already planning my elective in a developing country, where I hope to experience a back to basics approach to care, while embracing another culture.

 

Stephen McKenna | Adult Nursing Student |Queen’s University Belfast

Katie’s Student Nursing Experience

27 Aug, 15 | by Gary Mitchell, Associate Editor

On Wednesday 2nd September (8pm-9pm UK time) @EBNursingBMJ is co-hosting a twitter chat on student nursing and midwifery with @RCNStudents 

 

To celebrate the contributions our student nurses/midwives make – we are sharing blogs of their experiences in practice.  Today’s blog is from Katie Eckert, a third year student nurse from the University of Derby

Katie STDN

Before I started nursing I was a security officer who occasionally completed an Open University course to keep me busy. Matt, my husband, always told me “you would make a good nurse” and I would laugh the statement off. Don’t tell him but little did I know a couple of years on I would be following his advice and be about to commence my third year of studying. Although I had done Health Care Assistant work for a year before starting my course I still had no idea what to expect. University was very much the same as the Open University course apart from the fact that I actually went to a University for lectures. In the first year we learnt a lot of the “basics” in nursing around clinical skill and the government bodies that we needed to be aware of etc.   Until our first placements were announced I hadn’t really given it much thought. I had been allocated a local district nursing team for my first year which both excited me and scared me. So my first day came and with my uniform perfectly pressed and shoes polished I found myself ushered into a small office in a clinic full of nurses in royal blue. I sat in the corner and watched trying to take as much as I could in so I could impress my new mentor. When the office cleared we focused on my paperwork that I needed to get signed off. This included an interview to identify goals. Then she said “Why do you want to be a nurse?” Now I had prepared answers for the obvious questions like, “Where do you live?” “Have you any children?” “What year of study are you in?” but this totally threw me. I couldn’t sit there and say “Because my husband thought I might be good at it” so I quickly responded with “I want to help people”. To this day I haven’t got a clue if she believed me or not as she simply carried on with the paperwork. The truth was, of course I wanted to help people, but at the same time I really wasn’t sure. I never dreamed I would get onto the nursing course so when I did it was a bit of a whirlwind and I hadn’t sat back and thought about how I felt about it all.

During my second year I have continued to develop my clinical skills and learn a lot more about myself and how I manage situations on a busy Emergency Management Unit in a local trust. I am sure you can appreciate the new fear I felt when I learnt that this would be my second placement, what a jump from district nursing to emergency nursing. During this year I have faced many challenges, from the increasing difficulty of University work, to the higher expectations of my clinical skills as a second year student nurse. However, it has not put me off progressing into third year. If anything I have a huge desire to see where third year takes me.

If my first year mentor was to ask me the same question again now that I have completed 2 years of study, with the experiences I now have, I wouldn’t give the same answer. Of course I want to help people – but I have learnt that being a nurse is much more than that. I want to fulfil my desire to learn so as I can help positively change people’s lives. I want to develop as an individual and challenge myself on a daily basis. Now in my third year of nursing I am realising that Nursing is more than a career choice – it’s a way of life for me and my husband, who I have to say has been very supportive. This journey is far from over and I am thoroughly enjoying the challenges it is throwing at me and can’t wait to see where the journey will take me once I finish my degree next year.

Katie Eckert StN @KatieEckertStN

Anna’s Student Nursing Experience

26 Aug, 15 | by Gary Mitchell, Associate Editor

On Wednesday 2nd September (8pm-9pm UK time) @EBNursingBMJ is co-hosting a twitter chat on student nursing and midwifery with @RCNStudents 

To celebrate the contributions our student nurses/midwives make – we are sharing blogs of their experiences in practice.  Today’s blog is from Anna Jones, a second year student nurse on the children’s branch, from the University of Leeds 

Anna Jones

My name is Anna Jones and I am a second year student nurse. I am studying at the University of Leeds and my branch is children’s nursing. I am currently on my summer annual leave and I have to say, I’m enjoying every minute! As much as I enjoy my course, it’s a relief to have a break! To say that second year has been difficult would be an understatement. Continual deadlines whilst working on placement all year has been exhausting, but a challenge I am proud to say that I have overcome. Being a student nurse brings many challenges every day. Whether it’s completing an assignment, frantically trying to get a certain skill signed off or ironing your uniform after a twelve and a half hour shift ready for another the next day. What I would give for my own fairy god mother!

