I read the article[1] by Mehigan and Burnett in the July 2012 issue
of this Journal about training for nurses working in the field of sexual
and reproductive health (SRH) with interest.
This is certainly a challenge faced by many, and one which we are
trying to work on in Solihull at the moment. We have a significant number
of nurses who are shining stars in the world of SRH and are waiting for
funding to atten...
I read the article[1] by Mehigan and Burnett in the July 2012 issue
of this Journal about training for nurses working in the field of sexual
and reproductive health (SRH) with interest.
This is certainly a challenge faced by many, and one which we are
trying to work on in Solihull at the moment. We have a significant number
of nurses who are shining stars in the world of SRH and are waiting for
funding to attend a university-based course that is currently being run in
Coventry. We have an excellent relationship with our commissioner here and
luckily have managed to secure two or three places this year, which is
great news! However, some general practitioners are asking for a payment
to backfill the nurse's post whilst they are out of the practice.
All of our practice nurses have access to SHIP Training
(http://www.ship.bham.nhs.uk/), which provides an excellent foundation of
knowledge at entry level, with the course at Coventry being the next
level.
I agree and support the authors' thinking for nurses to have access
to the Diploma of the Faculty of Sexual and Reproductive Healthcare
(DFSRH) with equal accreditation. This would certainly overcome the need
to invest large amounts of money into a university-based course and would
give nurses an even footing within our field. It also provides an
established and structured programme of learning that has certainly been
tried and tested.
Over the coming months we will be making some decisions around the
type of training offered to our nurses, both within our CASH and GUM
services as well as within primary care. Taking on board the authors'
comments about "wobbly wheels" has really helped to clarify where we'll be
heading with our discussions.
Journal readers will probably gather that training and development
within the field is close to my heart as I am sure it is to Mehigan and
Burnett. Consequently, I would be willing to offer my assistance and
support to the worthy cause of improving training and accreditation for
nurses working within SRH.
Reference
1. Mehigan S, Burnett J. An innovative training for nurses in sexual and
reproductive health. J Fam Plann Reprod Health Care 2012;38:194-195.
We read with great interest the article[1] by Mehigan and Burnett in
the July 2012 issue of this Journal about training for post-graduation
nurses in this particular field of specialism and agree wholeheartedly
with the authors about the deplorable lack of standardised training in the
UK. It is important to equip nurses with knowledge and skills to provide
competency in the delivery of safe and effective methods of contra...
We read with great interest the article[1] by Mehigan and Burnett in
the July 2012 issue of this Journal about training for post-graduation
nurses in this particular field of specialism and agree wholeheartedly
with the authors about the deplorable lack of standardised training in the
UK. It is important to equip nurses with knowledge and skills to provide
competency in the delivery of safe and effective methods of contraception
and the treatment of sexual health problems.
At Oxfordshire Contraception and Sexual Health Service (CASH) we have
piloted our first training programme following the lead from the Reading
model. We have used the e-SRH e-learning theory followed by the Course of
5 (C5) with clinical experience organised in clinical placements with
dedicated mentors and course leader supervision.
A small cohort of nurses completed their training and evaluated the
course positively. We are embarking on another course soon and hope that
we can offer a more substantial validation in acknowledgement of all the
trainees' hard work.
We look forward to an accreditation from the Faculty of Sexual and
Reproductive Health (FSRH) that addresses the disparity in training and
assessment between doctors and nurses. A qualification for nurses similar
to the Diploma of the Faculty of Sexual and Reproductive Healthcare
(DFSRH) would be greatly appreciated.
Reference
1. Mehigan S, Burnett J. An innovative training for nurses in sexual and
reproductive health. J Fam Plann Reprod Health Care 2012;38:194-195.
Well done Berkshire. I completely agree with Mehigan and Burnett[1] - it
is essential that some standardisation is needed in the training of nurses
in SRH across the UK and it is preferable that this should be accredited
by the FSRH.
There is also the valuable point that there is a belief that accreditation
can only be achieved through academic institutes and the RCN! This is
usually at significant cost for the course, time...
Well done Berkshire. I completely agree with Mehigan and Burnett[1] - it
is essential that some standardisation is needed in the training of nurses
in SRH across the UK and it is preferable that this should be accredited
by the FSRH.
There is also the valuable point that there is a belief that accreditation
can only be achieved through academic institutes and the RCN! This is
usually at significant cost for the course, time out of practice and the
cost of replacing that member of staff for the duration of the course;
consequently not cost effective in these times of ever-reducing budgets. The
application for accreditation from the RCN is now very expensive. The
nurses that have had the enthusiasm and dedication to train in fitting implants and IUD/IUS (which increases the flexibility of the SRH service and
improves service user choice) need to have the opportunity to access
accreditation. I would support the notion that all nurses who have undertaken the
SRH course and extended training in these areas should be able to obtain
accreditation from the FSRH and therefore ensure that their skills are
transferable. I would be very happy to offer any assistance and support to
move this forward.
