Japanese nurse academics' pedagogical development using collaborative action research

BACKGROUND

To meet contemporary professional standards, nurse educators must provide students with educational content that considers active learning strategies.

OBJECTIVE

This study explored the process and challenges faced by nurse academics working collaboratively to implement an online problem-based learning course.

DESIGN

Collaborative action research.

SETTING

This study was conducted with nurse academics at Yamaguchi University in Japan from May 2020 to April 2022.

PARTICIPANTS

Five Japanese nurse academics and two Australian academics participated in this study.

METHODS

Nurse academics met regularly online to discuss issues and plan, act, and reflect on their experiences using Norton's (2001) five-step process. The meetings were recorded, and structured and written reflections from each participant were collected throughout the process. Data collected from the meetings and structured reflections were analysed to identify key themes.

RESULTS

In Step 1, the key stakeholders were discussed and issues were identified. Step 2 included planning a short seminar for the convenience of student participants, Step 3 involved the conduct of an online nursing ethics course (four sessions) for the students, and Step 4 included the evaluation. One year after the academics had completed their teaching, a discussion of future directions was conducted (Step 5). Through the collaborative action research process, four themes were identified: (1) creating a shared understanding, (2) adopting new paradigms for teaching and research, (3) learning and experiences while practicing, and (4) looking back and moving forward.

CONCLUSIONS

Despite some challenges experienced, the action research approach enhanced the curriculum development process, provided collegial opportunities to explore and learn together, and led to increased changes in the educational practice of academics, even beyond the collaborative action research.

Mothers' experiences of parenting a child with chromosomal structural abnormalities: The journey to acceptance

PURPOSE

This study aimed to investigate the process mothers go through in coming to terms with raising a child with chromosomal structural abnormalities.

METHODS

Sixteen mothers living in Japan were interviewed and a modified grounded theory approach was used for the analysis.

RESULTS

A total of 35 concepts, nine subcategories, and six categories were extracted. The six categories were: (a) Concern about abnormalities; (b) A healthy child is considered as a standard; (c) Deepening attachment to the child; (d) Acceptance of the child as s/he is; (e) Changing attitude toward disabilities; (f) Creating a frontier for other mothers. The parenting journey meant that parents did not move in a straightforward way from the beginning of the process to the endpoint but instead moved between "Deepening attachment to the child" and "Acceptance of the child as s/he is" before they moved ahead.

CONCLUSION

Having support and meeting peers of mothers with similar issues is essential for mothers to review their perspectives that healthy children are the standard against which to measure their child and to motivate them to raise their children, but it was extremely difficult to have such opportunities due to rarity of the disorder. It is crucial to accumulate more practical information so that mothers can access and use it. Mothers also need support to enhance their self-worth while giving due consideration to the possibility that they may be conscious of being stigmatized. Nurses need to advocate for these children and families to get the appropriate help, understanding and support.

Nurses' health beliefs about paper face masks in Japan, Australia and China: a qualitative descriptive study

Aim

To explore the health beliefs of clinical and academic nurses from Japan, Australia and China regarding wearing paper masks to protect themselves and others, and to identify differences in participants' health beliefs regarding masks.

Background

The correct use of face masks and consensus among health professionals across the globe is essential for containing pandemics, and nurses need to act according to policy to protect themselves, educate the public and preserve resources for frontline health workers. Paper masks are worn by health professionals and the general public to avoid the transmission of respiratory infections, such as COVID‐19, but there appear to be differences in health beliefs of nurses within and between countries regarding these.

Methods

This qualitative descriptive study used content analysis with a framework approach.

Findings

There were major differences in nurse participants’ beliefs between and within countries, including how nurses use paper masks and their understanding of their efficacy. In addition, there were cultural differences in the way that nurses use masks in their daily lives and nursing practice contexts.

Conclusion

Nurses from different working environments, countries and areas of practice hold a variety of health beliefs about mask wearing at the personal and professional level.

Implications for nursing policy and health policy

The COVID‐19 pandemic has sparked much discussion about the critical importance of masks for the safety of health professionals, and there has been considerable discussion and disagreement about health policies regarding mask use by the general public. Improper use of masks may have a role in creating mask shortages or transmitting infections. An evidence‐based global policy on mask use for respiratory illnesses for health professionals, including nurses, and the general public needs to be adopted and supported by a wide‐reaching education campaign.

