This study aimed to understand the attitudes of qualified nursing staff on an acute medical unit concerning the Modified Early Warning System (MEWS) score chart used to monitor patients. A combination of questionnaires and a focus group was used. All respondents believed that the MEWS is beneficial in their work but the point was also raised that MEWS scores can be miscalculated and there is sometimes difficulty in getting medical staff to review the patient, even if the MEWS score is significantly high. At times a qualified nurse's seniority or the colour of his or her uniform can affect the attitude of the medical staff and can mean the difference between the patient being reviewed or not. Certain medics have a culture of dismissing a high MEWS score because they were expecting these vital physiological signs to be abnormal, owing to that particular patient's past medical history or presenting complaint. Most hospitals in the NHS now use some sort of early warning system but, at times, staff seem to be unsure of the importance of the MEWS score or what action needs to be taken. The authors agree with the view that introduction of a standard NHS-wide chart would be of benefit to staff and patients.

The study finds a need for improved education in spirituality and spiritual care.

The aims of this study were to explore women's perceptions and experiences of being pregnant and having pre-existing type 1 diabetes mellitus, and to assess their physical, social, psychological, emotional and educational needs during their transition to motherhood.The qualitative design incorporated a purposive sample of seven women in their first pregnancy, who participated in one-to-one interviews with a researcher at 15-20 and 32-36 weeks gestation, and at 6-8 weeks post-partum.Qualitative analysis identified seven key themes from the data including: knowledge; physical and psychological impact; control and trust; catalyst to action; organisation of care and communication; attendance and intervention; expectations and systems.This study has shown that most women with diabetes who become pregnant are resigned to the fact that their pregnancy is considered high risk, and are willing to play their part to achieve a positive pregnancy outcome. However, they would also like to 'do the normal pregnant bit as well', 'normalise it and make it a nice experience' and make it feel 'less fragmented'. This woman-centred experience of pregnancy care, in women with type 1 diabetes mellitus, may motivate health professionals to revise their approach to care, prompt them to utilise the skills of each individual member of the multidisciplinary team to its full strength and potential, and assist in the provision of a positive, balanced and more holistic approach to care, specific to this client group.

As the case study approach gains popularity in nursing research, questions arise with regard to what it exactly is, and where it appears to fit paradigmatically. Is it a method, a design, are such distinctions important? Colin Jones and Christina Lyons review some of the key issues, with specific emphasis on the use of case study within an interpretevist philosophy.

Aim To observe the issues, benefits and challenges of providing dynamic telephone clinical advice to frontline clinicians by advanced paramedics of the North West Ambulance Service NHS Trust. Method In order to focus on the key issues the study used a mixed method approach. A group of 11 advanced paramedics took part in two focus groups which was then followed up with a questionnaire to frontline clinicians. Using focus groups in the research not only allows for the possibility of multiple realities but also for participant validation. Using a qualitative approach allowed theory to develop and emerge which was then codified into themes and the data was then used to develop a questionnaire for frontline clinicians who had received clinical advice in the past in order to provide an element of quantitative data. Findings Five themes emerged from the stud: function, responsibility, barriers, education and support. Conclusion The study finds that clarity is required in relation to responsibilities and clinicians would benefit from a structured model to communicate information over the telephone—we believe the introduction of remote advice has improved patient safety and support to staff and has created opportunity for additional learning.