Assessing a patient's level of consciousness is a skilled part of nursing practice. The epistemology of this activity is discussed using the four patterns of knowing identified by Carper. It is suggested that all four patterns and their interaction are necessary for a practitioner to be able to carry out this activity with the necessary reliability and accuracy that good safe practice dictates. A possible enhancement to how a practitioner gains this knowledge can be through the work of joint appointments, between education and clinical areas.
There is growing interest in the use of procalcitonin as a biomarker of bacterial infection. In particular, focus has been on the use of procalcitonin to facilitate a more timely diagnosis of sepsis and to guide the appropriate duration of antibiotic therapy. However, there is a lack of consensus in the literature concerning the role of measuring procalcitonin levels in clinical practice. This article reviews the evidence surrounding the utility of this biomarker for patients with sepsis in the intensive care environment. It is concluded that raised procalcitonin levels add little as a diagnostic criterion, however evidence supports the incorporation of procalcitonin-based algorithms relating to antibiotic stewardship in this patient population.
Aim: The aim of this study was to evaluate and summarise the current evidence base in relation to the gender-specific presentation and assessment of coronary heart disease. Background: Coronary heart disease (CHD) is one of the leading causes of death in both men and women worldwide. There remains a common misconception that CHD is predominantly a ‘man's disease’ and that CHD doesn't affect women until they are much older. Much of the evidence base is underpinned by male-based population studies. Design: A systematic review of current qualitative and quantitative primary research literature was used to establish if coronary heart disease patients would benefit from a gender-specific approach. Data Sources: Cochrane library (1898–2014), PubMed (1996–2014), MEDLINE (1946–2014), AMED (1985–2014), Embase (1974–2014), CINAHL (1937–2014), British Nursing Index (1994 – 2014), PsycINFO (1800–2014). Results: Selected studies were reviewed in English and critiqued in accordance with the critical review framework used by the National Institute for Health and Care Excellence. Conclusion: There are clear differences between the genders in relation to coronary heart disease. It is imperative that nursing practice acknowledges this through the greater application of gender-specific care.
Regarding health care services, the decision-making process occurs at three primary levels: macro (national), mid-range (hospital) and micro (individual practitioner). The research basis for this process at each of these levels is briefly discussed, with an emphasis concerning which type of data is and/or should be utilized. The paradigm assumptions behind data generation are also explored with reference to methodologies which seek to combine different types of data. The nursing profession, within the changing structure of the NHS, needs to take account of data generation if it is to play an active research role, and therefore be able to influence the health care decision-making process.
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