However, these challenges do not compare to the ones many patients encounter daily and I am forever putting my own life into perspective to realise how truly lucky myself and many others are to have good health. Working within the field of paediatrics is incredibly rewarding and a joy to meet and care for so many courageous children and families. The strength and resilience they have to face each day is remarkable and gives me the motivation to deliver the best care I can, because my patient’s deserve nothing less.

Like I mentioned, this year has been a tough one – I thought first year was difficult but nothing can prepare you for the jump to second year. I first worked on a day case surgical ward which I loved. Whilst the no nights and weekends were a bonus, meeting so many children and families every shift was a delight. I was able to accompany patients throughout their short stay in hospital, from their admission and the journey to the anaesthetic room to bringing them back to the ward and saying goodbye as they were discharged. Although this was a short experience for patients and their families, do not underestimate the fear and anxieties that are experienced and how valuable the role of nurses are to lend a comforting smile and words of encouragement as children prepare for their surgery.

Being a children’s nurse means delivering the upmost care to that patient, but also ensuring family centred care is encapsulated within practice because they are also on this journey, experiencing a vast range of emotions. Comforting a parent who was crying as their child had been anaesthetised and taken to surgery, having only known them for a few hours seems a bit of an awkward situation. But when you are in that role, that caring role of a nurse, you pat them on the back, lend them a shoulder to cry on or even give them a hug, all with no hesitation. Because if you cannot show that level of compassion and empathy, how can you truly fulfil your role as a nurse?

The rest of my placements this year have been based in the community, one of which was health visiting. Students often have mixed reactions about health visiting but for me it was very different to life on the ward! 9am starts was one of the best perks, an extra two hours in bed was bliss! Working 9-5 Monday to Friday was also a very different routine, and one which I actually found more tiring than 3 long days on a ward. Community placements were slightly more relaxed compared to the busy pace of a ward, but do not doubt the workload. One baby is born every forty seconds in the UK, and each one needs a health visitor. But I enjoyed the placement and an area of health care I would certainly consider further along in my career. Another placement within the community was based at a SILC school. These are Specialist Inclusive Learning Centres for children with special needs. This was a special placement for several reasons; meeting children with specialist and complex needs was so valuable as a student nurse. To see the small yet significant impact you were making on these children was endearing and a valuable learning experience for future practice. The school was also where my grandma had nursed for 20 years; I had quite literally stepped into her shoes! As you can see, nursing runs in the family…

I found that working in the community was a valuable experience to ascertain the care that is delivered outside of the hospital setting. It was also important to become aware of all the services available for children and families to ensure that you are working as part of a wider team to ensure that the care you deliver is holistic within the context of that patient. I realise I sound like I’m writing an essay but it is so important to deliver effective, person centred care. To put my job into perspective, I always try to imagine if it was my younger sister or brother being cared for which gives me the drive to deliver the care that my patients deserve. If my parents or grandparents had to go into hospital, I would want the best level of care delivered to them, as would everyone. This is why the notion of ‘person centred care’ should resonate throughout the nursing workforce and an aspect I will channel within my career. At the beginning of my nursing programme I discovered a quote by Maya Angelou that encapsulates this well within the context of nursing:

‘People will forget what you said, people will forget what you did, but people will never forget how you made them feel.’

I have one more placement of my second year, 4 weeks on a respiratory ward which I begin in a few weeks time. It’s been nice to relax and have some time off but I am looking forward to being thrown back into the whirlwind that is nursing. I will then continue straight into third year. My final year. With so many assignments and placements, qualifying has always seemed like a lifetime away, but now it’s only 60 weeks away (to be precise!) Am I apprehensive? Yes. I can already feel the huge weight that is third year beginning to rest on my shoulders with the prospect of dissertation and applying for jobs. Am I ready? Sometimes I’m not so sure, but I’ve got this far so there is definitely no turning back now! Am I excited with what the next few years will bring? Absolutely.

