Can one learn to think critically? - a philosophical exploration

Within nursing, critical thinking is a required skill that educators strive to foster in their students' development for use in complex healthcare settings. Hence the numerous studies published measuring critical thinking as a terminal outcome of education. However, an important comparison between different philosophical underpinnings such as person, truth and the nature of nursing, and how one defines and utilizes critical thinking in practice, has been absent from discussions about critical thinking and learning. When one views critical thinking with varying philosophical lenses, important questions are raised and discussion is expanded. These questions illuminate different perspectives of critical thinking and attempt to explore whether critical thinking can be learned in nursing. The implications of taking a single philosophical viewpoint and a pluralistic approach to understanding critical thinking and learning are explored.

In what direction should we go to promote health in mental health care?

There is a growing recognition of the need for health promotion interventions in all health care today. In spite of this, health promotion interventions among patients with mental illnesses have been scarce in research, practice, and policies. There is also an ambiguous interpretation of the definition of health promotion in the literature. The emphasis in this paper is thus to (1) discuss why we should pay attention to the interpretations of the concept of health promotion and (2) present a possible model for what nurses do when they intend to promote health in mental health care. This paper was presented at the Nordic Conference of Mental Health Nursing in Helsinki, Finland in 2010.

A nurse-led telephone session and quality of life after radiotherapy among women with breast cancer: a randomized trial

The purpose of this study was to investigate whether a nurse-led telephone session with patients suffering from breast cancer approximately ten days after final radiotherapy treatment affected their quality of life two to four weeks after radiotherapy. The study was conducted at the Radiotherapy ward at Vejle Hospital, Denmark between January and May 2010. The study population consisted of 100 patients, who were randomized with a 1:1 ratio to have either ordinary supportive conversations (control group), or ordinary supportive conversations and a supplementary nurse-led telephone session (intervention group). The quality of life was assessed using the questionnaires EORTC QLQ-C30 and EORTC QLQ-BR23. For statistical comparison of quality of life and for adjustment for covariates, multiple linear regression analysis was conducted. The mean [95 % CI] quality of life was 72.0 [66.4-77.6] in the control group and 69.9 [64.3-75.2] in the intervention group. Adjustment for covariates did not change the estimates. No statistically significant differences were found in the groups in either of the analyses. The nurse-led telephone session had no positive effect on the quality of life of patients with breast cancer two to four weeks after their final radiotherapy.

Meanings of being received and met by others as experienced by women with MS

In order to elucidate meanings of being received and met by others as experienced by women with multiple sclerosis (MS) we conducted a qualitative inquiry. We interviewed 15 women with MS and analysed the interviews with a phenomenological hermeneutic interpretation. The findings were presented in two themes: experiencing oneself as a valuable person and experiencing oneself as diminished. Meanings of being received and met by others, as experienced by women with MS, can be understood as containing two dimensions where treatment from others can mean recognising oneself through confirmation, as well as being ignored due to missing togetherness with others.

"They can do whatever they want": Meanings of receiving psychiatric care based on a common staff approach

This study deepens our understanding of how patients, when cared for in a psychiatric ward, experience situations that involve being handled according to a common staff approach. Interviews with nine former psychiatric in-patients were analyzed using a phenomenological-hermeneutic method to illuminate the lived experience of receiving care based on a common staff approach. The results revealed several meanings: discovering that you are as subjected to a common staff approach, becoming aware that no one cares, becoming aware that your freedom is restricted, being afflicted, becoming aware that a common staff approach is not applied by all staff, and feeling safe because someone else is responsible. The comprehensive understanding was that the patient's understanding of being cared for according to a common staff approach was to be seen and treated in accordance with others' beliefs and valuations, not in line with the patients' own self-image, while experiencing feelings of affliction.

Systematic review of the management of incontinence and promotion of continence in older people in care homes: descriptive studies with urinary incontinence as primary focus

AIM

This is a review of descriptive studies with incontinence as the primary focus in older people in care homes.

BACKGROUND

Incontinence is prevalent among residents of care home populations.

DATA SOURCES

MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications.

METHODS

A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007-2009. This is a report of descriptive studies. Results. Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes.

CONCLUSIONS

Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted.

Factors contributing to medication errors in Jordan: a nursing perspective

BACKGROUND

Significant efforts have been directed to understand medication errors in recent years. Therefore, this study was conducted to determine the factors contributing to medication errors and related areas for improvement, as perceived by nurses.

METHODS

Two hundred registered nurses were asked to complete a questionnaire which asked them to identify types, stages and issues perceived as contributing factors to medication errors.

RESULTS

Out of 200 delivered questionnaire, a total of 126 of registered nurses responded or completed the questionnaire representing a 63% response rate. The leading types of medication errors were wrong patient (26.2%) and wrong dosage (26.2%). The highest level of medication errors were 48.4%, 31.7% and 11.1% related to nurses, physicians and pharmacists, respectively. In addition, the leading causes of medication errors were due to heavy workload (41.4%) and new staff (20.6%).

CONCLUSIONS

A wide range of factors perceived as contributing factors of medication errors were identified. These results provide valuable information that could be used to improve the medication system in Jordan.

Current status of cardiac surgery allied health professionals in Asia

More and more allied health professions are getting involved in clinical health care. One estimate reported allied health personnel makes up 60 percent of the total health workforce. In Asia, in the field of cardiothoracic surgery, allied health personnel includes perfusionists, physician assistants, physiotherapist, intensivists, rehabilitation therapists, nutritionists and social workers. They work in collaboration with surgeons to provide a range of diagnostic, technical, therapeutic, cardiac care and support services to the patients and their families.Some allied health professions are more specialized. They must adhere to national training and education standards and their professional scope of practice. For example, the training of perfusionists consists of at least five years of academic in medical schools and another three-year-long clinical training in the hospital. The cardiac intensivists usually are medical doctors with a background in cardiology. They spend 3-4 years rotating in Internal Medicine, Anesthesiology, Emergency Rooms and Intensive Care Units. There have specialized medical societies to grant certified credentials and to provide continuing education. Other allied health professions require no special training or credentials and are trained for their work by the hospitals through on-the-job training. Many young health care providers are getting involved in the allied health personnel projects. They consider this as a career ladder because of the opportunities for advancement within specific fields.