Developing competencies in genetics nursing: Education intervention for perinatal and pediatric nurses

Nurses need to be appropriately trained in genetics to provide clinical care based on best practice for patients and families. This exploratory study describes an educational intervention using authentic stimulus material centered on a clinical case study of a family with a baby with Down syndrome. Quantitative and qualitative data were collected from a sample of 15 nurses and 27 students from three universities in Japan before and after completing an entry-level workshop on competency-based genetics nursing. Participants reported increased perceived genetics knowledge and clinical confidence. Despite more than 90% of the participants reporting that they understood the underlying genetics knowledge, their confidence and the ethical aspects of genetics nursing had not been promoted after the seminar. In contrast, the reflections, coded into three categories, showed they recognized families' needs for psychological support, family decision making, and protection and privacy and suggested that nurses had undergone a profound shift in understanding about these issues. Although indicating that a single seminar was insufficient, the study findings will be useful to develop educational materials on genetics for both students and nurses.

The role of online ethics consultation on mental health

BACKGROUND

Nurses experience moral distress when they cannot do what they believe is right or when they must do what they believe is wrong. Given the limited mechanisms for managing ethical issues for nurses in Japan, an Online Ethics Consultation on mental health (OEC) was established open to anyone seeking anonymous consultation on mental health practice.

RESEARCH OBJECTIVE

To report the establishment of the Online Ethics Consultation and describe and evaluate its effectiveness.

ETHICAL CONSIDERATIONS

The research was conducted in accordance with the Declaration of Helsinki.

RESEARCH DESIGN

This evaluation describes the outcomes of 5 years of operation of the Online Ethics Consultation on mental health in Japan.

PARTICIPANTS

The Online Ethics Consultation received 12 emails requesting consultation. Consultees included mental health nurses, psychiatrists, and service users.

FINDINGS

The most common questions directed to the service were about seclusion and physical restraint. Response time from receipt of email to sending a reply was between 1 and 14 days. Despite the disappointing number of consultations, feedback has been positive.

DISCUSSION

The Online Ethics Consultation was established to assist morally sensitive nurses in resolving their ethical problems through provision of unbiased and encouraging advice. Mental health care in Japan has been less than ideal: long-term social hospitalization, seclusion, and restraint are common practices that often lead to moral distress in nurses and the questions received reflected this. The head of the Online Ethics Consultation sent a supportive, facilitative response summarizing the opinions of several consultants.

CONCLUSION

This study provides key information for the establishment of an online ethics resource the adoption of which has the potential to improve the experience of nurses, allied health and clients of mental health services. This paper has implications for services concerned with improving patient care, managing nurses' moral distress, building ethics into decision-making.

Sleep disturbances and related factors among nurses

The aim of this study was to describe patterns and potential risk factors for sleep disturbances, including that of sleep apnea, among Thai registered nurses. A descriptive, cross-sectional design was implemented. A sample of 233 registered nurses was recruited from 10 nursing departments from a tertiary hospital. Participants completed a one-time, self-report questionnaire and a 1 week-long sleep diary. Descriptive and logistic regression statistics were used for the analysis. Approximately 76% of nurses slept less than 7 h, 12.3% had difficulty initiating sleep, and 5% had difficulty maintaining sleep. Short sleep duration was prevalent, and night shift work schedules that exceeded 10 episodes/month were perceived as contributing to difficulties with initiating sleep. After excluding males from the analysis, the risk for depression related to short sleep duration becomes statistically significant. Organizational policies for registered nurses' shift work should include effective management of night shift assignments, as well as interventional strategies and policy directions, to promote sleep quality and mental health to ensure nurse well-being and patient safety.

Evaluating the impact of an assertiveness communication training programme for Japanese nursing students: A quasi-experimental study

AIM

To examine the impact of an assertiveness communication training programme on Japanese nursing students' level of assertiveness and intention to speak up when concerned about patient safety.

DESIGN

A quasi-experimental design with two parallel groups was used.

METHODS

Third-year nursing students from two Japanese educational institutions were allocated to an intervention and control group. The intervention group completed the Theory of Planned Behaviour-Assertive Communication Questionnaire and the Japanese version of the Rathus Assertiveness Schedule after attending assertive communication workshops. The second group completed the surveys before attending the workshop and were referred as the control group. Data were collected in December 2017-January 2018.

