Dr Helen Aveyard

Background: Informed consent prior to nursing care procedures is an established principle which acknowledges the right of the patient to authorise what is done to him or her; consent prior to nursing care should not be assumed. Nursing care procedures have the potential to be unwanted by the patient and hence require an appropriate form of authorisation that takes into consideration the relationship between the nurse and patient and the ongoing nature of care delivery.

Research question: How do nurses obtain consent from patients prior to nursing care?.

Design: Critical incident technique and the collection of critical happenings.

Participants: 17 participants who were all qualified nurses took part in in-depth interviews.

Ethical considerations: Ethical approval was obtained from the university ethics committee.

Findings: Information giving is a key component prior to nursing care procedures. Nurses provide information to patients as a routine aspect of care delivery, and do so even when the patient is unable to communicate themselves. Whilst some participants described how information giving might be rushed or overlooked at times, it is clearly an established part of nursing care and is provided to ensure the patient knows what to expect when care is delivered. What is less clear is the extent to which information is given in order to seek the consent - rather than merely inform the patient - about nursing care.

Conclusion: Implied consent is often an appropriate way in which consent is obtained prior to nursing care procedures. It takes into account the ongoing care provision and the relationship that exists between the nurse and patient. However implied consent should not be assumed. Nurses need to ensure that information is given not only to inform the patient about a procedure but to enable the patient to give his or her consent and to find an alternative way forward if the patient withholds their consent.

Background: Focus group discussions for data collection in nursing research has increased. Data from focus groups provides rich in-depth understanding of a phenomenon, which can inform clinical practice. Guidance on facilitating focus groups has been developed, however there is a lack of guidance on techniques of translating, analysing and presenting focus group data from countries with linguistic differences. Aim: To explore contemporary examples of translating, analysing and presenting focus group data from countries with linguistic differences and provide an in-depth example of the decision making process from one study with focus group data from two countries. Methods: A discussion paper to guide recommendations for focus group data analysis from countries with linguistic differences. Discussion: The experience from undertaking focus groups across two countries and contemporary nursing research has highlighted the need for a clear rationale and transparency in the reporting of translating, analysing and presentation of data. Detailed and transparent reporting needs to include not only the translation process, but when this occurred, either pre
or post analysis, and when or if the data was amalgamated. Implications for research/practice: There is a clear need for evidence-based guidance on the reporting of translation, transcription and analysis of focus group data from countries with linguistic difficulties.

Stories enable us to explore hidden experiences (East et al 2010) or ‘unknown unknowns’ and are a way for people who have been through illness to share their experiences (Frank 2016). Much research is dependent on human memory (Barusch 2011) and qualitative research in particular relies on people telling stories or accounts to describe their experiences (Palacios et al 2015). Nursing research especially focuses on people's experiences of health and illness (Bonis 2008). Qualitative research can inform and facilitate positive change in health research (Streubert & Carpenter 2011) and focuses on the “meaning rather than the measurement” (Holloway & Biley 2011 p.968). One of the ways meaning can be explored is through asking people about their experiences. Participants are often invited to share their stories with researchers via interviews, focus groups or other means, and their memory is crucial to communicating these. The nature of much nursing research can be described as sensitive (Dempsey et al 2016). Here again memory plays a role, participants are asked to draw on memories of experiences that may be distressing or that may raise unanticipated issues for them. These can have serious consequences and remembering these events can trigger thoughts and emotions which can lead to Post-Traumatic Stress Disorder (PTSD) (McNally 2010). As a concept, memory is rarely discussed or described within qualitative nursing research. Rather, it is taken for granted and there is little acknowledgement that memory is much more complex than a simple storage and retrieval system. A discussion of the implications of this for qualitative nursing research is therefore timely. Furthermore, specific considerations on how to support participants recalling negative or traumatic events are pertinent. 

Background. Nursing research is dedicated to improving care, but research into end of life care can be challenging because of a possible reluctance by researchers to invite bereaved people to take part in studies.

Aim. To use a focused mapping approach to explore the recruitment to studies of grieving and bereaved people.

Discussion. There is no ‘gold standard’ method of recruitment and no best way to approach participants. The outcome of each method, measured by the percentage of potential participants recruited, appears to be unrelated to the approach used.

Conclusion. There is no evidence that participation in research harms those who have recently been bereaved, but there is evidence of benefits from participating.

Implications for practice. Researchers should not feel they need to protect the bereaved from participating in research and can invite bereaved individuals to join a study without worrying about causing them harm.

Background

In this paper we discuss the emergence of many different methods for doing a literature review. Referring back to the early days, when there were essentially two types of review; a Cochrane systematic review and a narrative review, we identify how the term systematic review is now widely used to describe a variety of review types and how the number of available methods for doing a literature review has increased dramatically. This led us to undertake a review of current practice of those doing a literature review and the terms used to describe them.