Adolescent opiate exposure in the female rat induces subtle alterations in maternal care and transgenerational effects on play behavior

The non-medical use of prescription opiates, such as Vicodin(®) and MSContin(®), has increased dramatically over the past decade. Of particular concern is the rising popularity of these drugs in adolescent female populations. Use during this critical developmental period could have significant long-term consequences for both the female user as well as potential effects on her future offspring. To address this issue, we have begun modeling adolescent opiate exposure in female rats and have observed significant transgenerational effects despite the fact that all drugs are withdrawn several weeks prior to pregnancy. The purpose of the current set of studies was to determine whether adolescent morphine exposure modifies postpartum care. In addition, we also examined juvenile play behavior in both male and female offspring. The choice of the social play paradigm was based on previous findings demonstrating effects of both postpartum care and opioid activity on play behavior. The findings revealed subtle modifications in the maternal behavior of adolescent morphine-exposed females, primarily related to the amount of time females' spend nursing and in non-nursing contact with their young. In addition, male offspring of adolescent morphine-exposed mothers (MOR-F1) demonstrate decreased rough and tumble play behaviors, with no significant differences in general social behaviors (i.e., social grooming and social exploration). Moreover, there was a tendency toward increased rough and tumble play in MOR-F1 females, demonstrating the sex-specific nature of these effects. Given the importance of the postpartum environment on neurodevelopment, it is possible that modifications in maternal-offspring interactions, related to a history of adolescent opiate exposure, plays a role in the observed transgenerational effects. Overall, these studies indicate that the long-term consequences of adolescent opiate exposure can impact both the female and her future offspring.

Variations in Maternal Behavior in C57BL/6J Mice: Behavioral Comparisons between Adult Offspring of High and Low Pup-Licking Mothers

The amount of maternal licking received by newborn rats affects their adult stress reactivity and maternal behavior. Mouse studies in which litters were cross-fostered between strains that exhibit high vs. low amounts of maternal behavior also suggest that rearing conditions affect adult outcomes. The current study is the first to compare within a single mouse strain (C57BL/6J) behavioral responses between adult animals reared by mothers that exhibited frequencies of pup-licking (PL) at the high end and the low end of the normal distribution within the strain. Maternal behaviors were coded during 10-s intervals every 3 min during five 1-h periods (two light, three dark cycle) on postpartum days 2, 4, 6, and 8 in 36 unrelated C57BL/6J mothers. The distribution of mean frequencies/h for PL, still crouched nursing, hovering over pups, self-grooming, and no contact with pups were determined. Offspring (6-12 weeks of age) from the eight mothers who exhibited the highest mean frequencies of PL and the seven mothers who exhibited the lowest PL frequencies underwent the following tests over three consecutive weeks: (1) elevated plus-maze (EPM) and 1-h open field on three successive days, (2) 3-h open field with an acute stressor (IP saline injection) at the 1-h time point, and (3) acoustic startle and prepulse inhibition. Females reared by low PL mothers exhibited significantly more time in the closed arms of the EPM, less locomotion, center time, and rearing during the first test in the open field, greater reactivity to an acute stressor, and reduced prepulse inhibition, an index of sensorimotor gating. Male offspring from low PL dams had reduced reactivity to an acute stressor, but no other altered performance in the behavioral tests. PL frequencies of C57BL/6J mothers appear to selectively alter behavior outcomes, primarily in female offspring.

The effect of unions on the distribution of wages of hospital-employed registered nurses in the United States

AIMS AND OBJECTIVES

We estimate the impact of unionisation on the wage structure of hospital-employed registered nurses in the USA. We examine whether unions have an effect on wage differences associated with race, gender, immigration status, education and experience, as well as whether there is less unexplained wage variation among unionised nurses.

BACKGROUND

In the past decade, there has been resurgence in union activity in the health care industry in the USA, particularly in hospitals. Numerous studies have found that unions are associated with higher wages. Unions may also affect the structure of wages paid to workers, by compressing the wage structure and reducing unexplained variation in wages.

DESIGN

Cross-sectional analysis of pooled secondary data from the United States Current Population Survey, 2003-2006.

METHOD

Multivariate regression analysis of factors that predict wages, with models derived from labour economics.

RESULTS

There are no wage differences associated with gender, race or immigration status among unionised nurses, but there are wage penalties for black and immigrant nurses in the non-union sector. For the most part, the pay structures of the union and non-union sectors do not significantly differ. The wage penalty associated with diploma education for non-union nurses disappears among unionised nurses. Unionised nurses receive a lower return to experience, although the difference is not statistically significant. There is no evidence that unexplained variation in wages is lower among unionised nurses.

CONCLUSIONS

While in theory unions may rationalise wage-setting and reduce wage dispersion, we found no evidence to support this hypothesis.

RELEVANCE TO CLINICAL PRACTICE

The primary effect of hospital unions is to raise wages. Unionisation does not appear to have other important wage effects among hospital-employed nurses.

Nursing bedside education and care management time during inpatient spinal cord injury rehabilitation

BACKGROUND

Nurses are an integral part of the spinal cord injury (SCI) rehabilitation team and provide significant education to the patient and family about the intricacies of living with SCI, as well as help manage the care process.

OBJECTIVE

This is the second in a series of reports by clinical nursing leaders involved in the SCIRehab research project, a multi-center, 5-year study to record and analyze details of SCI inpatient rehabilitation, with focus on descriptions of time spent by nurses on bedside education and care management.

METHODS

Six hundred patients with traumatic SCI were enrolled at six rehabilitation centers. Nurses providing usual care to patients with SCI documented the content and amount of time spent on each bedside interaction using portable electronic devices with customized software or a newly developed customized page in electronic documentation systems; this included details of education or care management. Patient and injury characteristics, including level and nature of injury, were taken from the medical record.

RESULTS

Nursing data for this report were derived from 42 048 shifts of nursing care. The mean total of nursing education and care management per patient was 30.6 hours (range 1.2-126.1, standard deviation (SD) 20.7, median 25.5). The mean number of minutes per week was 264.3 (range 33.2-1253, SD 140.9, median 241.9). The time that nurses spent on each activity was significantly different in each neurological injury group. Fifty percent of care management time was devoted to psychosocial support, while medication, skin care, bladder, bowel, and pain management were the main education topics.