Anna Jones @AnnaJones6

Implementing Acupuncture in NP Practice

24 Aug, 15 | by rheale

By Roberta Heale, Associate Editor EBN, @robertaheale, @EBNursingBMJ

A few months ago I blogged about taking courses in acupuncture. At that time, I promised to blog again about my experience in implementing acupuncture into my primary healthcare nurse practitioner practice. I had been frustrated by the lack of options for people with chronic pain and had decided to learn acupuncture as a way to offer patients an alternative to medication. After completing an acupuncture program and practicing on a few family members and friends, I worked out a deal with the agency where I practice as a NP to offer the service to clinic patients. My schedule quickly filled up with patients who had been referred by other NPs at the centre. Finally, one warm and sunny day at the end of June, I put my kit together and got started.

The patients who had taken appointments with me each suffered from multiple pain issues as a result of fibromyalgia, osteoarthritis, previous injury and more. I took the time to explain acupuncture risk and benefits to each person. I showed them photos of me taken during my courses to demonstrate that I’d needled and been needled every point in the course work, including the one attached where I’ve been given shoulder points. Everyone asked me ‘does it work?’. I told them about research showing the effectiveness, but from my own experience I had to say honestly ‘I don’t know’. I worked out a plan of care for each patient based on their symptoms and the areas that they felt were the priority.

acupuncture course

With no expectations, I was amazed at both the immediate and delayed response to acupuncture treatment. I estimate that over 80% of the patients had some positive reaction and although I began by treating local pain issues, I was totally unprepared for the wide range of benefits experienced. Almost all patients indicated that their pain was reduced, but they also described lessened anxiety and increased relaxation. There were reports of better sleep, feeling happier and even less constipation. In one instance, a patient was treated for bilateral lower leg pain. The treatment reduced the pain significantly, but the extensive varicose veins on her lower legs faded to almost nothing during the treatment! We were both quite surprised and she was thrilled and even moreso when the effect lasted.

In the short time I’ve practiced acupuncture I’ve learned that it’s difficult to quantify a patients’ reaction to treatment. The pain scale of 1-10 just doesn’t seem to be appropriate in capturing a response. It appears that the tendency in western healthcare to compartmentalize diagnoses and treatments doesn’t work as well with acupuncture. The benefits are more ubiquitous, more indefinable. While I can’t honestly say to an individual patient that ‘acupuncture will work’ for them, I certainly feel much more confident in saying that they will likely have some benefit from treatment.

I’m excited to continue to offer acupuncture to my patients. I hope as I become more proficient, I’ll be able to provide them with even more benefit.

International Family Nursing Association

19 Aug, 15 | by josmith

Kathleen A. Knafl, PhD, FAAN is Co-chair 12th International Family Nursing Conference, Treasurer Elect International Family Nursing Association, Frances Hill Fox Distinguished Professor, School of Nursing, University of North Carolina at Chapel Hill, USA

Formally incorporated in 2009, the International Family Nursing Association (IFNA), began as an group of international nurses who have met periodically since their first international meeting held at the University of Calgary in 1988. Remarkably, despite the absence of a formal organization, several hundred family nurses have convened ten times in six different countries prior to formalizing the association. We will be convening again August 18-21 in Odense Denmark. Over 450 family nurses will be attending the conference. 

IFNA is a wonderful resource and support for any nurse whose work, be it practice, education, or research, intersects with families. Please visit our website to learn more. Please visit our website at http://internationalfamilynursing.org/ 

A few highlights of why nurses participate in this organization include: 

  • IFNA is a global community of nurse scholars and practitioners from 35 countries who care about the health of families;
  • IFNA members are dedicated to the creation and exchange of NEW theory, research, practice, education, and policy about families and the nursing of families;
  • IFNA members have unprecedented opportunities for collaboration with colleagues around the world who share a passion for family nursing research, practice, education, and theory;
  • Social networking opportunities through the IFNA website and Twitter provide members with an opportunity to communicate directly with one another, share ideas and resources, and learn from each other;
  • Bi-annual international meetings provide opportunities for networking and exchanging new knowledge;  
  • New learning modalities such as webinars allow members to access expertise and consultation in family nursing research, practice, and education. 

Family Nursing: Learning from each other across the globe

17 Aug, 15 | by josmith

Dr Veronica Swallow PhD, MMedSci, RSCN, RGN is Associate Professor in Child, Young Person and Family Healthcare at the University of Leeds, UK, and the

International Family Nursing Conference (IFNC) 12 Country Liaison Coordinator for Europe (except Portugal/Spain) Japan, South Africa and member of the IFNC12 Conference Planning Committee

What is a family? Ideas about this may differ but our goals as nurses are generally similar. Whether working with adults, children or young people, we are concerned with people’s health and well being. As clinicians, educators, researchers or a combination of these we are interested in the needs and preferences of people who are part of a family unit.