RESULTS

A total of 123 out of 150 nursing students completed the surveys. Following the assertiveness communication training programme, a higher percentage of students from the intervention group demonstrated the intention to speak up. The intervention group also displayed higher levels of assertiveness, although the results were not statistically significant.

Developing leadership and capacity building: Reflections of a nurse leader

Globally, leadership in nursing and healthcare is vital to develop professional skills and knowledge to improve both practice and population health. Much can be learned from the leadership experiences of others, such as Professor Wipada Kunaviktikul from Thailand, a well-known nursing leader. Among her many life achievements, she is a founding member of the Editorial Board of Nursing & Health Sciences and was invited to share her life story with readers. Her life story includes experiences of leadership and capacity building in health, administration and education, across many organizations nationally and internationally. She describes how her early experiences contributed to her later achievements, such as working to establish international relationships, networks and collaborating centers, and English-language nursing degrees and training courses for Thai and international students. Nurses and other health professionals can reflect on how her values and commitment to nursing excellence have shaped her leadership style to the present time. The importance of role models and mentors in capacity building for leadership is emphasized in her personal leadership development and in the development of other leaders. In conclusion, leadership suggestions are given for future and present nursing leaders.

Exploring Japanese nurses' perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour

BACKGROUND

The hierarchical nature of healthcare environments presents a key risk factor for effective interprofessional communication. Power differentials evident in traditional healthcare cultures can make it difficult for healthcare professionals to raise concerns and be assertive when they have concerns about patient safety. This issue is of particular concern in Japan where inherent cultural and social norms discourage assertive communication.

AIM

The aim of this study was to (a) explore nurses' perceptions of the relevance and use of assertive communication in Japanese healthcare environments; and (b) identify the factors that facilitate or impede assertive communication by Japanese nurses.

DESIGN

A belief elicitation qualitative study informed by the Theory of Planned Behaviour was conducted and reported according to the COnsolidated criteria for REporting Qualitative research.

SETTINGS AND PARTICIPANTS

Twenty-three practicing Japanese registered nurses were recruited by snowball sampling from October 2016 to January 2017.

METHODS

Individual face-to-face semi-structured interviews were conducted and transcribed in Japanese and then translated into English. Two researchers independently conducted a directed content analysis informed by the Theory of Planned Behaviour. Participants' responses were labelled in order of frequency for behavioural beliefs about the consequences of assertive communication, sources of social pressure, and factors that facilitate or impede assertive communication in Japanese healthcare environments.

FINDINGS

Although person-centred care and patient advocacy were core values for many of the participants, strict hierarchies, age-based seniority, and concerns about offending a colleague or causing team disharmony impeded their use of assertive communication. Novice nurses were particularly reluctant to speak up because of their perception of having limited knowledge and experience.

CONCLUSION

This study identified Japanese nurses' behavioural, normative, and control beliefs in relation to assertive communication. The findings will be used to inform the development of a culturally appropriate assertiveness communication training program for Japanese nurses and nursing students.

The effect of a community mental health training program for multidisciplinary staff

BACKGROUND

Primary health workers play a critical role in providing health education to people with mental disorders. In China community health workers working with people with mental health problems lack experience and training in this area. Additionally, coordination between hospital and community staff is not well established. The aim of this study was to provide an interdisciplinary community mental health training program and to evaluate the effect of the training on staff knowledge about mental health and confidence in their roles.

METHODS

A three-day community mental health training program was offered specifically for interdisciplinary mental health professionals. Using a one-group pre-test post-test design, participants completed a self-assessment of mental health concepts and program evaluation which included asking participants to rate their satisfaction using a five-point Likert scale and to respond to open-ended questions.

RESULTS

Forty-eight participants including health professionals from colleges, hospital and community health centers were recruited. Only 8.7% of participants had ever received community mental health training. Post-test evaluation demonstrated improvements in knowledge, and most participants were very satisfied with the program.

CONCLUSION

The findings indicate that this brief interdisciplinary training program had a positive effect in improving knowledge about community mental health concepts and confidence in dealing with people with mental health disorders for multidisciplinary staff working in primary health care areas.

Cultural factors influencing Japanese nurses' assertive communication: Part 2 - hierarchy and power

Hierarchy and power characterize health-care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex in countries such as Japan, where deep-seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses' views and experiences of how cultural values impact assertive communication for health-care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses' communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills.