CONCLUSIONS

Nurses in SCI rehabilitation spend a significant amount of time providing education and psychosocial support to patients and their families. Typically, this is not included in traditional documentation systems. Quantification of these interventions will allow researchers to discern whether there are pertinent associations between the time spent on bedside activities and patient outcomes. The data will also be relevant for patient care planning and acuity staffing.

Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme

AIM

This paper is a report of the effectiveness of a structured multifaceted mentorship programme designed to implement evidence-based practice in a clinical research intensive environment.

BACKGROUND

Barriers to implementing evidence-based practice are well-documented in the literature. Evidence-based practice is associated with higher quality care and better patient outcomes than care that is steeped in tradition. However, the integration of evidence-based practice implementation into daily clinical practice remains inconsistent, and the chasm between research and bedside practice remains substantial.

METHODS

This quasi-experimental mixed methods study included three focused discussions with nursing leadership and shared governance staff as well as pre- (N = 159) and post-intervention (N = 99) questionnaires administered between June 2006 and February 2007. Online questionnaires included measures of organizational readiness, evidence-based practice beliefs, evidence-based practice implementation, job satisfaction, group cohesion and intent to leave nursing and the current job. Results.  Participants in the evidence-based practice mentorship programme had a larger increase in perceived organizational culture and readiness for evidence-based practice and in evidence-based practice belief scores than those who did not participate. Qualitative findings suggested that leadership support of a culture for evidence-based practice and the dedication of resources for sustainability of the initiative needed to be a priority for engaging staff at all levels.

CONCLUSION

These findings corroborate other studies showing that nurses' beliefs about evidence-based practice are significantly correlated with evidence-based practice implementation and that having a mentor leads to stronger beliefs and greater implementation by nurses as well as greater group cohesion, which is a potent predictor of nursing turnover rates.

Assessing the effect of two praying methods on the life quality of patients suffering from cancer hospitalized at Seyedo Shohada medical center of Isfahan University of Medical Sciences

BACKGROUND

Life quality and its promotional strategies among patients with acute and debilitating diseases, especially cancer, have been considered from a long time ago by medical and nursing societies. One of the methods to promote the patient's life quality is spiritual care which can be in form of prayer. The results of the studies done about the choice of the best praying method for the patients involves a lot of challenges. Thus, the researchers decided to examine the effect of two individual and choral praying methods on the life quality of the cancer-stricken patients.

METHODS

The present study was conducted in two-staged clinical trial using pre-post test administration in which the researcher examined the effect of two individual and choral praying methods on the life quality of 70 cancer-stricken patients. Data collection to assess the life quality was performed by World Health Organization Brief Life Quality Questionnaire.

RESULTS

The current research showed that the life quality score was increased in the individual-choral group after the intervention. Also, comparing the average life quality score in the two groups of individual and choral praying revealed a significant difference in which the quality of life had improved more in the choral praying group than in the individual praying group.

CONCLUSIONS

The findings of the present study indicated the positive effect of praying and supplication on the life quality of cancer-stricken patients. Generally, choral praying has a better effect on the life quality of cancer-stricken patients compared with praying individually. More studies with a larger sample size are suggested in order to verify the effect of praying on the life quality of cancer-stricken patients.

Ginger compress therapy for adults with osteoarthritis

AIM

This paper is a report of a study to explicate the phenomenon of ginger compresses for people with osteoarthritis.

BACKGROUND

Osteoarthritis is claimed to be the leading cause of musculoskeletal pain and disability in Western society. Management ideally combines non-pharmacological strategies, including complementary therapies and pain-relieving medication. Ginger has been applied externally for over a thousand years in China to manage arthritis symptoms.

METHOD

Husserlian phenomenological methodology was used and the data were collected in 2007. Ten purposively selected adults who had suffered osteoarthritis for at least a year kept daily diaries and made drawings, and follow-up interviews and telephone conversations were conducted.

FINDINGS

Seven themes were identified in the data: (1) Meditative-like stillness and relaxation of thoughts; (2) Constant penetrating warmth throughout the body; (3) Positive change in outlook; (4) Increased energy and interest in the world; (5) Deeply relaxed state that progressed to a gradual shift in pain and increased interest in others; (6) Increased suppleness within the body and (7) More comfortable, flexible joint mobility. The essential experience of ginger compresses exposed the unique qualities of heat, stimulation, anti-inflammation and analgesia.

CONCLUSION

Nurses could consider this therapy as part of a holistic treatment for people with osteoarthritis symptoms. Controlled research is needed with larger numbers of older people to explore further the effects of the ginger compress therapy.

Hospital nurse staffing and public health emergency preparedness: implications for policy

Hospital restructuring policies and an impending nursing workforce shortage have threatened the nation's emergency preparedness. Current emergency response plans rely on sources of nurses that are limited and overestimated. A national investment in nursing education and workforce infrastructure, as well as incentives for hospitals to efficiently maximize nurse staffing, are needed to ensure emergency preparedness in the United States. This review highlights the challenges of maintaining hospital nursing surge capacity and policy implications of a nursing shortage.

Regulation and mindful resident care in nursing homes

Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple-case study including field notes, interviews, and documents collected in eight nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities.

Pediatric nurses' cognitive representations of children's pain

The aim of this mixed methods exploratory study was to describe pediatric nurses' cognitive representations (CRs) of the assessment and management of children's pain and to determine the relationships between their CRs and their choices about pain assessment and morphine administration. We recruited a convenience sample of 87 nurses caring for hospitalized children at 4 institutions. We measured the CRs with the Conceptual Content Cognitive Map (3CM) technique and pain assessment and morphine administration with smiling and grimacing child vignettes. We used content analyses for the 3CM data and fit logistic regression models to predict participants' analgesic choice for each vignette. Nearly all (91%) participants identified the child's behavior as an assessment approach; 48% indicated it as most important. Participants (92%) identified pharmacologic as a management approach; 47% indicated it as most important. Participants' CRs did not predict assessment or morphine administration choices. Significantly more participants chose the appropriate analgesic response for the grimacing child than they did for the smiling child. Nurses with more years of pediatric experience were less likely to select administration of the appropriate morphine dose. The 3CM method provided insights into nurses' thinking about pain that are indicative of gaps, which may be amenable to interventions.

