As fourth-year King's College London medical students, we have read this article with great enthusiasm and felt we could identify with the concerns raised. We want to offer an additional perspective.
In terms of direct hazards, we have noticed that some of our colleagues have felt unsafe on specific placements. This is undoubtedly the case in psychiatry where patients may, unfortunately, become verbally abusive and at times physically intimidating.
Additional concerns may arise when students are placed peripherally in areas where there is a substantial crime. This can involve anything from petty theft to more serious crimes like muggings.
A clinical risk that we have been well trained to anticipate and handle are needlestick injuries. This is an example of adequate preparation making us feel more comfortable, i.e. working with sharps despite risks involved.
There are times when senior staff expectations are exceedingly high, and due to indirect risks such as stress and burnout, us students may fail to reach these standards. In some instances, lack of support and understanding perpetuate the cycle of stress. We have, however, noticed that this is less likely to occur when students have a longitudinal supervisor.
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical stu...
As fourth-year King's College London medical students, we have read this article with great enthusiasm and felt we could identify with the concerns raised. We want to offer an additional perspective.
In terms of direct hazards, we have noticed that some of our colleagues have felt unsafe on specific placements. This is undoubtedly the case in psychiatry where patients may, unfortunately, become verbally abusive and at times physically intimidating.
Additional concerns may arise when students are placed peripherally in areas where there is a substantial crime. This can involve anything from petty theft to more serious crimes like muggings.
A clinical risk that we have been well trained to anticipate and handle are needlestick injuries. This is an example of adequate preparation making us feel more comfortable, i.e. working with sharps despite risks involved.
There are times when senior staff expectations are exceedingly high, and due to indirect risks such as stress and burnout, us students may fail to reach these standards. In some instances, lack of support and understanding perpetuate the cycle of stress. We have, however, noticed that this is less likely to occur when students have a longitudinal supervisor.
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical students, we find that these interventions are mainly aimed at direct risks and hazards with the indirect types being overlooked.
We propose that students be made more aware of the types of indirect hazards they may encounter and better equip them to escalate concerns. This can take many forms, such as lectures, debriefing sessions, reflective practice and of course, one on one meetings with longitudinal supervisors.
We read with interest Malissa Warren's comment entitled, “Abdominal massage may decrease gastric residual volumes and abdominal circumference in critically ill patients” for our study, “The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study,” which was online published in the Evidence-Based Nursing Journal in April.
It is possible to criticize the fact that we did not include the protocol that we applied for enteral feeding and GRV measurement in the study methodology in detail. However, we want to say that there was no difference between the experimental and control groups in terms of both feeding rate and amount and GRV measurement. Both groups were homogeneous in these respects because this is a randomized controlled study. In the same article, there is evidence that there was no difference between the groups, for which GRV measurement is not suggested in terms of VAP development.1 However, this evidence is still disputed, and the necessity of GRV measurement is supported by some researchers.2 The writer also indicated that abdominal circumference measurement is not reliable in the case of oedema, acid, anasarca and obesity. We want to respecify that both groups body weights are similar (experimental group=69.9 16.7 and control group=69.7 16.3) and no patients with oedema, acid, anasarca were included in this study....
We read with interest Malissa Warren's comment entitled, “Abdominal massage may decrease gastric residual volumes and abdominal circumference in critically ill patients” for our study, “The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study,” which was online published in the Evidence-Based Nursing Journal in April.
It is possible to criticize the fact that we did not include the protocol that we applied for enteral feeding and GRV measurement in the study methodology in detail. However, we want to say that there was no difference between the experimental and control groups in terms of both feeding rate and amount and GRV measurement. Both groups were homogeneous in these respects because this is a randomized controlled study. In the same article, there is evidence that there was no difference between the groups, for which GRV measurement is not suggested in terms of VAP development.1 However, this evidence is still disputed, and the necessity of GRV measurement is supported by some researchers.2 The writer also indicated that abdominal circumference measurement is not reliable in the case of oedema, acid, anasarca and obesity. We want to respecify that both groups body weights are similar (experimental group=69.9 16.7 and control group=69.7 16.3) and no patients with oedema, acid, anasarca were included in this study. Moreover, it is known that rather than enteral feeding, parenteral feeding is preferred in advanced cases such as abdominal acid deposition.3
Last, the limitations of our study are clear. However, it should not be forgotten that there are many criteria to ensure homogeneity between groups in this study. With these criteria, it is not impossible, but pretty difficult to increase the larger sample size, and this was suggested as a result of our study.