Increasing undergraduate nursing students' cultural competence: an evaluation study

BACKGROUND

Cultural competence has become increasingly important for Chinese health professionals because of internationalization and the opening up of China to overseas visitors and business as well as a growing awareness of the needs of minority groups within China. This study aimed to evaluate a workshop designed to improve cultural competence among Chinese undergraduate nursing students.

METHODS

A one-group pretest and posttest design was applied. The intervention was a one-day workshop based on transformative learning theory using a variety of teaching strategies. Forty undergraduate nursing students from a university in Wuhan, China selected by convenient sampling received the intervention. Data were collected before the intervention (T1), immediately after the intervention (T2), and 1 month (T3) and 3 months (T4) following the intervention through the Chinese version of Cultural Competence Inventory for Nurses (CCIN). A researcher-designed evaluation form including open-ended questions was also used.

RESULTS

Participants' scores by CCIN increased significantly in the total score (p < .001) as well as the components of cultural awareness (p = .003), cultural knowledge (p < .001), cultural understanding (p = .007) and cultural skills (p < .001), but not in cultural respect. This improvement maintained at T3 and T4. Overall, participants were satisfied with the workshop, and the qualitative results supported the effects of this intervention.

CONCLUSIONS

The one-day workshop was effective in improving nursing students' cultural competence. Replication or further refinement of this workshop is recommended for future research among additional nursing students with diverse backgrounds.

Cultural factors influencing Japanese nurses' assertive communication. Part 1: Collectivism

Culture influences the way health-care professionals communicate with each other and their ability to relate to colleagues in an assertive manner. Cultural barriers can also make it difficult for nurses to speak up even when they have concerns about patient safety. An understanding of the potential impact of cultural factors is therefore needed when developing assertiveness communication training programs. This paper presents the findings from a study that explored Japanese nurses' perceptions of how culture and values impact assertive communication in health care. Semistructured interviews with 23 registered nurses were undertaken, and data were analyzed using directed content analysis. Two major themes were identified: collectivism and hierarchy/power. In the present study, we discuss the cultural values related to collectivism that included four categories of "wa" (harmony), "uchi to soto" (inside and outside), implicit communication/ambiguity, and "nemawashi" (groundwork). The findings highlight the impact of culture on nurses' assertive communication behaviors and can be used to inform the design of culturally-appropriate assertiveness communication training programs for Japanese nurses working both within their own country or internationally.

Incidence, Type, Related Factors, and Effect of Workplace Violence on Mental Health Nurses: A Cross-sectional Survey

OBJECTIVE

Workplace violence and its impact on mental health nurses have yet to be thoroughly explored in China. This study aims to investigate the incidence, type, related factors, and effects of workplace violence on mental health nurses as well as identifying coping strategies.

METHODS

A researcher - designed workplace violence questionnaire and the Maslach Burnout Inventory-General Survey were distributed to nurses at a mental health hospital in Wuhan, China.

RESULTS

Most nurses reported a high incidence of workplace violence (94.6%) in the past year ranging from verbal aggression, sexual harassment, to physical attack. The forms of violence significantly correlated with each other (r>0.5, p=0.000). Working on the psychiatric intensive care unit for adult males and being a male nurse placed nurses at significantly higher risk for workplace violence. Providing routine treatment, caring for male patients, and working the night shift increased the risk of sexual harassment. Nurses who believed that workplace violence was preventable experienced a significantly lower incidence of violence. Burnout levels of the mental health nurses were relatively mild, but increased with age, professional title, years of employment and frequency of workplace violence.

CONCLUSION

The incidence of workplace violence among mental health nurses is common, and its frequency is correlated with nurses' level of burnout. Management and clinical nurses should work together on an organization-wide strategy targeting the major identified risk areas to reduce the incidence of workplace violence and minimize its impact on nurses.

Baccalaureate nursing students' perspectives of peer tutoring in simulation laboratory, a Q methodology study

OBJECTIVES

The study aim was to identify the perceived perspectives of baccalaureate nursing students toward the peer tutoring in the simulation laboratory. Insight into the nursing students' experiences and baseline data related to their perception of peer tutoring will assist to improve nursing education.

DESIGN

Q methodology was applied to explore the students' perspectives of peer tutoring in the simulation laboratory.

PARTICIPANTS

A convenience P-sample of 40 baccalaureate nursing students was used.