PERSPECTIVE

Findings are from an innovative, unique measure of nurses' knowledge and beliefs about the complex phenomenon of children's pain management. Extensive details about the thought processes of pediatric nurses regarding pain assessment and management surfaced through this analysis, which provide excellent information for direction of future research and practice innovations.

Dealing with grief related to loss by death and chronic pain: suggestions for practice. Part 2

OBJECTIVE

This paper, the second of two, represents a theoretical framework for interventions related to loss by death of someone close, or chronic pain. This work is based on our previous understanding where grief is considered an integrated experience which involves movements on several continua.

METHODS

We have performed a comparison between two interventions dealing with grief and chronic pain using different designs. Interrelated experiences and processes were identified.

RESULTS

Life phenomena like grief and loss caused by death and chronic pain, seem to have many qualities in common and may overlap each other. A common core containing emptiness, vulnerability and exhaustion is identified.

DISCUSSION

Despite advances in research and thinking in recent years, several issues related to grief caused by death or chronic pain remain a challenge in clinical settings and research. When preparing interventions, we must pay attention to the relearning process, the common core and the interplay between these bodily expressions.

CONCLUSION

We believe there is a value in future research and practice to consider losses caused by death and chronic pain, together as well as separately. Our comprehensive approach indicates that understanding the processes involved in one sort of grief may help understand the processes involved in the other.

Perception of violence against women among future health professionals in an Industrial Township

BACKGROUND

There is a growing concern that medical education does not prepare the future health professional to effectively deal with violence against women. Against this background, the present study was undertaken.

AIMS

To elicit perception of violence against women among medical and nursing students, and study the association of these perceptions with certain demographic and social variables.

SETTINGS AND DESIGN

The study was conducted among students of a Medical College and a Nursing College both located at Pune, India. A cross-sectional descriptive study design was used to elicit the perceptions of the study subjects toward violence against women.

MATERIALS AND METHODS

A random sample of 125 medical and 125 nursing students was selected. Both quantitative and qualitative methods of data collection were employed. Qualitative data collection was done by focus group discussions with key persons such as dean and faculty of medical and nursing colleges. The syllabi of medical and nursing colleges were also reviewed for any topic related to domestic violence.

STATISTICAL ANALYSIS

The WHO/CDC Statistical and Epidemiology Software Package was used for data entry and statistical analysis. Various associations were explored by nonparametric tests (Mann-Whitney) for ordinal data and by Chi-square and ODDS ratio (with 95% confidence intervals), for categorical data.

RESULTS

Overall 35.6% (95% CI 29.1%-42.6%) of the study participants had witnessed/were aware of violence against women among their family/acquaintances. This awareness was significantly more among female respondents (OR=2.65, 95% CI 1.37-5.16), Chi Sq=9.81, df=1, P=0.001. Other socioeconomic variables such as urban/rural background, education, and income were not associated with perception about family violence. Majority (>80%) agreed/strongly agreed that social agencies should do more to help battered women. Course content on violence against women was lacking in both medical and nursing syllabi.

CONCLUSIONS

Female participants were generally more perceptive about the issue. Medical and nursing syllabi should incorporate strategies for dealing with violence against women.

Part 5: parent-adolescent and teen parent-child relationships

PURPOSE

The purpose of this paper is to examine nursing's contribution to understanding the parent-adolescent and the teen parent-child relationships.

CONCLUSION

Relationships between parents and adolescents may reflect turmoil and affect adolescents' health and development. The social and developmental contexts for teen parenting are powerful and may need strengthening. Several interventions to help teen mothers interact sensitively with their infants have been developed and tested.

PRACTICE IMPLICATIONS

Nurse researchers have begun to provide evidence for practitioners to use in caring for families of adolescents and teen parents to acquire interaction skills that, in turn, may promote optimal health and development of the child.

An intervention to improve nurse-physician communication in depression care

OBJECTIVES

Depression in older adult home care recipients is frequently undetected and inadequately treated. Failed communication between home healthcare personnel and the patient's physician has been identified as a barrier for depression care. The purpose of this pilot intervention study was to improve nurse competency for communicating depression-related information to the physician.

DESIGN

A single group pre-post experimental design.

SETTING

Two Medicare-certified home healthcare agencies serving an urban and suburban area in New York.

PARTICIPANTS

Twenty-eight home care nurses, all female Registered Nurses.

INTERVENTION

Two-hour skills training workshop.

MEASUREMENTS

To evaluate the intervention, pre-post changes in effective nurse communication using Objective Structured Clinical Examinations and nurse survey reports.

RESULTS

The intervention significantly improved the ability of the home care nurse to perform a case presentation in a complete and standard organized format pre versus postintervention. The intervention also increased nurse-reported certainty to communicate depression-related information to the physician.

CONCLUSIONS

Our findings provide support for the ability of a brief, depression-focused communication skills training intervention to improve home care nurse competency for effectively communicating depression-related information to the physician.

Visualism and technification-the patient behind the screen

At stake in this study is the patient's credibility. The Cartesian philosophical standpoint, which holds sway in western thinking, questions with scepticism whether the reported symptoms are "real." Do they reside in the body, or are they mentally concocted. However, from the caring perspective any symptom must be both listened and attended to in its own right, not just scrutinized as evidence for an accurate diagnosis.In cognitively and emotionally complex high-tech units caregivers are juggling a precarious handful of cards. Technical tasks take precedence or have more urgency than caring behaviour. Assuming an irremediable tension between object-subject and care-cure in nursing is futile dualism. By addressing the essence of technology-the non-neutral and highly visual technology-this paper aims to find, from a philosophical point of view, a more comprehensive understanding for the dominance visualism and technification within intensive care.Screens give us access to vital signs. Screens record numbers and lines that relate to a graph and afford superfine spiked "readings." However, the most relevant vital signs may be missing.

Part 4: parent-child relationships at risk

PURPOSE

The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-child's chronic condition or occurrence within a risky context.

CONCLUSIONS

Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified.

PRACTICE IMPLICATIONS

Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

A concept analysis: assuming responsibility for self-care among adolescents with type 1 diabetes

PURPOSE

This concept analysis clarifies "assuming responsibility for self-care" by adolescents with type 1 diabetes.

METHODS

Walker and Avant's (2005) methodology guided the analysis.

RESULTS

Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making.

