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Treating pain during pregnancy and breast feeding

16 Apr, 17 | by josmith

This week’s EBN Twitter Chat on Weds 19th April at 8-9pm UK time will focus on pain during pregnancy, how important and difficult is to treat pain during pregnancy and breast feeding.

The Twitter Chat will be hosted by Dr Massimo Allegri, Assistant Professor in Anesthesia Intensive Care and Pain Medicine at the University of Parma (Italy),@allegri_massimo. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward, You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The Pain Department of University Hospital of Parma is one of the biggest pain clinic in Italy and it is the most important research centre about acute ad chronic pain in Italy and one of the most important in Europe.

Furthermore, next year a new PhD Position in Pain will be settled up together with Alborg University and Prof Lars Arendt Nielsen about chronic pain and central sensitization. Furthermore, University of Parma organizes one of the most important translational pain meeting in the world: SIMPAR (www.simpar-pain.com).

Pain affects 20% of adult population worsening not only quality of life, but also outcome of patients who refer it. Unfortunately, pain continues to being undertreated and under-recognized. Chronic pain is not just a symptom but it is a real disease that needs an accurate diagnosis and appropriate therapy against the pain generator pathophysiology.

This problem is even more important during pregnancy and breastfeeding. The fear to give drugs that can hurt foetus/neonate can drive the physician to a “wait and see” approach that cannot solve the problem to the mother. Furthermore, during pregnancy there are several physiological changes that can worsen previous pain or generate new one. Finally, all the drugs are obviously off label and it is difficult to know exactly their real toxicity.

On Wednesday 19th April during the twitter chat we will continue the conversation to consider how to drive the therapy for patients during pregnancy and breastfeeding. We will discuss all together which multidisciplinary approach could be useful and how important is to diagnose the right pathophysiological mechanism that triggers the acute or chronic pain:

  • Which are the classifications of the drugs that could drive clinicians to use the drugs to alleviate pain?
  • When is more harmful to use some specific drugs?
  • Which concerns do we have to consider when we give a drug to a breastfeeding mother?
  • How to perform the right pathophysiological diagnosis?
  • Do we have to stop some drugs if the women would like to become pregnant

Please join us to discuss this important medical, nursing and public health challenge.

References

1 Coluzzi F, Valensise H, Sacco M, Allegri M Chronic pain management in pregnancy and lactation. Minerva Anestesiol. 2014 Feb;80(2):211-24.

2  Narayan B, Nelson-Piercy C. Medical problems in pregnancy. Clin Med (Lond). 2016 Dec;16(Suppl 6):s110-s116.

3 Tepper D. Pregnancy and lactation–migraine management. Headache. 2015 Apr;55(4):607-8.

Caesarean section increases risk of preterm birth in subsequent pregnancy

12 Apr, 17 | by josmith

Professor Allison Shorten

Center for Interprofessional Education and Simulation, University of Alabama at Birmingham

Prevention of preterm birth remains an important priority for international perinatal research. Identification of risk factors is important for development of effective preterm birth prevention strategies. One of our latest EBN commentaries, by international experts Laura Visser, Marjon A de Boer and Ben W Mol, presents an interesting discussion of recent research by Wong and Wilks (2016), which highlights a relationship between caesarean section and preterm birth in subsequent pregnancies. As the quest to identify risk factors for preterm birth continues, our commentators note that large observational studies are needed to determine the pathophysiology and possible causal relationships between the risk factors identified (Caesarean section, new tobacco use, short interpregnancy interval) and preterm birth. Caesarean section rates remain high and are increasing in many countries around the globe, making it important to examine relationships between Caesarean section and problems that may arise in subsequent pregnancies. Read more about this interesting case control study and recommendations for future research and clinical management.

 

Reference:

Wong LF, Wilkes J, Korgenski K, et al. Risk factors associated with preterm birth after a prior term delivery. BJOG 2016;123:17728.