METHOD

Fifty-eight selected Q statements from each participant were classified into the shape of a normal distribution using an 11-point bipolar scale form with a range from -5 to +5. PQ Method software analyzed the collected data.

RESULTS

Three discrete factors emerged: Factor I ("Facilitate or empower" knowledge acquisition), Factor II ("Safety Net" Support environment), and Factor III ("Mentoring" learn how to learn).

CONCLUSIONS

The findings of this study support and indicate that peer tutoring is an effective supplementary strategy to promote baccalaureate students' knowledge acquisition, establishing a supportive safety net and facilitating their abilities to learn in the simulation laboratory.

Translation and Adaptation of a Nursing Swearing Impact Questionnaire Into Chinese

BACKGROUND

Verbal aggression and swearing are the most frequently encountered violence in the health care industry. Nurses are the most frequent victims. Not known is the incidence and impact of swearing against nurses in China.

OBJECTIVES

(a) Develop a Chinese version of the Nursing Swearing Impact Questionnaire; (b) report the preliminary findings from the use of the tool.

METHOD

Using a translation-back translation procedure, focus groups and expert review, followed by a survey of 32 participants.

RESULTS

The Chinese version of the Nursing Swearing Impact Questionnaire has been developed, and cultural differences and different attitudes toward verbal aggression and swearing in disparate groups and workplaces have been highlighted.

CONCLUSIONS

This is the first Chinese tool to research nurses' perspectives and experiences of swearing in the workplace. Nurses in China face serious challenges, and the impact of swearing on nurses requires more attention.

Nurses' perceptions of health beliefs and impact on teaching and practice: a Q-sort study

AIM

To understand Chinese nurses' perceptions of health beliefs, their content, origin and the influence of sociocultural factors, as a basis of their evidence-based practice. This study contributes to a larger study to establish the health beliefs of Japanese, Australian, Chinese, South Korean and Thai nurses.

BACKGROUND

Registered nurses teach patients and students about maintaining or attaining health are subject to the same range of influences and their health beliefs may be antithetical to current health evidence.

METHODS

Q-method design using q-sort and interview was used to explore the perspectives on a range of health beliefs of 60 nurses in four cities in China.

FINDINGS

Three factors arose from the perceptions of the participants about health and accounted for 50.2% of the total variance: (1) social impact, (2) 'the importance of evidence', and (3) beliefs rooted in culture.

DISCUSSION

Influence on nurses' health beliefs was explored in terms of the internalized and frequently unconscious beliefs, values and norms tying them to their communities, reflecting the need for nurses to be aware of their health beliefs and behaviours.

CONCLUSIONS

Education for nurses in practice needs to acknowledge that individual practitioners' beliefs strongly influence health teaching for patients and families. In order to implement evidenced-based practice and teach in line with current evidence nurses need to critically examine and reflect on the impact of culture, society and the media on their own health beliefs.

IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY

Education policy needs to consider that culture and societal pressures affect nurses' health beliefs and practice. Critical thinking, reflective and evidence-based practice need to be emphasized in clinical training and nurse education. China also needs to develop policies to allow nurses to be able to assess the reliability of health information on the Internet and to make quality health research more available.

Women's experiences of making healthcare decisions about their breast cancer: A phenomenological study

There are few studies about how healthcare decisions are made for women with breast cancer in China and this knowledge is vital, both to further develop person-centered health care and to ensure that women have a voice in their healthcare decisions. This phenomenological study explored the meaning of women's lived experiences of making healthcare decisions about their breast cancer in China. Semistructured, in-depth interviews were conducted with a purposive sample of eight women with breast cancer. Data were analyzed using Colaizzi's phenomenological analytic method. The results of this study identified four themes: authority and expertise, lack of knowledge, family support, and Chinese cultural and social influences. Women were deferential to medical authority and perceived expertise, but they wanted to be involved to a greater degree in healthcare decisions. It is important for health professionals to optimize women's participation in decision-making by removing barriers and advocating on their behalf.