Family units take many forms but the form does not indicate how healthy the family or family members are, or how they function as individuals or as a unit. The family form is merely the physical makeup of the family members in relationship to each other (Webster Dictionary 2010). So a global meeting of Family Nurses is a wonderful opportunity to learn from each other, and return home better prepared to support the people we work with or on behalf of.

So, what do Family Nurses do? At a fabulous event 18th to 21st Aug 2015 in Denmark around 500 Family Nurses from around the world will meet to share Family Nursing knowledge and experiences http://internationalfamilynursing.org/2015/01/12/registration/; why not join us in person or via Social Media Twitter #IFNC12; Facebook to find out what we are discussing.

Under the leadership of Professors Kathy Knafl and Janet Deatrick (both highly respected Family Nurses and the Conference Co-Chairs) we and members of the other IFNA committees have been privileged to be part of a mammoth exercise to pull together a truly fascinating and varied Programme of presentations, posters and social events. This promises to be an inspiring, educational and enjoyable event for all. The IFNC12 is our opportunity to promote and enhance Family Nursing and Healthcare wherever we live and work.

Reference: Webster’s New World Law Dictionary Copyright © 2010 by Wiley Publishing, Inc., Hoboken, New Jersey

A Birth Partner Checklist

12 Aug, 15 | by josmith

Steve Hogarth, Senior Lecturer Midwifery, University of Huddersfield

Having a baby in the UK is the safest it has ever been. However, women and babies are still being exposed to substantial and sometimes multiple avoidable harms, during labour and birth. Human factors, working culture, communication and teamwork are key themes associated with avoidable harm in maternity care. The success of the WHO surgical checklist in reducing harm and improving team work and communication in operating theatres is a model which is transferable to labour and birth.

Our response was to create a safety checklist to be used in collaboration with women and their birth partners. The project aimed to improve communication between the midwives/other clinical staff and the birth partners, meaning that in effect the development of the checklist will be personal and potentially empowering for mothers and partners during labour and birth to ensure that basic care is delivered reliably and safely.

In March 2013, we generated ideas for the birth partner checklist, which included focus groups. The purpose of these groups was to generate ideas from healthcare professionals for the content and potential themes that could be incorporated into the checklist. We used the NICE Intra partum Birth Guidelines (2007) as a reference to help inform some of the suggestions.

Midwife extract: ‘After today’s session I will go away and have a look at my parent craft input and probably tweak the parent craft presentation to look at it a lot more from a birthing partner’s point of view and hopefully get them to be a little bit thought provoking and involve them more in the process of labour.” Another Midwife, said: “I did not what to expect but it has all been extremely positive and it is nice to hear that there could be some extremely improved changes to how we care.’

In May and June 2013 we undertook interviews with new parents Parent (1) highlighted that ‘having a checklist in labour would be very helpful, knowing what will happen and what to do if there is a problem would really help’. Parent (3), said ‘I always like to know what is going on and if I have a checklist this would help me to have an understanding of when thing need.

The evaluation of the project were mixed response from both health professionals and birth partners, with the qualitative part of the evaluation took the form of a thematic analysis of the responses. Salford_SHINE_AW

Effect of early clamping of the cord on neonatal circulation

10 Aug, 15 | by josmith

Charlotte Kenyon, Senior Lecturer and Midwife, University of Huddersfield

The Hungarian obstetrician and midwife Agnes Gereb said that you can measure the freedom of a country by its freedom to birth. Within the UK we are fortunate that despite the budgetary and staffing constraints currently being experienced across the National Health Service, there are still a range of care choices available for expectant women and their families. The wonders of modern medicine mean that we are in the position to be able to meet the needs of an increasingly complex population. Moreover we are able to save the lives of mothers and babies who in might otherwise have died. Pregnancy and birth for the majority of women remains low risk and obstetric intervention is not needed, but the advancement of medicine is a double edged sword; with the massive achievements of modern medicine there is a potential risk of over medicalising the care of those who remain low risk. I would like to suggest that in developed countries, where there is freedom to choose our agenda, we should focus on the premise that the health of a nation can be measured by its health around birth.