PRACTICE IMPLICATIONS

Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.

Recent developments in public health nursing in the Americas

This study presents an assessment of the participation and training of nurses in public health areas in the Americas. Information was gathered through a literature review and interviews with key informants from Mexico, Colombia, and Paraguay. Results demonstrate that there is significant variation in definitions of public health nursing across the region and current systematized data about the workforce profile of public health nursing personnel is not available for many countries in the Americas. There are significant regional differences in the levels and types of training of nurses working in public health areas and an increasing number of nurses are pursuing training in public health at the master's and doctoral levels. Many nurses carry out some or all of the essential functions of public health, but are not considered to be public health nurses. Generally, auxiliary and technical nurses have a broader presence in public health areas than professional nurses. In the future, regional health systems reforms should support increased recruitment and training of public health nurses, as well as stronger roles in public health research and health care at the individual, community, and population levels.

Nursing Roles within a Stroke Telemedicine Network

Time sensitive acute stroke treatments and the growing shortage of vascular neurologists compound to create a gap in the delivery of care to meet the American Stroke Association guidelines in underserviced regions. Audio/video consultation (telemedicine), which has been evolving since the late 1990's, is a putative solution. While telemedicine can serve as a valuable facilitative tool, the telestroke consultation is only one piece of a complex collaboration between hub and spoke environments and clinical personnel. The growing use of telemedicine in stroke offers more opportunities for all nurses to participate in the continuum of cerebrovascular disease care. A review of this collaboration will include but will not be limited to: algorithms of the acute stroke evaluation, hub and spoke staff meetings, stroke education for spoke staff, and patient follow-up post acute treatment. Our team's telemedicine experience, utilizing research, education, and clinical practice, will be described.

Training nursing staff to recognize depression in home healthcare

OBJECTIVES

To describe the implementation and acceptability of the TRaining In the Assessment of Depression (TRIAD) intervention, which has been tested in a randomized trial. The primary aim of TRIAD is to improve the ability of homecare nurses to detect depression in medically ill, older adult homecare patients.

DESIGN

Description of the important components of TRIAD, its implementation, and evaluation results from nurse surveys.

SETTING

Three certified home healthcare agencies in Westchester County, New York.

PARTICIPANTS

Thirty-six homecare nurses.

INTERVENTION

Participants randomly assigned to TRIAD (n=17) were provided with the opportunity to observe and practice patient interviewing. The approach focused on clinically meaningful identification of the two "gateway" symptoms of depression and is consistent with the newly revised Medicare mandatory Outcome and Assessment Information Set (OASIS-C). Control group participants (n=19) received no training beyond that which agencies may have provided routinely.

MEASUREMENTS

Baseline and 1-year nurse confidence in depression detection, and postintervention acceptability ratings of the TRIAD intervention.

RESULTS

Participants randomized to the TRIAD intervention reported a statistically significant increase in confidence in assessing for depression mood (P<.001), whereas the usual care group's confidence remained unchanged (P=.34) 1 year later.

CONCLUSION

An educational program designed to improve depression detection by giving nurses the skills and confidence to integrate depression assessment into the context of routine care can be successfully implemented with homecare agency support. The authors discuss the intervention in terms of OASIS-C and the "real world" realities of intervention implementation.

Motivational Interviewing (MI) to Change Type 2DM Self Care Behaviors: A Nursing Intervention

AIMS

This paper evaluates a novel nursing intervention designed to improve physical and psychological outcomes for adult patients with Type 2 DM.

BACKGROUND

Self care behaviors are an important component of diabetes treatment, yet for many reasons, patients do not adhere to suggested plans. Motivational Interviewing (MI) is a patient centered strategy that helps overcome ambivalence to change. Nurses, who frequently educate patients with diabetes about self care, can use MI as a way to improve health behaviors.

METHODS

As a component of a large RCT, focus groups were used to evaluate the impact of an MI nursing intervention. Nineteen patients (8% of treatment group) participated in four different groups. IPA was used to explore patient response to the intervention.

RESULTS/FINDINGS

Patients were able to reflect on and identify responses to sessions with the study nurses that differed from "typical" health care provider visits. Many of their descriptions captured the essence of MI practice.

CONCLUSION

MI is a viable and useful technique for nurses to use in educating and caring for persons with Type 2 DM.

Knowledge, attitudes and perceptions of nurses and nursing students towards HIV/AIDS

OBJECTIVE

To describe attitudes, knowledge and perceptions of nurses and nursing students towards the people who live with HIV/AIDS (PLWHA).

METHODOLOGY

Bibliographic study in which six electronic databases were searched using the key words: "attitude", "knowledge", "nursing", perceptions", "HIV/AIDS". Publications between 1998 and 2007 were considered.

RESULTS

560 articles limited by scientific researches or ministerial reports membership were retrieved. Finally a total of 38 publications were selected, the analysis showed that the level of knowledge of nurses and nursing students about PLWHA is good and the attitudes towards HIV/AIDS have improved over time. Nurses and nursing students have been able to identify both positive and negative aspects in the PLWHA care personally and professionally because there is a more favourable perception.

CONCLUSION

There are few studies in Latin America and Chile that study the attitudes and knowledge of the studied population towards PLWHA. According to publications found the knowledge and attitudes have improved because the perception is more favourable.

Ambiguity in knowledge transfer: The role of theory-practice gap

BACKGROUND

In spite of much literature written about the theory-practice gap in the international nursing journals, there is evidence that indicates this subject has not been probed comprehensively since nursing education was transferred to universities in Iran. In the recent years, the public and the government have criticized Iranian nurses because of poor quality of patient care. Although this subject has been lamented by some researchers, there is no comprehensive work on how this gap resulted. In the process of a larger study on "nursing knowledge translation to practice", of one PhD thesis, this process was explored.

METHODS

Using grounded theory analysis, indepth interviews were undertaken with a purposive sample of 29 nurses, with different levels of experience, from the school of nursing in Tehran University of Medical Sciences in 2006 from January to August. Data were analyzed using the constant comparative method.

RESULTS

Three main themes emerging from this study included clinical behavior structure, paradoxical knowledge and practice, and divergent nursing organization.