Read EBN cimmentary :

http://ebn.bmj.com/content/20/2/42

Dementia Awareness Training with a Difference

3 Apr, 17 | by hnoble

Karen Galway and Catherine Monaghan, School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast Northern Ireland. BT9 7BL

 

This week’s EBN Twitter Chat on Wednesday 5th April between 8-9 pm (UK time) will focus on dementia, how we can break the taboo and improve education in this area.

The Twitter Chat will be hosted by Dr Karen Galway a Lecturer in Mental Health nursing At the School of Nursing and Midwifery, Queens University Belfast. Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward, You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

The School of Nursing and Midwifery at Queen’s University Belfast has been championing improvements in dementia care through continuing professional development training over the past two decades.  The increasing prevalence of dementia, which has been referred to as the dementia tsunami, means that healthcare professionals need more training, support and resources to help alleviate symptoms and maximise quality of life. There is a clear need for specialised training as we continue to learn more about how to prevent, diagnose and treat the condition.

We teamed up with AFTAThought Training Consultants, to take our programme of training to a new level. AFTAThought was formed in 1988, and has been inspiring people to think differently ever since. “We’re passionate about what we do, delivering training through drama to bring issues, policies and legislation to life and we’ve trained just shy of a million people.”  Topics addressed in this inaugural partnership training included; public awareness, effective management, role of primary care, person centered care, communication challenges, identity, capacity and caregiving.

Approximately 300 students, researchers, statutory sector and voluntary sector health and social care professionals attended the event and we received some remarkable feedback indicating a strong and healthy appetite for this type of dementia training.  Many of those who provided feedback related the awareness training to their own personal experience with dementia, as a carer or as a professional.

Gary Mitchell, Research Coordinator at Four Seasons Healthcare commented on the training session; “You’re really filling a gap with this training. It is much needed.”

The awareness training was based on a local policy document (Dementia Learning Development Framework, 2016) and peer reviewed publications we have produced 1–4. The format was based a number of scenarios including; initial recognition of a problem by an individual, reactions from their family and the GP, disclosing a diagnosis and managing family dynamics, capacity to make decisions, transitions to nursing and residential care and hospital admissions. The session ended with a touching account of how it feels to be a family member caring for someone with dementia. There wasn’t a dry eye in the house, this training hit home and you could hear a pin drop.

We were thrilled to receive spontaneous feedback via email and from some students in subsequent classes. Some of these are quoted below;

“I just wanted to send an email to say what a fantastic experience and incredible insight the dementia lecture was. I lost my father to vascular dementia 18 months ago and was delighted to see that the experiences of family and the person living with dementia was so realistically and sensitively portrayed.”

“I was a student of yours way back in 2013. I attended the dementia awareness session yesterday & just wanted to get in touch to let you know I thoroughly enjoyed it. It was a very powerful and emotive experience.”

“Fantastic training! Really enjoyed the experience and a great insight to dementia. Puts things into perspective and creates a better way of thinking. Very overwhelming performance, it was brilliant.”

“That was the best lecture I’ve ever had”

On Wednesday 5th April during the twitter chat we will continue the conversation to consider these dementia questions that we have yet to answer;

  1. What are the best ways to break the taboo of dementia?
  2.  How can we best help people discuss and share their concerns, thoughts and feelings and maybe seek help earlier?
  3. What way should education be delivered, to allow all disciplines of health care professionals to access training that will increase the quality of dementia care?

Please join us to discuss this important medical, nursing and public health challenge.

References

1           Carter G, van der Steen J, Galway K, Brazil K. GPs’ perceptions of the barriers and solutions to good quality palliative care in dementia. Dement Int J Soc Res Pract 2015; In Press.

2           Brazil K, Carter G, Galway K, Watson M, van der Steen JT. General practitioners perceptions on advance care planning for patients living with dementia. BMC Palliat Care 2015; 14: 1–6.

3           Mitchell G, McCollum P, Monaghan C. The personal impact of disclosure of a dementia diagnosis: a thematic review of the literature. Br J Neurosci Nurs 2013; 9: 223–8.

