Charting some challenges in the art and science of nursing

Associations between Psychosocial Work Environment Factors with Work Engagement and Burnout in Nursing

The psychosocial work environment (i.e., job demands and resources) is a significant determinant of nurses’ health and motivation; yet, despite the close associations between specific work environment factors, various frameworks suggest different aspects as the most important among the rest. Having in mind the assumption that a more abstract level of analysis might be equally relevant for understanding the work environment and predicting significant outcomes, the aim of this study was to discern the latent factors of nursing work environment and to evaluate their significance in predicting nurses’ work engagement and exhaustion. Two hundred eleven nurses participated in a two-wave time-lagged survey (ΔT = 8 months). In this survey, 1 Expanded Nursing Stress Scale and several subscales of the Work Design Questionnaire were used to measure main job demands and resources in nursing. At that time, 2 participants were asked to fill out an Utrecht Work Engagement Scale and Copenhagen Burnout Inventory. Exploratory factor analysis (EFA) and hierarchical regression analysis were used for analyzing the data. The EFA results revealed that two factors can be discerned, each related to main job demands and resources accordingly. Based on these results, the aggregated indexes of job demands and resources were calculated. A linear regression analysis showed that these indexes predicted nurses’ work engagement and exhaustion no worse than specific factors, despite the loss of variance due to aggregation. Practical implications of such conclusions are also discussed in the article.

The leading edge in nursing research

The following is the opening address given by Professor Alison Tierney at the Royal College of Nursing's International Nursing Research Conference held at Heriot Watt University, Edinburgh, on April 3, 1998

Called to Nursing

Purpose:This study uncovers reasons students report for wanting to become nurses, to quantify those who feel that they are called to nursing, and to learn what “being called” means to them. Method:A descriptive, cross-sectional survey was conducted with all students enrolled in nursing courses at one program in a private, faith-based university. Findings:Most students decided to go to nursing school while in high school or college and chose nursing because they had a desire to help others. The most common personal characteristics they identified that will be helpful in nursing were being caring or compassionate. Almost two thirds of the students indicated they were “called” by God to become nurses. Conclusion and Implications:Findings can help nursing educators and leaders determine howto better recruit and retain individuals into the nursing profession and howto support and encourage caring and compassionate qualities in all nurses.

Of bedpans and ivory towers? Nurse academics’ identities and the sacred and profane: A Bernsteinian analysis and discussion paper

AIM

In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics' identities.

BACKGROUND

The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it.

METHOD

Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated.

FINDINGS

Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics' attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills.

CONCLUSIONS

To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing's development as an academic discipline.

Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder, and comorbidity

BACKGROUND

In children, attention-deficit/hyperactivity disorder (ADHD), tic disorder (TD), and their coexistence (ADHD + TD comorbidity) are very common and clinically important. Associated sleep patterns and their clinical role are still insufficiently investigated. This study aimed at characterizing these sleep patterns in children with ADHD, TD, and ADHD + TD comorbidity and determining whether, in ADHD + TD, the factors ADHD and TD may affect the sleep pattern in an independent (additive) or in a complex (interactive) manner.

METHOD

By means of polysomnography, sleep patterns were investigated in 4 groups of unmedicated 8.0-16.4-year-old children (healthy controls, ADHD-only, TD-only, and ADHD + TD). Each group consisted of 18 subjects matched for age, gender, and intelligence.

RESULTS

ADHD was primarily characterized by increase in rapid eye movement (REM) sleep, whereas TD patients displayed lower sleep efficiency and elevated arousal index in sleep. In children with ADHD + TD, both effects appeared. No interaction between the ADHD and TD factors was found for any of the sleep parameters. Significant correlations between sleep patterns and clinical symptoms were found.

CONCLUSIONS

ADHD and TD are characterized by specific sleep alterations. When coexisting, the two disorders alter the sleep pattern in an additive manner, suggesting a high impact on clinical and therapeutic perspectives.

Behavioural characteristics and gene expression in the hyperactive wiggling (Wig) rat

Recently, congenic wiggling (Wig) rats were described as a good model for attention-deficit hyperactivity disorder; 12- to 14-week-old animals demonstrated hyperactivity, impulsive behaviour and an impaired working memory. Here, we show that 4- to 5-week-old Wig rats displayed significantly greater spontaneous motor activity than control rats during a period of darkness. Subcutaneous injection of 4 mg/kg methamphetamine exacerbated hyperactivity, the reverse of its effect in rats with neonatally induced 6-hydroxydopamine lesions. Immunohistochemistry showed low levels of tyrosine hydroxylase in the ventral midbrain, similar to 6-hydroxydopamine-treated rats. In cDNA macroarrays, 4-week-old Wig rats showed increased expression of the adenosine A2a receptor in the dorsal striatum, macrophage migration inhibitory factor in the frontal cortex, ventral striatum and midbrain, and calbindin 2 in the dorsal and ventral midbrain. Expression of the gamma-aminobutyric acid (GABA) transporter and sterol carrier protein 2 genes was reduced in all regions. Dopamine transporter gene expression was increased in the dorsal midbrain but decreased in the ventral midbrain, a pattern distinct from that induced by 6-hydroxydopamine. Although abnormal development of dopaminergic neurons may underlie motor hyperactivity, other mechanisms may control responsiveness to methamphetamine. Wig rats may provide a model of attention-deficit hyperactivity disorder in which treatment with psychostimulants accelerate the hyperactivity.

