The structure of nursing: a national examination of titles and practice profiles

AIM

To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country.

INTRODUCTION

Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems.

BACKGROUND

The prevailing approach to nursing workforce planning focuses on number of nursing staff needed in relation to the number of patients. The level of expertise and skill mix of registered nurses as a variable in workforce planning is rarely considered.

METHODS

A national cross-sectional electronic survey of registered nurses in Australia was conducted using the validated Advanced Practice Role Delineation tool developed from the Strong Model of Advanced Practice. The study involved a sample of 5599 registered nurses.

RESULTS

Sixty-six nursing position titles nationally were mapped using cluster analysis technique and gave rise to seven clusters of equivalent Australian jurisdictional nursing position titles and practice profiles.

DISCUSSION

Effective workforce policy and planning is reliant upon access to reliable evidence. This research is an international first in that it has provided comprehensive knowledge of the clinical level and practice profiles of a national nursing workforce.

IMPLICATIONS FOR NURSING POLICY

Effective, patient-centred workforce planning must consider both the numerical and expertise mix of a nursing workforce. This research provides Australian health service and policy planners with evidence-base knowledge of the nursing workforce. Internationally, this research establishes a platform from which to develop validated tools and established processes to support replication of this research.

What keeps nurses busy in the mental health setting?

ACCESSIBLE SUMMARY

Recent evidence suggests that the interactional work of mental health nursing has been eroded and redirected to the task-based roles of medicine. This study utilized work sampling methodology to observe the proportion of time nurses working in a mental health setting spend in direct care, indirect care and service-related activities. Nurses spent 32% of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes.

ABSTRACT

The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasizes the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting spend in the activities of direct care, indirect care and service-related activities. Nurses spent 32 of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes.

Regional variation in composition and antimicrobial activity of US propolis against Paenibacillus larvae and Ascosphaera apis

Propolis is a substance derived from antimicrobial plant resins that honey bees use in the construction of their nests. Propolis use in the hive is an important component of honey bee social immunity and confers a number of positive physiological benefits to bees. The benefits that bees derive from resins are mostly due to their antimicrobial properties, but it is unknown how the diversity of antimicrobial activities among resins might impact bee health. In our previous work, we found that resins from different North American Populus spp. differed in their ability to inhibit in vitro growth of the bee bacterial pathogen Paenibacillus larvae. The goal of our current work was to characterize the antimicrobial activity of propolis from 12 climatically diverse regions across the US against the bee pathogens P. larvae and Ascosphaera apis and compare the metabolite profiles among those samples using LC-MS-based metabolomic methods. Samples differed greatly in their ability to inhibit both bacterial and fungal growth in vitro, but propolis from Nevada, Texas, and California displayed high activity against both pathogens. Interestingly, propolis from Georgia, New York, Louisiana, and Minnesota were active against A. apis, but not very active against P. larvae. Metabolomic analysis of regional propolis samples revealed that each sample was compositionally distinct, and LC-FTMS profiles from each sample contained a unique number of shared and exclusive peaks. Propolis from Aspen, CO, Tuscon, AZ, and Raleigh, NC, contained relatively large numbers of exclusive peaks, which may indicate that these samples originated from relatively unique botanical sources. This is the first study to characterize how the diversity of bee preferred resinous plants in the US may affect bee health, and could guide future studies on the therapeutic potential of propolis for bees.

Temporal bone meningiomas

Meningiomas involving the temporal bone may originate from arachnoid cell nests present within the temporal bone (intratemporal), but more frequently originate from arachnoid cell nests of the posterior or middle cranial fossa with secondary invasion of the TB (extratemporal). In this study, we retrospectively reviewed the charts of 13 patients with meningiomas involving the temporal bone who underwent surgery. Tumors of the posterior fossa with only temporal bone hyperostosis, but without invasion, were excluded. Patients presented primarily with otologic symptoms and signs. The tumors originated in the temporal bone (5/13), jugular foramen (4/13), petroclival region (2/13), the asterion (1/13) or the internal auditory meatus (1/13). All of the intratemporal meningiomas had the radiological appearance of en-plaque menigiomas. The tumor extended into the middle ear (11/13), eustachian tube (5/13), and/or the labyrinth (3/13). A gross total resection was achieved in 11 patients and a subtotal resection in 2 patients. The lower cranial nerves were infiltrated by tumor in 4 patients, and were sacrificed. At a mean follow-up of approximately 6 years, 12 patients are currently alive and doing well and 1 died from tumor progression. Six patients showed tumor recurrence and were reoperated on (5/6) or followed conservatively (1/6). Surgical treatment of temporal bone meningiomas is associated with high recurrence rate due to indiscreet tumor margins. Combined surgical approaches (temporal craniotomy and mastoidectomy) by neurosurgical and otological teams are recommended for meningiomas originating in the temporal bone.