'An exploration of the health beliefs of Chinese nurses' and nurse academics' health beliefs: A Q-methodology study'

Q-methodology was used to investigate the health beliefs of Chinese clinical nurses and nurse academics. Twenty-eight participants from one hospital and nursing school in China were involved. The four stages of this study included: (i) concourse development from literature review, Internet searches, and key informant interviews; (ii) A pilot study to develop the Q-sample from the concourse; (iii) participants sorted the Q-sample statements along a continuum of preference (Q-sorting); and (iv) PQ data analysis using principal component analysis and varimax rotation. Five viewpoints were revealed: (i) factor 1--health management and the importance of evidence; (ii) factor 2--challenging local cultural belief, and Eastern and Western influences; (iii) factor 3--commonsense; (iv) factor 4--health and clinical practice; and (v) factor 5--health and nursing education. This study presents a need for nurses and nurse academics to think critically, examine their long-held health beliefs, and promote the use of evidence-based practice.

Health beliefs and their sources in Korean and Japanese nurses: A Q-methodology pilot study

BACKGROUND

Many health beliefs do not have supporting scientific evidence, and are influenced by culture, gender, religion, social circumstance and popular media. Nurses may also hold non-evidenced-based beliefs that affect their own health behaviours and their practices.

OBJECTIVES

Using Q-methodology, pilot Q-cards representing a concourse of health beliefs for Japanese and South Korean nurses and explain the content and sources of health beliefs.

DESIGN

Qualitative.

SETTINGS

Two university campuses, one each in Japan and Korea.

PARTICIPANTS

A convenience sample of 30 was obtained, 14 clinical nurses and 16 academic nurses.

METHODS

Literature reviews and expert informants were used to develop two sets of 65 Q-cards which listed culturally appropriate health beliefs in both Japan and Korea. These beliefs were examined in four structured groups and five individual interviews in Japan, and five groups and two individual interviews in Korea.

RESULTS

Our unique study revealed six categories regarding sources of health beliefs that provide rich insights about how participants accessed, processed and transmitted health information. They were more certain about knowledge from their specialty area such as that from medical or nursing resources, but derived and distributed many general health beliefs from personal experience, family and mass media. They did not always pass on accurate information to students or those in their care, and often beliefs were not based on scientific evidence.

CONCLUSION

Findings highlight the dangers of clinical and academic nurses relying on health belief advice of others and passing this on to patients, students or others, without mindfully examining the basis of their beliefs through scientific evidence.

A grounded theory study of 'turning into a strong nurse': Earthquake experiences and perspectives on disaster nursing education

BACKGROUND

While Asia has the dubious distinction of being the world's most natural disaster-prone area, disaster nursing education and training are sparse in many Asian countries, especially China where this study took place.

OBJECTIVE

To explore the earthquake disaster experiences of Chinese nurses and develop a substantive theory of earthquake disaster nursing that will help inform future development of disaster nursing education.

DESIGN

A qualitative study employing grounded theory, informed by symbolic interactionism.

PARTICIPANTS AND SETTING

Fifteen Chinese registered nurses from five hospitals in Jiangxi Province who undertook relief efforts after the 2008 Wenchuan Earthquake.

METHODS

Data were collected in 2012-2013 in digitally-recorded, semi-structured, in-depth interviews and reflective field notes, and analyzed using Glaser's grounded theory method.

RESULTS

Participants were unprepared educationally and psychologically for their disaster work. Supporting the emergent theory of "working in that terrible environment", was the core category of "turning into a strong nurse", a process of three stages: "going to the disaster"; "immersing in the disaster"; and "trying to let disaster experiences fade away". The participants found themselves thrust in "terrible" scenes of destruction, experienced personal dangers and ethical dilemmas, and tried the best they could to help survivors, communities and themselves, with limited resources and confronting professional work.

CONCLUSIONS

Our rich findings confirm those of other studies in China and elsewhere, that attention must be paid to disaster education and training for nurses, as well as the mental health of nurses who work in disaster areas. Emergent theory helps to inform nurse educators, researchers, leaders and policy makers in China, and elsewhere in developing strategies to better prepare nurses for future disasters, and assist communities to prepare for and recover after earthquake disasters.

A comparison of three types of stimulus material in undergraduate mental health nursing education

AIMS AND OBJECTIVES

The paper discusses an innovative educational approach that compared the use of different textual forms as stimulus materials in the teaching of an introductory mental health course.

BACKGROUND

Practitioners in many disciplines, including nursing, appreciate the value of narratives in making sense of experiences, challenging assumptions and enhancing learning: they enable exploration of reality from different perspectives and create an emotional resonance. Narratives help nursing students to uncover embedded meanings, values and beliefs; they can include written texts, illustrated texts or picture books.

PARTICIPANTS

180 students enrolled in an elective undergraduate nursing course.