We know that science changes and improves every day and think that, despite the issues discussed above, our pilot study with reflections to the clinical setting leads other research in this field.
References
1. Reignier J, Mercier E, Le Gouge A, et al. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013;309:249–56.
2. Elke G, Heyland D. Residual Gastric Volume and Risk of Ventilator-Associated Pneumonia. JAMA 2013;309:2090.
3. Johnson TM, Overgard EB, Cohen AE, DiBaise JK. Nutrition Assessment and Management in Advanced Liver Disease. Nutrition in Clinical Practice 2013;28:15-29.
If you enjoyed this EBN Notebook you may also like to read the EBN
Research Made Simple paper looking at Qualitative data analysis: a
practical example. This is available at:
Click here
For more information about Hypothesis testing and p values: how to
interpret results and reach the right conclusion see the EBN Research Made
Simple paper published in April 2013.
If you want to learn more about p values see EBN Research Made Simple
paper "What is a p value and what does it mean?" from April 2012.
For more information about Hypothesis testing and p values: how to
interpret results and reach the right conclusion see the EBN Research Made
Simple paper published in April 2013.
If you want to learn more about p values see EBN Research Made Simple
paper "What is a p value and what does it mean?" from April 2012.
If you enjoyed this EBN Notebook you may also like to read the EBN
Research Made Simple paper looking at Qualitative data analysis: a
practical example. This is available at:
Click here
If you would like to know more about systematic reviews why not read
the EBN Research Made Simple paper What is a systematic review? Available from:
Click here
If you enjoyed this paper and want to know more about blinding read
the EBN Research Made Simple paper Blinding: an essential component in
decreasing risk of bias in experimental designs available from:
Click here
Trussardi and Gott[1] provide an insightful commentary on our
integrative review paper on dignity in end-of-life care.[2] They raise
some interesting points about the definition of dying with dignity in end-
of-life care, some with which we concur and others would view differently.
People in different cultural, social and historical contexts may
understand the concept of dignity differently. H...
Trussardi and Gott[1] provide an insightful commentary on our
integrative review paper on dignity in end-of-life care.[2] They raise
some interesting points about the definition of dying with dignity in end-
of-life care, some with which we concur and others would view differently.
People in different cultural, social and historical contexts may
understand the concept of dignity differently. However, instead of
proposing a standard definition that applies to everyone, the concept of
dignity should be understood as consisting of an inherent value, a
personal and social dimension. Dignity is inherent to our humanity,
meaning everybody has the right to die with dignity. Each individual
perceives dignity according to his or her personal culture, beliefs,
values and wishes.[2] As such, dying with dignity is a subjective
experience that is mediated by social influences, comprised of
relationships and encounters developed over the course of ones life.[3]
To support dignity in end-of-life care, health professionals should
keep in mind whose dignity they are going to support; what patients
consider important and how they understand dignity, rather than assume
they can apply their own professional perspective. Our paper did not
separate patients, family members and health professionals perspectives of
dying with dignity, since the majority of themes were identified in all
three groups. While health professionals' understanding of dignity should
not be substituted for the opinions of patients, their understanding can
affect the delivery of service to patients and families. Furthermore, it
appears that health professionals view dignity according to how their
patients and families understand it; and based upon their professional
experience in hospice.[4]
As Trussardi and Gott indicate, the process of dying happens with or
without professional support. Family members are often the primary
caregivers for patients dying at home. The care they offer to support
patient dignity deserves study, but was not within the scope of our review
paper. We examined dying with dignity in the context of hospice and
palliative care, where health professionals are the primary caregivers.
With diminishing independence, the dignity of dying patients is
increasingly affected by care. Hence, qualified professional services are
essential within hospice and palliative care.
Trussardi and Gott try to deemphasize the importance of autonomy as a
key characteristic of dignity by citing the notion of "interdependence".
However, autonomy and interdependence are not mutually exclusive. Autonomy
refers to the extent to which patients have a sense of control over their
life circumstances.[5] Interdependence occurs when two or more autonomous
individuals rely on and are responsible for each other; it implies a
reciprocal relationship rather than a solely dependent relationship. For
example, dying patients and their families are emotionally interdependent,
but patients may still have a strong sense of autonomy so long as they are
able to make their own decisions. The dynamic of interdependency between
dying patients and their families might be better understood as a
meaningful relationship, which while interdependent, can strive towards
maintaining patient autonomy and dignity.
Acknowledgments
The author would want to thank Dr. Harvey Max Chochinov for his
valuable feedback and comments on an earlier draft of this paper.