CONCLUSIONS

It seems that nursing education with some praxis and paradoxes in the realm of nursing knowledge and practice, along with divergent organizational structure have decreased nurses' ability in applying their professional knowledge and skills in order to bridge the gap between theory and practice. Moreover, in spite of increased academic input into nursing education, clinical behaviors of both education and practice settings was perceived as "traditional routine-based".

Part 3: Interaction and the parent-child relationship--assessment and intervention studies

PURPOSE

This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play).

CONCLUSIONS

Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies.

PRACTICE IMPLICATIONS

Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

A comparison of usability evaluation methods: heuristic evaluation versus end-user think-aloud protocol - an example from a web-based communication tool for nurse scheduling

We evaluated a web-based communication tool for nurse scheduling using two common usability evaluation methods, heuristic evaluation and end-user think aloud protocol. We found that heuristic evaluation performed by human-computer interaction (HCI) experts revealed more general interface design problems, while end-users' think-aloud protocols identified more obstacles to task performance. To provide the most effective and thorough evaluation results, a combination of heuristic evaluation and end-user think-aloud protocol is recommended.

Public health and nursing: a natural partnership

The health of individuals occurs within the context of their environment and the other individuals they interact with in the communities they live in, work in and visit. Promoting the health of the public requires multiple strategies aimed at improving the environment, the health knowledge of groups and individuals, maintaining adequate food and water, and reducing the spread of disease. Many disciplines are needed to meet these goals, but the largest segment of the professional health work force required to meet these needs is nursing. Historically, nursing leaders in public health such as Florence Nightingale and Lillian Wald made significant inroads related to serious health issues because they were nurses. Today across the globe, nurses provide the key components of public health interventions including well baby care, health education, screening and immunization clinics, disaster management and emergency preparedness. With the growing nursing shortage in acute care settings, the brain drain of nurses from certain areas of the world, the shrinking public dollars for preventive health care, the nursing workforce needed to continue to provide these essential health care services is threatened. It is essential to put the spot light on nursing's role in public health with the hopes of attracting more public funds and more nurses to provide these essential services.

Part 1: Introduction

PURPOSE

Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified.

CONCLUSIONS

A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship.

IMPLICATIONS

Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.

Part 2: Grasping the early parenting experience--the insider view

PURPOSE

The purpose of this integrative review is to systematically and critically synthesize nursing scholarship on parents' perspectives of the parent-child relationship during infancy.

CONCLUSION

Research has shown that the process of establishing the parent-child relationship is highly individualized and complex. Numerous barriers and facilitators influencing this relationship have been identified that are relevant to nursing.

PRACTICE IMPLICATIONS

Nurses have an important opportunity to positively affect the developing parent-infant relationship. Screening parents for depression and providing parents with resources and support are key nursing interventions supporting the parent-infant relationship.

Struggle with a gap between intensive care units and general wards

Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process-the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' "struggling with a gap." The "gap" was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved.

Important issues to quality of life among norwegian older adults: an exploratory study

The increasing numbers of older people and higher expectations of a “good life” within societies, has lead to international interest in the enhancement of quality of life (QoL) among older adults. Understanding whether the same aspects of life are equally important to the life quality of subgroups of older people is important in helping health professionals plan social and health care policy and caring strategies. The purpose of this study was to describe the importance given to 38 areas of QoL among Norwegian older adults and to identify differences in importance ratings by age, gender, marital and health status. This exploratory study was conducted with 379 older adults (mean age 73.3 years, SD 6.9) consisting of two cohorts. The first cohort (n = 287) comprised of non-hospitalized participants, were recruited from two national senior organizations, two political senior organizations and a voluntary organization in Eastern Norway. Participants responded to a postal survey. The second cohort (n = 92) comprised of hospitalized and ambulatory patients, were recruited from three medical wards and one outpatient clinic at a county hospital in Eastern Norway. Data was collected by personal interviews and interview assisted. All importance ratings were found to reflect substantial areas of importance. Highest mean importance was assigned to activities of daily living, mobility, sensory abilities, health and home environment. Least important was sex life, adequate social help, chance to learn new skills, body image and appearance and free of dependence on medications and treatment. There were a number of significant mean group differences by age, gender, marital and health status. Sixteen of the items detected significant between- group differences. Future application of the importance questions could facilitate understanding and recognition of important issues in subgroups of older adults.

Chronic disease management in Sub-Saharan Africa: whose business is it?

Public health specialists and clinicians alike agree that Humanity faces a global pandemic of chronic diseases in the 21^st century. In this article we discuss the implications of this pandemic on another global issue, the health workforce. Because both issues are particularly acute in Sub-Saharan Africa (SSA), we will focus on this region and use Cameroon as a case in point. We first gauge the epidemic of chronic conditions in SSA. We then discuss the implications of chronic conditions for the reshaping of health systems and the health workforce. We conclude by making a strong case for the building up and strengthening the health workforce, insisting on the crucial role of nurses, their training, and involvement in chronic disease management.

Effect of GI endoscopy nurse experience on screening colonoscopy outcomes

BACKGROUND

The effect of the GI endoscopy nurse experience on colonoscopy outcomes is unknown.

OBJECTIVE

To determine whether the nurse experience was associated with screening colonoscopy complications, procedure length, and cecal intubation.

DESIGN

A retrospective analysis of screening colonoscopies performed by attending physicians between August 2003 and August 2005. Nurse experience was measured in weeks.

SETTING

University of North Carolina Hospitals.

SUBJECTS

Twenty-nine nurses were employed during the study period, 19 of whom were newly hired. A total of 3631 eligible screening colonoscopies were analyzed.

MAIN OUTCOME MEASUREMENTS

The primary outcome was any immediate complication; secondary outcomes included time to cecum, total procedure time, and cecal intubation rate.

RESULTS

In procedures staffed by nurses with 2 weeks of experience or less, 3.2% had complications compared with 0.3% for procedures with more experienced nurses (odds ratio [OR] 10.4 [95% CI, 3.55-30.2]). For nurses with 6 months or less of experience, 18% of procedures had cecal-intubation times more than 1 standard deviation above the mean compared with 12% for more experienced nurses (OR 1.60 [95% CI, 1.30-1.97]). Similar results were seen for the total procedure duration (OR 1.61 [95% CI, 1.32-1.97]) and cecal-intubation rates (OR 1.81 [95% CI, 1.37-2.39]). All relationships held after adjusting for potential confounding factors.