METHOD

This project afforded students the choice of critically analysing (a) a chapter from one of two autobiographies, (b) an illustrated text, or (c) an illustration from a picture book. Each text was a narrative account from a personal or carer's perspective of the experience of mental illness. Their written submissions were then analysed by means of a qualitative descriptive approach.

RESULTS

In analysis of the autobiographies students tended to paraphrase the authors' words and summarise their experiences. Those choosing the illustrated text were able to link the images and text, and provide a deeper and more insightful level of interpretation, albeit influenced by the author's personal account and expressed emotions; however, those analysing a picture book illustration demonstrated a surprising level of critical and creative thinking, and their interpretations were empathetic, insightful and thoughtful.

CONCLUSION

The use of picture books, although not a common approach in nursing education, appears to engage students, challenge them to think more deeply, and stimulate their imagination.

Swearing: its prevalence in healthcare settings and impact on nursing practice

Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nurses and nursing practice. Nurses are, of all health workers, most likely to be targets of verbal aggression, and up to 100% of nurses in mental health settings report verbal abuse. The literature contains no reference to the effects on nurses of exposure to swearing. This paper reports the findings of a questionnaire study of 107 nurses working in three clinical settings, which used a mixed methods approach. Participants reported high levels of swearing by patients, 32% citing its occurrence from one to five times per week and 7% 'continuously'; a similar incidence arose across the nursing teams at all sites, but being sworn at in anger by another staff member happened rarely. The study failed to show significant differences in the frequency of swearing between mental health and paediatric settings, but did find gender-based differences in both frequency of use and offendedness. High degrees of distress among nurses subjected to swearing were evident; moreover, respondents appeared to have only a limited range of interventions to draw upon in dealing with exposure to such treatment.

An overview of swearing and its impact on mental health nursing practice

Swearing is a subject largely ignored in academic circles but impossible to ignore in the workplace. Nurses encounter swearing from patients and their carers, staff and managers and use swearwords in communication with each other. Language is the major tool of the mental health nurse and swearing an aspect of language frequently used in situations of intense emotion. This paper provides an overview of the historical, legal and cultural aspects of swearing in an Australian context in order to assist nurses in their practice.

Lawmaking: how to be heard in Lansing and Washington

In one way or another, government regulation affects your medical practice. Whether it is the fee schedule you receive from Medicare or a mandatory hospital stay for a new mother, decisions in Lansing and Washington, D.C. are making an impact in health care. As physicians, we are a highly valuable source of information, and therefore need to contribute our expertise to the political processes that will shape public policy for the future. Physicians must realize that without advocacy, all of our knowledge will remain untapped by our lawmakers.

Functional expression of Arabidopsis thaliana anthranilate synthase subunit I in Escherichia coli

Anthranilate synthase is involved in tryptophan (Trp) biosynthesis. Functional expression of subunit I from Arabidopsis (ASA1) was achieved in bacteria as a protein fused with glutathione S-transferase (GST). The active product was purified in a single step on a glutathione-Sepharose column. The Vmax (45 nmol min-1mg-1), the apparent K(M) for chorismate (180 microM), and the feedback inhibition by Trp (complete inhibition by 10 microM Trp) of the purified fusion product (GST-ASA1) were comparable to anthranilate synthase purified from plants. Polyclonal antibodies raised against the fusion project and purified by affinity chromatography on a GST-ASA1-Sepharose column cross-reacted with a 61.5-kD protein in a partially purified anthranilate synthase preparation from corn seedlings. GST-ASA1 cleavage by thrombin, as well as site-directed mutagenesis modifications of the Trp allosteric site, inactivated the recombinant protein.

Purification and characterization of the Manduca sexta neuropeptide processing enzyme carboxypeptidase E

The neuropeptide processing enzyme carboxypeptidase E (CPE) (E.C.3.4.17.10) has been well studied in vertebrates but its presence in invertebrates has not yet been reported. CPE activity in insects is present in membrane-bound and soluble forms. The soluble CPE has been purified to homogeneity from the brain of the tobacco hornworm Manduca sexta. It is a 57 kDa glycoprotein containing 9% sugars. It is activated 9.2 +/- 1.8 fold by CoCl2 and inhibited by chelating agents. Its sensitivity to guanidinoethyl-mercaptosuccinic acid, and its molecular mass, make this enzyme a good candidate to be the insect equivalent of the mammalian CPE. Furthermore, its lack of sensitivity towards p-(chloromercuri)benzenesulfonate puts it closer to the vertebrate carboxypeptidase M (CPM). We postulate that insects may possess a single protein fulfilling both CPE and CPM functions.