Comorbidity of attention deficit hyperactivity disorder in juvenile bipolar disorder

OBJECTIVE

There is some evidence to suggest that attention deficit hyperactivity disorder (ADHD) and juvenile bipolar disorder could be related. This is based on studies of comorbidity and some preliminary family study data. However, doubts continue to be raised about the relationship between the two disorders. This study examined the comorbidity of disruptive behavior disorders (DBD) that include ADHD, oppositional defiant disorder (ODD) and conduct disorder (CD) in juvenile bipolar disorder.

METHOD

Seventy-three subjects with onset of bipolar disorder at age 18 years or younger were evaluated using structured interviews (Missouri Assessment of Genetics Interview for Children, Structured Clinical Interview for DSM-IV Axis I disorders--Clinician Version, and Operational Criteria Checklist for Psychotic Disorders version 3.4). Information was collected from subjects as well as from their parents. Patients with comorbid DBD were compared with patients without DBD.

RESULTS

Ten subjects (14%) had one or more comorbid DBD. ADHD, CD, and ODD were present in three (4%), two (3%), and eight (11%) subjects, respectively. Those with DBD had earlier onset of bipolar disorder and spent more time ill compared to those without DBD.

CONCLUSIONS

The rates of comorbid DBD in juvenile bipolar disorder are low. The study does not support a definite relationship between ADHD and juvenile bipolar disorder. Higher rates reported previously may be due to differing methods of subject ascertainment. Samples recruited from community and general psychiatric settings may help to clarify the relationship between bipolar disorder and ADHD.

Varieties of preschool hyperactivity: multiple pathways from risk to disorder

In this paper we examine the characteristics of preschool attention deficit hyperactivity disorder (ADHD) from both mental disorder and developmental psychopathology points of view. The equivalence of preschool and school-aged hyperactivity as a behavioral dimension is highlighted together with the potential value of extending the use of the ADHD diagnostic category to the preschool period where these behaviours take an extreme and impairing form (assuming age appropriate diagnostic items and thresholds can be developed). At the same time, the importance of identifying pathways between risk and later ADHD is emphasized. Developmental discontinuity and heterogeneity are identified as major characteristics of these pathways. We argue that models that distinguish among different developmental types of early-emerging problems are needed. An illustrative taxonomy of four developmental pathways implicating preschool hyperactivity is presented to provide a framework for future research.

Motor activity and gene expression in rats with neonatal 6-hydroxydopamine lesions

A rat model of a hyperkinetic disorder was used to investigate the mechanisms underlying motor hyperactivity. Rats received an intracisternal injection of 6-hydroxydopamine on post-natal day 5. At 4 weeks of age, the animals showed significant motor hyperactivity during the dark phase, which was attenuated by methamphetamine injection. Gene expression profiling was carried out in the striatum and midbrain using a DNA macroarray. In the striatum at 4 weeks, there was increased gene expression of the NMDA receptor 1 and tachykinins, and decreased expression of a GABA transporter. At 8 weeks, expression of the NMDA receptor 1 in the striatum was attenuated, with enhanced expression of the glial glutamate/aspartate transporter. In the midbrain, a number of genes, including the GABA transporter gene, showed decreased expression at 4 weeks. At 8 weeks, gene expression was augmented for the dopamine transporter, D4 receptor, and several genes encoding peptides, such as tachykinins and their receptors. These results suggest that in the striatum the neurotransmitters glutamate, GABA and tachykinin may play crucial roles in motor hyperactivity during the juvenile period. Several classes of neurotransmitters, including dopamine and peptides, may be involved in compensatory mechanisms during early adulthood. These data may prompt further neurochemical investigations in hyperkinetic disorders.

AD/HD and the capture of attention by briefly exposed delay-related cues: evidence from a conditioning paradigm

BACKGROUND

The selective attention of children with attention deficit/hyperactivity disorder (AD/HD) to briefly exposed delay-related cues was examined in two experiments using a dot-probe conditioning paradigm.

METHOD

Colour cues were paired with negatively (i.e., imposition of delay) and positively valenced cues (i.e., escape from or avoidance of delay) during a conditioning phase. These cues were presented alongside neutral cues in a subsequent dot-probe detection phase.

RESULTS

In experiment 1 teacher-identified children with AD/HD (N = 12), but not controls (N = 12), displayed an attentional bias towards both positively and negatively valenced cues. In experiment 2 children with a diagnosis of hyperkinetic disorder (N = 15), but not controls (N = 15), displayed a bias towards delay-related cues. However, this effect was largely carried by the response to positively valenced cues.