Method

We undertook a focused mapping review and synthesis. Literature reviews; defined as papers with the terms review or synthesis in the title, published in five nursing journals between January 2017–June 2018 were identified. We recorded the type of review and how these were undertaken.

Results

We identified more than 35 terms used to describe a literature review. Some terms reflected established methods for doing a review whilst others could not be traced to established methods and/or the description of method in the paper was limited. We also found inconsistency in how the terms were used.

Conclusion

We have identified a proliferation of terms used to describe doing a literature review; although it is not clear how many distinct methods are being used. Our review indicates a move from an era when the term narrative review was used to describe all ‘non Cochrane’ reviews; to a time of expansion when alternative systematic approaches were developed to enhance rigour of such narrative reviews; to the current situation in which these approaches have proliferated to the extent so that the academic discipline of doing a literature review has become muddled and confusing. We argue that an ‘era of consolidation’ is needed in which those undertaking reviews are explicit about the method used and ensure that their processes can be traced back to a well described, original primary source.

This literature review was conducted to describe the range of organisations and informal groups providing peer support to personal budget users in the UK between the launch of direct payments in 1997 and 2016. Forty-five research reports included relevant evidence. This has been aggregated to show how peer networks supported individual users, as well as to describe their wider role in policy development and implementation. Despite their diversity, the support they provided often had common characteristics. Peer networks fostered collaboration, enhanced communication, built confidence amongst people who were entitled to a personal budget, and applied specialist knowledge that was often derived from the lived experience of network members. None of these characteristic was exclusive to peer networks. However, they may have been more deeply culturally embedded here than in other settings, which perhaps accounts for the positive experiences of support reported in the research literature.

Background. Assistant practitioners have knowledge and skills beyond the level of traditional support workers, and work in many clinical settings. However, some assistant practitioners lack a clearly defined role and may be under-used due to issues around accountability and uncertainty about their purpose. This paper explores the assistant practitioner role from the perspectives of assistant practitioners and registered nurses. Methods. This study aimed to explore the role of the assistant practitioner from the perspectives of assistant practitioners and registered nurses in two NHS hospital trusts in Oxfordshire, United Kingdom. Six qualitative focus groups were undertaken between February–March 2017. Ethical approval was obtained (FREC 2016/05) and written consent was provided by participants. Data was analysed thematically analysed using the Framework method. Results. Nineteen participants (assistant practitioners, n = 12; registered nurses, n = 7) were recruited using convenience sampling. Emerging themes related to ‘fluctuating roles and responsibilities of assistant practitioners’, ‘role differences between registered nurses and assistant practitioners’, ‘working relationships’, ‘supervision’ and ‘redefining nursing pathways’. The Results and Discussion sections highlight a lack of role clarity and blurring of boundaries between the roles of assistant practitioners and registered nurses, with many tasks undertaken by both. This lack of ownership of ‘nurse-specific’ roles by registered nurses was evident and clear differences were only encountered with regard to accountability. The development of the Nursing Associate role provides managers with the opportunity to redefine staff banding hierarchies to ensure that clinical staff are aware of their role capabilities and limitations and are practicing safely, whilst promoting career development and progression pathways. Conclusion. Addressing issues around role clarity can benefit professional development, satisfaction, role identity and ownership for registered nurses and assistant practitioners, by recognising the individual and collective value they bring to the clinical team. The findings can help inform the development of the Nursing Associate role.

Background. Inflammatory Bowel Disease is a chronic, untreatable condition represented by two illnesses, Crohn's and Ulcerative Colitis. Despite high incidence in well-developed industrialised countries, and the significant impact of symptoms on patient's quality of life, little is known about living with Inflammatory Bowel Disease.

Aim. To explore the patients' experiences of living with Inflammatory Bowel Disease.

Design. A qualitative systematic review.

Data sources. CINAHL, Medline, British Nursing Index and PsycINFO were searched using the following keywords: Inflammatory Bowel Disease AND experiences. We have limited the search to studies published in English from 2000 to 2017.

Review method. Thematic synthesis.

Results. Data from 23 studies, identified that fatigue, incontinence and uncertainty about future, body image, and lack of information from healthcare professionals dominated the experiences of those living with Inflammatory Bowel Disease. Also, patients living with Inflammatory Bowel Disease were reluctant to disclose their illness due to lack of public awareness and stigma surrounding symptoms. From these, an overarching theme has been identified: Living in isolation and exclusion.

Conclusion. Patients with Inflammatory Bowel Disease face a variety of problems, often their priorities and those of healthcare professionals differ greatly. Healthcare professionals have little evidence needed to provide adequate, holistic care to this group. With a rise in the Inflammatory Bowel Disease population in newly industrialised countries it is estimated that the condition is turning into a global disease, potentially making long term care unsustainable. More evidence is needed to understand the concerns of this group.