4           Mitchell G, McCollum P, Monaghan C. Disclosing a diagnosis of dementia: A background to the phenomenon. Nurs Older People 2013; 25: 16–21.

Engaging Students with Twitter

26 Mar, 17 | by josmith

Kirsten Huby, Lecturer Children’s Nursing, University of Leeds (@KirstenHuby)

Emma Wilson, Children’s Nursing Student, University of Leeds (@Emzieness

The latest Horizon report (Adams Becker et al., 2017) recognises collaborative learning as one of the key trends that will be driving Higher Education for the next few years. It suggests that collaborative learning improves engagement, encourages learning that relates to practice and enables communities of practice to be developed. For healthcare students this type of learning can be used to develop the skills to think critically, problem solve and become open to recognising the diverse nature of the health and social care arena. Technology can help to promote collaborative learning but will only be successful if we can engage students and ensure they see the purpose of what is to be achieved.

 

It has been suggested social networking sites (SNS) encourage the type of collaborative learning advocated by (Adams Becker et al., 2017, Prestridge, 2014) ,we cannot assume that a particular type of SNS will necessarily work. In a study on the use of Twitter, students tended to use a tweet to ask a question of a lecturer rather than to collaborate between themselves. The author considers that students may need to be guided and supported to recognise the depth of knowledge and understanding that can be shared in this way (Prestridge, 2014). This implies that in order to be fully engaged students need to understand the purpose of the interaction and the tool that is being used.

To do this, informative learning opportunities and consultation with students needs to occur. The twitter community is diverse; some nurses opt to have separate ‘nursing’ accounts, others opt to combine professional and personal tweets as one online personality. Ultimately this comes down to personal preference. However, it must be considered that social media guidance has been set by the NMC (Nursing and Midwifery Council, 2015) and this and the requirements of the NMC Code must be adhered to at all times; on and offline and regardless of whether an account is identified as personal, professional or both. Student nurses therefore need to have an awareness of their responsibilities and potential accountabilities surrounding any social media use in relation to this.

A significant factor which potentially hinders student participation with SNS in a learning environment is whether they are comfortable with lecturers/mentors potentially having the ability to view personal posts/tweets. One such way around this is to have a specific agreement to not follow students back from University curated accounts. This means that students can view informative tweets / retweets on their timelines, but their own postings aren’t automatically or as easily visible. This leads to an element of ‘privacy’ and choice, allowing students to choose whether to engage with lecturers if they want to, but also benefit from some of the wider aspects of using SNS such as furthering knowledge / sharing views on current research or topical issues and collaborating and engaging with other students and professionals. As we take the next steps with the @UoLchildnursing account we hope to increase our engagement with students and with the help of motivated student twitter champions such as @Emzieness we hope this will be possible.

Adams Becker, S. et al. 2017. NMC Horizon Report: 2017 Higher Education Edition. 2017 ed. Austin, Texas: The New Media Consortium.

Nursing and Midwifery Council. 2015. Guidance on using social media responsibly. London.

Prestridge, S. 2014. A focus on students’ use of Twitter – their interactions with each other, content and interface. Active Learning in Higher Education. 15(2), pp.101-115.

To tell or not to tell? Honesty and hope in cancer nursing.

19 Mar, 17 | by dibarrett

Jan Hunter, Lecturer in Nursing, University of Hull

In the rather paternalistic past of the NHS, the established wisdom was that ‘doctor knew best’. If it was deemed a patient didn’t need to know they had a poor prognosis, then they didn’t find out (unless they had the wherewithal to put two and two together, or the audacity to ask outright). Thankfully, we are moving away from the days of selectively withholding information, with candour and truth-telling now at the centre of patient care. Nurses – with their ability to forge strong bonds of trust with patients – are well-placed to act as leaders in the discussion of disease progression and prognosis. Though this cements the place of nurses as autonomous practitioners, it also requires us to face one of the key challenges in cancer care: how do we balance truth-telling with the desire to reduce distress and give hope to patients and carers?