LIMITATIONS

A retrospective, single-center study.

CONCLUSIONS

GI endoscopy nurse inexperience is associated with an increase in immediate complications, prolonged procedure times, and decreased cecal-intubation rates for screening colonoscopies. These findings have implications for nurse training, procedure efficiency, colonoscopy quality assessment, and patient safety.

Clinical taxonomy development and application in spinal cord injury research: the SCIRehab Project

BACKGROUND/OBJECTIVE

Applying practice-based evidence research methodology to spinal cord injury (SCI) rehabilitation requires taxonomy (typology or classification) of rehabilitation interventions provided by every discipline contributing to SCI rehabilitation. The rehabilitation field currently lacks such taxonomy.

METHODS

SCIRehab project researchers and clinicians representing 7 rehabilitation disciplines from 6 US inpatient SCI rehabilitation facilities worked in discipline groups during 2 face-to-face meetings and weekly discipline-specific teleconferences for 9 months to identify key contributions of each discipline to SCI rehabilitation and to develop a classification of treatment interventions used by each discipline. These clinician groups were charged with designing documentation systems that collected enough details to describe treatment adequately while not imposing an unrealistic data collection burden on clinicians. Completed documentation systems were programmed onto handheld personal digital assistants (PDAs) to facilitate data entry by clinicians at the point of care.

RESULTS

Seven discipline-specific SCI rehabilitation taxonomies were developed that describe and quantify intervention activities (major categories of treatment offered by the discipline) and the activity-specific details (variables deemed important to fully describe the interventional process). Much treatment information is unique to each discipline; some is common across disciplines.

CONCLUSIONS

The taxonomies provide a format with which clinicians document actual interventions performed with or for patients. The SCIRehab project has developed the first comprehensive multidisciplinary taxonomy for describing the details of the SCI rehabilitation process and designed a PDA-based documentation system based on that taxonomy that allows clinicians to describe the specifics of their interactions with their patients.

SCIRehab Project series: the supplemental nursing taxonomy

CONTEXT

Spinal cord injury (SCI) rehabilitation nurses document the occurrence of educational and care management efforts in traditional nursing documentation methods but not the intensity (or dose) of such interactions. This article describes a process to capture these nursing interventions.

METHODS

Nurses at 6 US inpatient SCI centers used 2 in-person meetings and weekly telephone calls over 9 months to develop a taxonomy of nursing patient education efforts and care management.

RESULTS

This was subsequently incorporated into a point-of-care documentation system and used to capture details of nursing care for 1,500 SCI rehabilitation patients enrolled in the SCIRehab study. The taxonomy consists of 10 education and 3 care management categories. The point-of-care system includes time spent on each category along with an indication of whether the patient and/or family received the education/care management. In addition, a subjective measure of patient participation in nursing activities is included.

CONCLUSIONS

Creation of a SCI rehabilitation nursing taxonomy is feasible, and its use has had an impact on nursing practice. It also has implications for future clinical documentation, because greater accuracy and details of patient education and care management will be a permanent practice in the participating systems at the conclusion of the study.

Children's Environmental Health Faculty Champions Initiative: a successful model for integrating environmental health into pediatric health care

BACKGROUND

Pediatric medical and nursing education lack the environmental health content needed to properly prepare health care professionals to prevent, recognize, manage, and treat environmental exposure-related diseases. The need for improvements in health care professionals' environmental health knowledge has been expressed by leading institutions. However, few studies have evaluated the effectiveness of programs that incorporate pediatric environmental health (PEH) into curricula and practice.

OBJECTIVE

We evaluated the effectiveness of the National Environmental Education Foundation's (NEEF) Children's Environmental Health Faculty Champions Initiative, which is designed to build environmental health capacity among pediatric health care professionals.

METHODS

Twenty-eight pediatric health care professionals participated in a train-the-trainer workshop, in which they were educated to train other health care professionals in PEH and integrate identified PEH competencies into medical and nursing practice and curricula. We evaluated the program using a workshop evaluation tool, action plan, pre- and posttests, baseline and progress assessments, and telephone interviews.

RESULTS

During the 12 months following the workshop, the faculty champions' average pretest score of 52% was significantly elevated (p < 0.0001) to 65.5% on the first posttest and to 71.5% on the second posttest, showing an increase and retention of environmental health knowledge. Faculty champions trained 1,559 health care professionals in PEH, exceeding the goal of 280 health care professionals trained. Ninety percent of faculty champions reported that PEH had been integrated into the curricula at their institution.

CONCLUSION

The initiative was highly effective in achieving its goal of building environmental health capacity among health care professionals. The faculty champions model is a successful method and can be replicated in other arenas.

[Not Available]

Introduction:

E-Learning methods such as webcasting are being used increasingly in healthcare education, including that of nurses and midwives. Webcasting means live synchronous broadcasting over the internet, where students participate simultaneously in text ‘chat room’ interactive discussions when logged on to a webpage where they can see and hear a presentation such as a PowerPoint lecture, a list of other participants, and access ‘chat rooms’.

Aims:

This paper reports student participation and satisfaction with the use of webcasting in a third year undergraduate nursing and midwifery research methods module in one higher education institution faculty of health and social work in the southwest of England, with students from distributed geographical locations.

Materials and Methods:

Students chose either webcasts or face-to-face lectures. Following each of the four webcasts, a web-based evaluation questionnaire was administered in a cross-sectional survey design.

Results:

Two thirds of students took part in webcasts and found them to be an acceptable teaching and learning strategy. Travel and cost savings were noted through not travelling to the main university campus, and these were statistically significantly correlated with students’ perception of gaining from the module and their overall satisfaction with webcasting. Across the four webcasts 5446 purposeful messages were posted indicating engagement with the material under study.

Conclusions and Recommendations:

Webcasting is an effective teaching and learning strategy which is popular with students, allows remote access to teaching and learning, and offers time and cost savings to students. Further research is required to investigate the educational potential of this new technology.

Use of recommended osteoarthritis pain treatment by older adults

AIM

This paper reports on a study conducted to describe what traditional and non-traditional treatments older adults with osteoarthritis use for pain management, their reported pain relief, and factors associated with use of recommended initial gold standard treatment (acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs, and exercise and/or physical therapy) as designated by conventional western medicine.