References
1. Trussardi G, Gott M. Clarification of the common aspects of
dignity in end-of-life care. Evid Based Nurs Published Online First: 4
February 2015. doi: 10.1136/eb-2014-102007
2. Guo Q, Jacelon CS. An integrative review of dignity in end of life
care. Palliat Med 2014;28:913-40.
3. Pleschberger S. Dignity and the challenge of dying in nursing
homes: the residents' view. Age Ageing 2007;36:197-202.
4. Guo Q. A preliminary model of dignity management in hospice. PhD
Thesis, University of Massachusetts Amherst, Amherst, MA, 2014.
5. Chochinov HM, Hack T, McClement S, et al. Dignity in the
terminally ill: a developing empirical model. Soc Sci Med 2002;54:433-43.
As fourth-year King's College London medical students, we have read this article with great enthusiasm and felt we could identify with the concerns raised. We want to offer an additional perspective.
In terms of direct hazards, we have noticed that some of our colleagues have felt unsafe on specific placements. This is undoubtedly the case in psychiatry where patients may, unfortunately, become verbally abusive and at times physically intimidating.
Additional concerns may arise when students are placed peripherally in areas where there is a substantial crime. This can involve anything from petty theft to more serious crimes like muggings.
A clinical risk that we have been well trained to anticipate and handle are needlestick injuries. This is an example of adequate preparation making us feel more comfortable, i.e. working with sharps despite risks involved.
There are times when senior staff expectations are exceedingly high, and due to indirect risks such as stress and burnout, us students may fail to reach these standards. In some instances, lack of support and understanding perpetuate the cycle of stress. We have, however, noticed that this is less likely to occur when students have a longitudinal supervisor.
Overall we understand that certain risks are unavoidable, and we appreciate the vast number of measures in place aimed at safeguarding against risks and hazards during clinical placements. From our experience as medical stu...
Show MoreDear Editor,
We read with interest Malissa Warren's comment entitled, “Abdominal massage may decrease gastric residual volumes and abdominal circumference in critically ill patients” for our study, “The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study,” which was online published in the Evidence-Based Nursing Journal in April.
Show MoreIt is possible to criticize the fact that we did not include the protocol that we applied for enteral feeding and GRV measurement in the study methodology in detail. However, we want to say that there was no difference between the experimental and control groups in terms of both feeding rate and amount and GRV measurement. Both groups were homogeneous in these respects because this is a randomized controlled study. In the same article, there is evidence that there was no difference between the groups, for which GRV measurement is not suggested in terms of VAP development.1 However, this evidence is still disputed, and the necessity of GRV measurement is supported by some researchers.2 The writer also indicated that abdominal circumference measurement is not reliable in the case of oedema, acid, anasarca and obesity. We want to respecify that both groups body weights are similar (experimental group=69.9 16.7 and control group=69.7 16.3) and no patients with oedema, acid, anasarca were included in this study....
If you enjoyed this EBN Notebook you may also like to read the EBN Research Made Simple paper looking at Qualitative data analysis: a practical example. This is available at: Click here
Conflict of Interest:
None declared
Readers of this EBN Notebook might like the EBN Research Made Simple paper looking at What is qualitative synthesis? This is available at: Click here
Conflict of Interest:
None declared
Readers of this EBN Notebook might like the EBN Research Made Simple paper entitled: Selecting the sample. This is available at: Click here
Conflict of Interest:
None declared
For more information about Hypothesis testing and p values: how to interpret results and reach the right conclusion see the EBN Research Made Simple paper published in April 2013.
If you want to learn more about p values see EBN Research Made Simple paper "What is a p value and what does it mean?" from April 2012.
These are both available at:
Cli...
If you enjoyed this EBN Notebook you may also like to read the EBN Research Made Simple paper looking at Qualitative data analysis: a practical example. This is available at: Click here
Conflict of Interest:
None declared
If you would like to know more about systematic reviews why not read the EBN Research Made Simple paper What is a systematic review? Available from: Click here
Conflict of Interest:
None declared
If you enjoyed this paper and want to know more about blinding read the EBN Research Made Simple paper Blinding: an essential component in decreasing risk of bias in experimental designs available from: Click here
Conflict of Interest:
None declared
Dear Editor,
Trussardi and Gott[1] provide an insightful commentary on our integrative review paper on dignity in end-of-life care.[2] They raise some interesting points about the definition of dying with dignity in end- of-life care, some with which we concur and others would view differently.
People in different cultural, social and historical contexts may understand the concept of dignity differently. H...
Pages