Reference 1. Mehighan S, Burnett J. An innovative training for nurses in sexual and reproductive health. J Fam Plann Reprod Health Care 2012;38:194–195.
(FIGURES AVAILABLE FROM AUTHOR ON REQUEST - UNABLE TO UPLOAD TO THIS SITE)
The two letters describing individuals' different techniques for
implant removal are timely [1,2]. Routine removal with or without refit is
common practice throughout the UK as implants have become widely available
and popular. It is not yet clear whether introduction of Nexplanon will
lead to fewer difficult removals. It is evident from th...
(FIGURES AVAILABLE FROM AUTHOR ON REQUEST - UNABLE TO UPLOAD TO THIS SITE)
The two letters describing individuals' different techniques for
implant removal are timely [1,2]. Routine removal with or without refit is
common practice throughout the UK as implants have become widely available
and popular. It is not yet clear whether introduction of Nexplanon will
lead to fewer difficult removals. It is evident from these letters and
conversations between clinicians that diverse and innovative approaches
have evolved for fit and removal. These letters are therefore relevant as
they highlight the need to recognise key principles when removing (and
fitting) implants: whatever the technique it should be minimally
traumatic/invasive, effective and - importantly - safe for the patient
and safe for the operator. Dr Menon questions the merit of Dr Kandiyil's
splinting technique for routine removal. He points out that blind
introduction of the needle theoretically and unnecessarily could damage
deeper structures. I would be interested to learn, in terms of these
principles, what comparative advantages Dr Kandiyil's method has over the
simple use of local anaesthetic and scalpel for palpable devices.
Removal of impalpable implants presents a different situation and
this same technique, when used with ultrasound guidance, minimises risk to
otherwise unseen structures and focuses the operating field on the precise
location of the implant. It also has the advantage of bringing the implant
superficially towards the skin where it is then often palpable (Figures 1 and 2).
Ultrasound-guided splinting technique therefore provides safety
advantages for the patient. Having used this method for a few years I
have, however, faced the challenge of identifying a technique that is
'safe' for the operator (and for this reason have been reluctant to teach
the method to others). Use of a regular phlebotomy needle puts the
operator at risk of injury. I have considered various needles
(amniocentesis, spinal, etc.) looking for combined properties of slim but
firm, suitable to penetrate arm skin, and long enough that the exposed end
can be safely sheathed while operating. Most recently the flush needle
pictured (Figure 3) has proved one satisfactory solution.
I am keen to learn what other devices clinicians have found safe and
suitable for this use.
Splinting is just one novel practice that has been adopted. The
following are examples of other developments: (1) bandages are no longer applied following implant fitting or removal, (2) fitters no longer anaesthetise along the insertion track and (3) ethyl chloride used as an alternative to lignocaine hydrochloride for fitting (not removal).
Organon convenes implant-fitting workshops but there has been to my
knowledge no formal arrangement for appraisal of practice. I wonder
whether it is time as a specialty for a process of bringing together
experiences and methods, complete with success rates, complications,
advantages/disadvantages and patient feedback with the intention of
improving practice and informing training for the future. I look forward
to hearing Journal readers' views on this.
References
1. Kandiyil VN. Easy method for Implanon removal [Letter]. J Fam Plan Reprod
Health Care 2012;38:207-208.
2. Menon K. Implanon removal technique [Letter]. J Fam Plan Reprod Health Care, published online 13th August 2012.
I read the article[1] by Mehigan and Burnett in the July 2012 issue of this Journal about training for nurses working in the field of sexual and reproductive health (SRH) with interest.
This is certainly a challenge faced by many, and one which we are trying to work on in Solihull at the moment. We have a significant number of nurses who are shining stars in the world of SRH and are waiting for funding to atten...
We read with great interest the article[1] by Mehigan and Burnett in the July 2012 issue of this Journal about training for post-graduation nurses in this particular field of specialism and agree wholeheartedly with the authors about the deplorable lack of standardised training in the UK. It is important to equip nurses with knowledge and skills to provide competency in the delivery of safe and effective methods of contra...
Well done Berkshire. I completely agree with Mehigan and Burnett[1] - it is essential that some standardisation is needed in the training of nurses in SRH across the UK and it is preferable that this should be accredited by the FSRH. There is also the valuable point that there is a belief that accreditation can only be achieved through academic institutes and the RCN! This is usually at significant cost for the course, time...
(FIGURES AVAILABLE FROM AUTHOR ON REQUEST - UNABLE TO UPLOAD TO THIS SITE)
The two letters describing individuals' different techniques for implant removal are timely [1,2]. Routine removal with or without refit is common practice throughout the UK as implants have become widely available and popular. It is not yet clear whether introduction of Nexplanon will lead to fewer difficult removals. It is evident from th...
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