MSMS sees opportunity for meaningful change

The Michigan State Medical Society believes there is a real opportunity for professional liability reform in Michigan. In our view, the likelihood of such reform has increased significantly during the past several months for three major reasons. The most important factor is the election of Governor Engler, who has indicated that medical liability reform is his top health policy priority. Governor Engler appears to view liability reform as a key step toward improving access to health care, containing health care costs, and improving the quality of health care. Second, data released by Professor Robben Fleming, former Governor Blanchard's factfinder on liability, shows that Michigan hospitals and physicians pay extremely high professional liability premiums--just under $500 million annually. Finally, the recent Hutzel Hospital decision, in which the plaintiff won a judgment of $19 million, has focused tremendous media attention on the liability problem in Michigan.

Biologic aggressiveness of palpable and nonpalpable prostate cancer: assessment with endosonography

The biologic aggressiveness of palpable versus nonpalpable prostate cancer was evaluated in 666 patients studied with endosonography over a 24-month period. Biologic aggressiveness was defined by a combined histologic and grade-stage category score. In 314 patients suspected of having prostate cancer 328 biopsies were performed. Carcinoma was detected in 99 patients, by means of both palpation and endosonography (n = 80), endosonography alone (n = 9), and palpation alone (n = 8); two cancers were not detected with either palpation or endosonography. All patients with normal results of digital examination had a combined grade-stage category score lower than 9. Fifty-five of 69 patients (80%) with abnormal results of digital examination and available histologic data had a histologic score of 6 or higher; 38 of these patients (69%) had a combined grade-stage category score of 9 or higher. Although the number of patients is small, these data suggest that nonpalpable cancers are biologically less aggressive than palpable ones and that the advantage of endosonography over palpation in detection of clinically significant cancers is limited.

2,5-Anhydro-1-deoxy-1-phosphono-D-altritol, an isosteric analogue of alpha-D-ribofuranose 1-phosphate

Condensation of tetramethyl methylenebisphosphonate with 2,3-O-isopropylidene-5-O-trityl-D-ribose gave a mixture of 2,5-anhydro-1-deoxy-1-(diethoxyphosphinyl)-2,3 -O-isopropylidene-5-O-trityl-D-altritol and -allitol. Separation of the isomers and deprotection gave 2,5-anhydro-1-deoxy-1-phosphono-D-altritol and -allitol. The former is the stable isosteric methylenephosphonate analogue of alpha-D-ribose 1-phosphate, the ribose donor in nucleoside phosphorylase catalyzed nucleoside biosynthetic reactions. It did not, however, inhibit purine nucleoside phosphorylase at concentrations of 6 mM.

A method for lacting dowel pins in artificial stone casts

The technique described in this article produces a removable die that can be reseated in the artificial stone cast with great accuracy and with little or no movement of the die during fabrication procedures. It provides an easy way to locate dowel pins after the artificial stone cast has hardened.

2'-O-Acyl-6-thioinosine cyclic 3',5'-phosphates as prodrugs of thioinosinic acid

A series of 2'-O-acyl derivatives of 6-thioinosine cyclic 3',5'-phosphate (6-HS-cRMP) were prepared and examined for their cytotoxic effects on S49 mouse lymphoma cells which were deficient in hypoxanthine-guanine phosphoribosyltransferase (HGPRTase). Cytotoxicity increased with the lipophilicity of the acyl group to a lowest EC50 of 65 micrometer for the 2'-O-palmityl derivative. Addition of a mutation in the gene for cAMP-dependent protein kinase to the HGPRTase-deficient cell line confers resistance to 2'-O-butyryl-cAMP but not to 2'-O-butyryl-6-HS-cRMP, indicating that the latter does not exert its toxic effect via activation of protein kinase. The time course of cell kill by 2'-O-palmityl-6-HS-cRMP resembled that of 6-mercaptopurine and not that of cyclic AMP in these cells. The data suggest that the intact cyclic nucleotides are penetrating the cells and being converted, by phosphodiesterase action and deacylation, to the first toxic metabolite of 6-mercaptopurine, thioinosinic acid.