BACKGROUND

Osteoarthritis is characterized by joint pain, stiffness and limited range of motion and has been designated an international health burden by the World Health Organization. Demographic and cultural factors have been shown to affect both traditional and non-traditional osteoarthritis treatment decisions.

METHOD

A descriptive correlational design was used, with secondary analysis of data collected between July 2006 and July 2007 in two randomized controlled studies using the Brief Pain Inventory Short Form and testing older adults' pain communication.

RESULTS

The frequency of use of gold standard treatment was 28.0% (n = 128). Both traditional and non-traditional treatments were used by 46.4% (n = 212) of the participants. Logistic regression revealed that those with higher education (odds ratio 1.56, CI 1.24-1.96, P = 0.001), and non-White race, regardless of educational level (odds ratio 2.02, CI 1.20-3.40, P = 0.008), were more likely to use gold standard treatment.

CONCLUSION

Factors influencing older adults' use of gold standard treatment for their osteoarthritis pain need to be identified so that greater numbers of older adults can be supported to use recommended treatment to obtain greater pain relief.

[Nursing research development: analysis study]

OBJECTIVE

to present the areas of research in the School of Nursing at the Pontificia Universidad Catolica de Chile between 2001 and 2004, as well as presenting a new proposal for increased impulse in nursing research.

METHODOLOGY

development was carried out in four phases: I. Evaluation of current scientific production through the revision of the organization's annual plans; II. Analysis of information provided by key informants; III Literature review and group work with academics from the organization; IV. Triangulation of information.

RESULTS

sixty per cent of the scientific production in the School of Nursing at the Pontificia Universidad Católica de Chile between 2001 and 2004 could not be organized within the determined areas or lines of research for those years. Diverse proposals were elaborated in order to allow academics to incorporate themselves into the new areas of research avoiding dispersion and centralizing common strengths among existing projects. After the triangulation of information, three new areas of research were created: 1. Formation of human resources in health, 2. Nursing Care Management and 3. Strengthening of clinical nursing.

CONCLUSIONS

it is suggested that researchers from the SON-UC orient their work towards those areas identified, which will contribute to strengthening research and improving both internal and external visibility of the academic entity; attracting new resources for research.

Comparison of two user interfaces for accessing context-specific information resources related to hazards and near misses

The Hazard and Near Miss Reporting System (HNMRS) was designed to promote patient safety mindfulness as part of a patient safety curriculum for Advanced Practice Nursing (APN) students. We are extending the functionality of the system beyond reporting to Just-in-Time learning by providing context-specific links to internal and external information resources related to the type of hazard or near miss reported. As part of this process, 55 APN nursing students compared two different interfaces on ease of use and reported their perceptions of usefulness and intention to use the information resources links integrated into the HNMRS. The students demonstrated a significant preference for the Category-based Interface as compared to the Question-based Interface (p<.001). Mean scores for perceptions of usefulness and intention to use the context-specific links in the HNMRS for reference purposes reflected moderate to strong agreement.

Feasibility and acceptability of continuous glucose monitoring and accelerometer technology in exercising individuals with type 2 diabetes

AIMS AND OBJECTIVES

The aim of this study was to develop role model data for an intervention to motivate non-exercising individuals with type 2 diabetes mellitus to engage in regular physical activity. Toward that end, the study 1) described Continuous Glucose Monitoring System data and obtained role model CGMS graphs, 2) described a monitor to measure exercise amount and intensity and 3) explored participants' experiences of the monitors and perceptions of the glucose monitoring data.

BACKGROUND

Physical activity is a cornerstone of diabetes treatment yet the majority of individuals with diabetes are inactive. Thus, increasing physical activity in these individuals demands innovative interventions.

DESIGN

A two-phase, multi-method design was used.

METHODS

In phase 1, a descriptive design was used to describe physical activity patterns and glucose levels for 72 hours in nine exercising adults with type 2 diabetes. In phase 2, a focus group interview was used to collect data from seven phase-1 participants. Verbatim transcripts of the audio taped focus group were analysed for themes and trends.

RESULTS

The glucose monitor data captured lower glucose levels after exercise. Compared to formal diabetes education, visual data from the glucose monitoring technology were perceived as more relevant to participants' particular, everyday experiences with exercise, diet and stress. Participants reported a reinforced commitment to their exercise and diet regimens after using Continuous Glucose Monitoring System. Technology issues were identified, e.g. discomfort wearing activity monitors and forgetting to enter calibration and event data in glucose monitors.

RELEVANCE TO CLINICAL PRACTICE

Participants found that visual glucose monitoring data reinforced self-management behaviors, such as exercise. Our results suggest that data depicting the response of glucose levels to diet and exercise could be a useful tool to change behavior in individuals with type 2 diabetes.

Solving nursing shortages: a common priority

AIMS AND OBJECTIVES

This paper provides a context for this special edition. It highlights the scale of the challenge of nursing shortages, but also makes the point that there is a policy agenda that provides workable solutions.

RESULTS

An overview of nurse:population ratios in different countries and regions of the world, highlighting considerable variations, with Africa and South East Asia having the lowest average ratios. The paper argues that the 'shortage' of nurses is not necessarily a shortage of individuals with nursing qualifications, it is a shortage of nurses willing to work in the present conditions. The causes of shortages are multi-faceted, and there is no single global measure of their extent and nature, there is growing evidence of the impact of relatively low staffing levels on health care delivery and outcomes. The main causes of nursing shortages are highlighted: inadequate workforce planning and allocation mechanisms, resource constrained undersupply of new staff, poor recruitment, retention and 'return' policies, and ineffective use of available nursing resources through inappropriate skill mix and utilisation, poor incentive structures and inadequate career support.

CONCLUSIONS

What now faces policy makers in Japan, Europe and other developed countries is a policy agenda with a core of common themes. First, themes related to addressing supply side issues: getting, keeping and keeping in touch with relatively scarce nurses. Second, themes related to dealing with demand side challenges. The paper concludes that the main challenge for policy makers is to develop a co-ordinated package of policies that provide a long term and sustainable solution.

RELEVANCE TO CLINICAL PRACTICE

This paper highlights the impact that nursing shortages has on clinical practice and in health service delivery. It outlines scope for addressing shortage problems and therefore for providing a more positive staffing environment in which clinical practice can be delivered.