In some patients, there may be a temptation to try and ‘soften the blow’ of bad news. For example, a measured disclosure of bad news over time may be deemed the most appropriate approach in patients we judge to be vulnerable or those we perceive to have a lower ability to cope. Superficially, holding back some information might be viewed as nothing more than a ‘white lie’ to protect patients and help prepare them for bad news. However, no matter how well intentioned, making judgements on when to offer full disclosure may serve to undermine the bond of trust between a patient and nurse.

more…

Desert Island Discs and the role of the health care professional in addressing child health inequalities….

12 Mar, 17 | by atwycross

Blog written by Kath Evans 

This week’s EBN Twitter Chat on Wednesday 15th March between 8-9 pm (UK time) will focus on the role of the health care professional in addressing child health inequalities. The Twitter Chat will be hosted by Kath Evans (@kathevans2) a children’s nurse who works at NHS England and leads on improving experiences of care in maternity, infant, children and young people’s services and Professor Alison Twycross (@alitwy) – editor of Evidence Based Nursing. This Blog provides some context for the Chat.

Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward, You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

I love listening to Desert Island discs as I run (admittedly at a pretty slow pace) around my local park, it was Dame Carol Black and her desert island discs that got me running again back in February 2016. She’s still running in her 70s, and as I’m in my 40s I didn’t think I had any excuse not to lace up my running shoes and get plodding!

However it was Sir Michael Marmott’s  desert island discs podcast (who published ‘Fair Society, Healthy Lives’  ‘The Marmot Review’  )  that got me thinking that we now know so much about child health inequalities and the reasons for them, and yet they continue to exist.

As health care professionals we also see child health inequalities day in day out on our wards, in schools, A&E or Urgent Care centres in fact anywhere where healthcare is delivered. The infant brought in dead having suffocated after co-sleeping, the 4 year old drinking cola from a bottle whilst being admitted for dental extractions due to tooth decay, the obese five year old, the 8 year old awaiting a child protection medical so malnourished and with hair so matted and infested that the play specialist and nurse spend hours bathing and treating her with such kindness that shines a light on compassion in practice and exemplifies the non-judgemental attitude of health care professionals, whilst knowing the social deprivation many of the children are facing. more…

Women with sickle cell disease carry additional risks for pregnancy

7 Mar, 17 | by josmith

Professor Allison Shorten, Director Center for Interprofessional Education and Simulation, University of Alabama, and Associate Editor Evidence-Based Nursing

 One of our most recent EBN commentaries reminds us of the health challenges faced by women with sickle cell disease globally. One of our expert commentators, Dr Eugene Oteng-Ntim from Guy’s and St Thomas’ Hospital, discusses a recent study by Bogfor et al (2016), highlighting the need for future research to address the high rates of maternal and infant morbidity and mortality associated with sickle cell disease in pregnancy. Globally, sickle cell disease is one of the most common genetic conditions, and when combined with pregnancy, risks are higher, regardless of whether women are living in low or high income countries. Read more about this recent systematic review and meta-analysis, and recommendations for health policy and clinical management.

Commentary: Oteng-Ntim, E. (2017) Pregnancy in women with sickle cell disease is associated with risk of maternal and perinatal mortality and severe morbidity, Evidence Based Nursing,

http://dx.doi.org/10.1136/eb-2016-102450

Reference:

Boafor TK, Olayemi E, Galadanci N, et al. Pregnancy outcomes in women with sickle-cell disease in low and high income countries: a systematic review and meta-analysis. BJOG 2016;123:6918.

Do Nurse-Led Programs Make a Difference?

26 Feb, 17 | by rheale

This week’s EBN Twitter Chat is on Wednesday 1st of March, between 8-9 pm (UK time) and will be hosted by Roberta Heale (@robertaheale) Associate Editor at EBN.