It is only in recent times that there has been growing awareness of the need for analytical scrutiny of the evidence to support clinical practice. Prior to this many clinical interventions became embedded through custom and practice rather than robust research and review. With custom and practice there is a risk that we cause more harm than good through our actions. One such example can is the practice of managing the third stage of labour; in this stage the placenta and amniotic membranes are birthed. During an undisturbed, physiological third stage of labour, the umbilical cord will continue to pulsate for several minutes with the transfer of placental blood is known as placental transfusion. For a number of years it has been common practice to clamp and cut the cord, and administer a synthetic oxytocic drug to the woman in order to reduce the risk of post partum haemorrhage. Many newly qualified midwives may not have observed, yet alone undertaken a physiological third stage by the time that they qualify. The famous French obstetrician Michel Odent has written extensively about the potential harm, including a possible link to autism, caused by widespread use of synthetic oxytocin. Whilst there is still much research be undertaken in this area, until recently the impact of concurrent early severance of the umbilical cord on the neonate has received scant attention. At the risk of sounding crass, these babies are our future and the impact on them of our actions at birth have the potential for significant long term consequences, not just for individual them self but for society as a whole.

The effect of early clamping of the cord on neonatal circulation is a 20-35% reduction in blood volume. Notwithstanding the negative effects of a sudden drop in circulating volume on the fetal brain and internal organs, this loss of blood volume deprives the neonate of a significant amount of iron, enough iron to meet the needs of a newborn for around 3 months. This is further magnified in pre-term neonates. The continuing flow of blood from the placenta to the neonate assists the complex transition from fetal circulation in the uterus to neonatal circulation in extra-uterine life. Early cord clamping therefore has a detrimental effect on this transition. Even a brief delay in clamping the cord will be advantageous to cardio respiratory transition and stabilisation of blood volume, pressure and circulation. Many individuals believe that reduction in blood volume and associated nutrients alone in this critical period of neonatal development has the potential to contribute to a number of medical disorders in later life including cardiovascular disease, late onset diabetes mellitus and mental wellbeing. Fortunately, the scrutiny of evidence mentioned earlier has enabled us to advance our understanding of the impact of our actions on the neonate and to begin to address them. The Royal College of Obstetricians, Royal College of Midwives, International Federation of Gynaecologists and International Confederation of Midwives, World Health Organisation to name just a few are now recommend a delay in clamping the cord which is more in line with the physiological processes. However, we must still continue to ensure that we analyse and evaluate the care we provide and the consequences of our clinical actions. Only through doing so can we seek to ensure that our actions are supportive of optimum health not just for individuals but for society as a whole.

Shell we talk about bones?

3 Aug, 15 | by hnoble

Matthew Carson – PhD student, Queens University Belfast

In 1997 a pioneering study showed that bone formation could be stimulated in humans solely through injections of powdered nacre, or mother of pearl, derived from the shells of oysters. The findings of this work were exceptional but cannot be fully appreciated without first understanding the scale of bone related disorders.

Fractures, whilst an obvious choice when thinking of bone damage, tend to heal within 2 months of injury. Massive trauma can result in complex fractures which are more difficult to treat, whilst a small number of normal fractures can show delayed healing. Osteoporosis on the other hand is poorly understood but more prevalent and difficult to treat. This disease causes a decrease in bone mass and a breakdown in structure, making bones weaker and more likely to fracture after even mild impacts and falls. People in their fourth or fifth decade of life are most at risk of developing osteoporosis; particularly postmenopausal women, of which 30% are estimated by the World Health Organization to have the condition. From a sufferer’s perspective, the disease can be extremely painful, limit movement and significantly reduce quality of life. It’s also expensive, with osteoporosis related fracture treatment costing UK health services £5.4 billion to treat in 2010 and £37.4 billion for Europe as a whole. This condition alone highlights the need for effective clinical interventions for bone disorders, yet there are many others not expanded upon here, such as osteopetrosis and Paget’s disease of bone.

