Exploring apprentice nursing associates' experiences of their home placements in primary care or social care

BACKGROUND

An increasing number of apprentice nursing associates undertake their home placement in primary care or social care, but there is limited understanding of apprentice nursing associates' experiences in these settings.

AIM

To explore apprentice nursing associates' experiences of a home placement in primary care or social care and provide initial insight into what may support or hinder their professional development in these settings.

METHOD

A mixed-methods study design was used with qualitative interviews complemented by a quantitative survey. Participants were recruited among 27 current or former apprentice nursing associates studying at one London university. Eleven current or former apprentices were interviewed and 15 completed the survey.

FINDINGS

Participants' motivations for applying to become nursing associates were to develop professionally and advance their careers. They experienced supportive learning environments where they felt part of the team, but also unsupportive learning environments where they were denied protected learning time and supervised practice. Several participants experienced unfair treatment and abuses of power, including non-payment for university days and external placements, sexual harassment and marginalisation.

CONCLUSION

Apprentice nursing associates can have suboptimal experiences of home placements in primary care or social care and be subjected to unfair treatment and abuse. Urgent action is required from higher education institutions and employers to ensure apprentice nursing associates are adequately supported.

Identifying the relationship between delirium and falls

Delirium, which may present as acute fluctuation in arousal and attention and changes in a person's behaviours, can increase the risk of falls, while a fall can increase the risk of developing delirium. There is, therefore, a fundamental relationship between delirium and falls. This article describes the main types of delirium and the challenges associated with recognition of the condition and discusses the relationship between delirium and falls. The article also describes some of the validated tools used to screen patients for delirium and includes two brief case studies to illustrate this in practice.

Experiences of using simulation in dementia education

This article describes the development of a simulation training day for multidisciplinary teams (MDTs) working on acute adult wards with the aim of improving their confidence in supporting people with dementia who are distressed. Recommendations are made for those who may be interested in delivering simulation training in their area of practice. Registered nurses, non-registered support workers and occupational therapists experienced in dementia care took part in a one-day simulation training pilot session that included three 'skill stations' with three patient simulation scenarios. A session at the end of the day was used to generate qualitative feedback and develop a strategy to advance this style of teaching. Feedback highlighted the need for further development of the skill stations and scenarios. The pilot showed that simulation training works well from an MDT perspective, but the content requires careful consideration in terms of stretching participants' abilities without causing high levels of anxiety.

What approach should I take if I think an older person is lonely?

The normal human emotion of loneliness is a sign of wanting contact with people and it is known that prolonged exposure to loneliness can have a devastating effect on a person's well-being.

Consequences of loneliness on physical activity and mortality in older adults and the power of positive emotions

This longitudinal study examined the effect of greater happiness on the mortality and physical activity rates in a population of community-dwelling older people. In effect, it looked at the ability of happiness to 'undo' the negative effects of loneliness.

Feelings of loneliness and living alone as predictors of mortality in the elderly: the PAQUID study

This large population study carried out in France investigated how living alone and feelings of loneliness affect mortality rates in older community-dwelling people.

Loneliness and quality of life in chronically ill rural older adults

This article reports on a pilot study of older residents with chronic illness in rural Virginia, US, and the effect loneliness has had on their medication use, disease control and quality of life.

Supporting people with dementia to eat

The aim of this systematic review was to identify the best ways of supporting people with dementia to eat. Five electronic databases were searched, with a date range from January 2004 to July 2015. Following screening of the 233 studies identified, 22 were included in the final analysis. The study interventions focused on educational programmes, environmental or routine changes, and assistance with eating, with the strongest evidence shown in the more complex educational programmes for people with dementia. The evidence suggests that staff who support people with dementia to eat should undertake face-to-face education programmes and aim to give people enough time when helping them to eat. However, cultural change may be needed to ensure individual assessments are carried out to identify those having difficulty eating, and to ensure they are afforded enough time to eat their meals.

Assessment of older adults in the emergency department

Older people make extensive use of emergency departments, yet there is evidence that optimum care is difficult to provide for those with complex health and social problems. Inappropriate hospital admissions for older people have also been documented. This article describes the establishment of an assessment team for older people (ATOP) that has been created to address these issues in a district general hospital. In the four months of the study period, the ATOP prevented admission of 178 of the 666 patients seen. Of these 178 patients, 19 re-attended the hospital and six were admitted.

Face to face. Interview by Ruth Williams

Vicki Leah qualified as a nurse in 1985. She has worked in a number of clinical leadership roles in acute care. Last year Vicki took up her post as nurse consultant--older people at Broomfield Hospital, part of Mid Essex Hospital Services NHS Trust, where she leads a multidisciplinary elderly assessment team which aims to improve the experience of older people in the hospital's emergency department and medical assessment unit. She spoke to Ruth Williams

Recognition of ST elevation by paramedics

OBJECTIVE

To define the ability of UK paramedics to recognise ST segment elevation using a prehospital 12 lead electrocardiogram (ECG).

METHODS

Analysis of the diagnostic ability of seven paramedics 12 months after a two day training course, using interpretation of a 12 lead ECG by two cardiologists as the criterion standard. Comparison of paramedic and A&E SHO diagnosis to determine accuracy, specificity, sensitivity, negative predictive value, and positive predictive value of paramedic interpretation.

RESULTS

Paramedics showed a median accuracy of 0.95 (95% CI 0.88 to 0.98), a specificity of 0.91 (95% CI 0.53 to 1.0), a sensitivity of 0.97 (95% CI 0.94 to 0.99), a NPV of 0.77 (95% CI 0.62 to 0.92) and a PPV of 0.99 (95% CI 0.92 to 1.0). This was not significantly different from a group of experienced A&E SHOs.

CONCLUSIONS

UK paramedics can recognise ST elevation using a 12 lead ECG. Radio transmission of an ECG may not be necessary to pre-alert the hospital.

In-hospital resuscitation--what should we be teaching?

This paper examines the initial actions that should take place following the sudden collapse of a patient in a hospital. The current Basic Life Support guidelines are not designed for this situation, yet are commonly taught to hospital staff. An alternative algorithm for Hospital Resuscitation has been developed. Additional factors, such as the recognition of the sick patient and the importance of audit should be included in hospital resuscitation training. A tiered approach to resuscitation training within a hospital should be adopted and national standards developed.

Resuscitation training for medical students

This paper describes the systematic training of undergraduate medical students in resuscitation skills, aimed at overcoming the well known deficiencies in the resuscitation skills of junior doctors. This training can be integrated with the medical curriculum, but takes a considerable commitment in teaching time. To give each of our 240 medical students 36 h of resuscitation training, including an advanced life support (ALS) course for all students, 2442 h of teacher's time is required each year. It is important that teaching is continued on the wards as part of the training of pre-registration house officers. The amount of teaching time required justifies the appointment of Medical School Resuscitation Officers, dedicated to teaching medical students, dental students and pre-registration house officers.