The Twitter chat this week will focus on a commentary about a nurse-led exercise program for hemodialysis patients. Nursing care very often incorporates health promotion and disease prevention programming, particularly related to chronic disease management. In fact, the development and implementation of health programs are somewhat unique skills to nursing; that often go unrecognized. In this age of fiscal accountability, it’s important to highlight and evaluate nurse-led programs to offer evidence to both improve and sustain them. It’s even more important to determine positive patient outcomes from these programs. We’ll explore the prevalence of nurse-led programs along with facilitators and barriers. How are programs evaluated and what recommendations do nurses who have participated in a health program have for those of us thinking about developing one?

To read the commentary, please click on this link: http://ebn.bmj.com/content/19/1/12

Participating in the Twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account, contributing is straightforward. You can follow the discussion by searching links to #ebnjc, or contribute by creating and sending a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN Twitter chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

Questions to consider prior to the Twitter Chat:

  1. What are your experiences with nurse-led programs? What were the outcomes?
  2. What do you think are important considerations for nurse-led programs?
  3. What are the facilitators and barriers to nurse-led programs?

 

 

Do you Choose Wisely?

20 Feb, 17 | by rheale

By Roberta Heale, Associate Editor BMJ @EBNursingBMJ  #ebnjc  @robertaheale

There is a growing trend for overuse of healthcare interventions, including prescriptions and treatments. Choosing Wisely is a global initiative with a mission to improve decision making between health care providers and patients and to decrease the use of unnecessary, or unwarranted tests and treatments. Choosing Wisely encourages discussion with patients related to the following five questions:

  1. Do I really need this test, treatment or procedure?
  2. What are the risks or downsides?
  3. What are the possible side effects?
  4. Are there simpler, safer options?
  5. What will happen if I do nothing?

(see Choosing Wisely UK http://www.choosingwisely.co.uk/about-choosing-wisely-uk/)

Health care provider groups can participate in this initiative by developing lists of tests or treatments that are widely used, but have little or no supporting evidence. It isn’t only physician groups with concerns about unwarranted tests or treatments. Appropriate, evidence-based nursing care is essential to optimal patient outcomes and our care deserves evaluation. The Canadian Nurses Association recruited 12 participants to develop a list of nine nursing interventions that “Patients and Nurses Should Question”. Check them out here: http://www.choosingwiselycanada.org/recommendations/nursing/

Choosing Wisely provides a systematic and positive platform for the critique of routine care and these processes have the potential to lead to better implementation of evidence into practice.

Living with paediatric chronic illness: What are the developmental challenges?

12 Feb, 17 | by atwycross

 

Abbie Jordan (@drabbiejordan), University of Bath and Line Caes (@LineCaes5), University of Stirling will be leading this week’s EBN Twitter Chat (#ebnjc) on Wednesday 15th February between 8-9pm UK time focusing on the developmental challenges of living with a paediatric chronic illness.

 

 

 

Participating in the Twitter Chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward:

  • Go to your Twitter account
  • Follow the discussion by searching for #ebnjc once linked to the discussion, click “all tweets” to keep up-to-date with recent tweets
  • Add the EBN chat hash tag (#ebnjc) to your tweets to join in, this allows everyone taking part to view your contribution

Chronic illness in childhood is common, with figures estimating as many as one in four families in the US reporting caring for a child or adolescent with an ongoing health condition (Compas et al., 2012).  As noted by Christie and Katun (2012), receiving a diagnosis of a chronic condition marks the start of a long and challenging journey for children and their families. This journey may change along the way as children grow up and develop new skills. To explore this, research has focused on exploring what it is actually like for children and their families to live and grow up with a chronic condition (Compas et al., 2012; Palermo et al., 2014).  In addition to the challenges associated with managing a chronic illness (e.g. repeated hospital appointments, daily treatment requirements), a substantial number of children who live with a chronic illness experience emotional and social difficulties. Not only the child, but their entire family is affected, with some parents and siblings reporting emotional distress and poor relationship functioning (Knecht et al., 2015; Palermo and Eccleston, 2009).

more…

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