So what can be done clinically to address these complications? There are three key factors that need to be considered when attempting tissue regeneration for the treatment of musculoskeletal disorders. These include a scaffold for tissue growth to take place upon, a cellular component to carry out tissue formation and the inclusion of bioactive factors. Bioactive factors refer to any substance which is able to produce a biological response in the body of the host. In the field of tissue regeneration this is focused upon those factors able to increase the action of the cellular component and therefore decrease healing times and improve patient outcomes. Specifically for bone regeneration Bone Morphogenetic Proteins, or BMPs, are the most clinically developed example of a bioactive. These proteins are known to stimulate bone formation, with both BMP-2 and BMP-7 available for clinical application in the US and UK. Both are being more frequently used in treatment, though their success is highly variable between individuals, gender, age groups and the type of bone being treated. As such there is a need for more effective bioactives to stimulate healing.

One highly promising reserve of novel bioactives is the ocean, which contains a huge variety of organisms adapted to survive under a range of different environmental conditions. Returning to the example of nacre from oyster shells, this shiny material is mostly comprised of a type of calcium carbonate, as well as a small organic component containing proteins important to the process of shell mineralisation. This composition is similar to that of human bone, which led Atlan and his team to the hypothesis that its inclusion in sites of damage may promote healing. Powdered nacre was mixed with the blood of eight middle-aged female patients before being injected into upper jaw defects. Bone biopsies, taken after six months, showed that nacre was non-toxic, presented good biodissolution and enhanced mineralisation. These results indicate the potential of marine extracts to promote healing in relatively simple procedures which require minimal processing steps.

Whilst nacre sparked the interest of the scientific community it is by no means the only marine extract which shows clinical potential. Many algaes have been shown to contain extracts able to promote the activity of bone forming cells, particularly brown macroalgaes. Mineralising species such as the red algae L. coralloides are also thought to increase mineralisation, and there is even a company devoted to selling a ground version of the algae for human consumption. In fact the organisms so far tested solely for their impact on bone cells and tissues are fairly diverse, including corals, sea cucumbers, many molluscs and bacteria, amongst others. However, considering the great diversity of invertebrate life within the oceans, these examples represent only a fraction of the total species which could be tested.

Overall, many marine extracts tested to date do show real promise for the stimulation of bone healing. However, our understanding of these processes is still limited, specifically as to what molecules actually stimulate cell activity and the mechanism of these effects. Furthermore, the majority of research has so far focused on determining the response of cells and little effort has been made to test their impact in animal injury models. Until these steps are taken the clinical use of many extracts will remain limited. However, research in this area continues apace, and the real question now is not whether marine extracts are feasible for use, but how long until they are common place in a clinical setting?

Reality Check

26 Jul, 15 | by rheale

Roberta Heale, EBN Associate Editor @robertaheale

Tomorrow morning I’ll be going to an appointment with an orthopedic physician. Last week I twisted my ankle, fell and found out that I’d broken a chip off my right lateral malleolus. It’s been less than a week with a cast, but it’s been real eye-opening experience.

At first I was frustrated. To start, let’s discuss the crutches. What an enormous nuisance. Awkward, and almost dangerous when I first get out of bed still half asleep. Next, it’s my driving foot. I’ve been ‘trapped’ at home all week. Quite a shock for such an active person! However, after a few days passed I suddenly had a large dose of humble awareness.

I really don’t have it all that bad, in fact, I have very little to complain about. My husband has done all the cooking. He’s wrapped my leg up in plastic so I’m able to shower. Our house is several levels, but all the important bits are all on the main floor (bathroom, bedroom, kitchen, sitting room). Not only do I have amazing support and quick access to good healthcare, but I’m incredibly fortunate to have the physical strength to maneuver on the crutches and do my personal care myself. I also have the mental capacity to make my own decisions. I have a job which gives me the flexibility to work from home and great benefits to cover the cost of crutches and medications.

Since this realization I’ve taken a step back and decided to treat this time as a gift. I’ve been forced to slow down. I’m taking the time to heal and take the time to realize my blessings. I hope that this feeling stays with me when I re-enter my hectic life and that I realize that most of the patients I see don’t have the same benefits in their lives. I hope too, that I’ll be more aware of the need for my advocacy. It’s unfortunate that it takes a minor mishap to confirm for me how lucky I am, but if it makes me a better health care provider it’s well worth it.

Analysis and discussion of developments in Evidence-Based Nursing

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