CONCLUSIONS

These results confirm the dot-probe conditioning paradigm as a useful test of motivational influence on attention. They provide the first evidence of qualitative differences in the attentional style of children with AD/HD and give further support to those theories that highlight the motivational significance of delay in AD/HD.

Repeated methylphenidate treatment in adolescent rats alters gene regulation in the striatum

Methylphenidate is a psychostimulant which inhibits the dopamine transporter and produces dopamine overflow in the striatum, similar to the effects of cocaine. Excessive dopamine action is often associated with changes in gene expression in dopamine-receptive neurons. Little is known about methylphenidate's effects on gene regulation. We investigated whether a methylphenidate treatment regimen known to produce behavioural changes would alter gene expression in the striatum. Using in situ hybridization histochemistry, we assessed the effects of acute and repeated methylphenidate treatment on the expression of immediate-early genes (c-fos, zif 268) and neuropeptides (dynorphin, substance P, enkephalin) in adolescent rats. Acute methylphenidate treatment (0-10 mg/kg, i.p.) produced a dose-dependent increase in the expression of c-fos and zif 268. These effects were most pronounced in the dorsal striatum at middle to caudal striatal levels, and were found for doses as low as 2 mg/kg. Repeated treatment with methylphenidate (10 mg/kg/day, 7 days) increased the expression of dynorphin, which was highly correlated with the acute immediate-early gene response across different striatal regions. Moreover, after repeated methylphenidate treatment, cocaine-induced expression of c-fos and zif 268, as well as of substance P, was significantly attenuated throughout the striatum. These effects of repeated methylphenidate treatment mirror those produced by repeated treatment with cocaine or other psychostimulants and are considered to reflect drug-induced neuroadaptations. Thus, our findings demonstrate that acute and repeated methylphenidate treatment can produce molecular alterations similar to other psychostimulants.

The validity of attention deficit hyperactivity and hyperkinetic disorder symptom domains in nonclinical Dutch children

Examined the validity of attention deficit hyperactivity disorder (ADHD) and hyperkinetic disorder (HKD) symptom domains in a sample of Dutch school children aged 10 to 14 years (N = 558). Confirmatory factor analysis indicated that symptoms of inattention, hyperactivity, and impulsivity were satisfactorily represented in various models. Psychopathological correlates of ADHD/HKD symptom domains were examined through their associations with the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). As expected, all three symptom domains were strongly associated with externalizing problems. Furthermore, inattention and hyperactivity were more strongly related to CBCL/YSR attention problems, whereas impulsivity was more strongly associated with symptoms of aggression and delinquency.

Executive function profile of children with attention deficit hyperactivity disorder

We explored the neuropsychological profile for executive functions of children with attention deficit hyperactivity disorder (ADHD) to assess whether problems associated with the two most cited relevant processes--inhibition and attentional problems--were the core of any executive function difficulty. A battery of executive function tests was administered to 31 children with a clinical diagnosis of ADHD and to 33 normal control participants, all aged between 7 and 12. The executive function battery encompassed a number of tasks, selected because each had multiple measures: a sustained attention reaction time task, a related vigilance task, an adaptation of the Hayling Sentence Completion Test, an adaptation of the Brixton Spatial Rule Attainment Test, a Letter Fluency task, a number Stroop task, and an "n-back" working memory task. The overall pattern of the results fit well with those obtained in previous studies as far as abnormalities of the ADHD group in the domain of inhibitory processes, attentional functions, and executive functions. The children with ADHD, although performing well on baseline tasks, performed more poorly than the controls on all the experimental tasks with one borderline exception: Letter Fluency, where the children with ADHD showed a very different pattern than most adult frontal lobe subgroups. However, there was no specific impairment on measures of inhibitory processes. In addition, strategy generation and use were severely affected in the ADHD group. Particular findings fitted well with disorders of a high-level effort system and of a monitoring system.

Does nursing education have a future?

This paper analyses the relationship between government and nurse education policy using the current changes in England as a case study. It argues that there are times when ideologies of governments and professions coalesce, signifying the most opportune times for advancement. It also illustrates times when policy shifts are made because nursing is perceived as relatively insignificant in the order of health policies and politics. It goes on to argue that nursing leaders need to be aware of the political and policy context in order to select the most effective methods of moving the agenda forward. Using UK reforms, particularly the English strategy document Making a Difference (Department of Health 1999d) as a case study, the paper analyses recent events in nurse education to illustrate the key points. The paper concludes by suggesting that the nursing profession must recognize promoters and barriers for change and commit itself to the transformation of nursing practice through the realization of a new educational agenda that embraces the principles of new democracy. Namely, these are equality, mutual responsibility, autonomy, negotiated decision-making, inclusivity, collaboration and celebrating diversity.

The virtue of nursing: the covenant of care

It is argued that the current confusion about the role and purpose of the British nurse is a consequence of the modern rejection and consequent fragmentation of the inherited nursing tradition. The nature of this tradition, in which nurses were inducted into the moral virtues of care, is examined and its relevance to patient welfare is demonstrated. Practical suggestions are made as to how this moral tradition might be reappropriated and reinvigorated for modern nursing.