Genetics in the OR--implications for perioperative nursing practice

New developments in deoxyribonucleic acid (DNA) technology are increasing understanding of the role of genetics in health and disease. This kind of health information requires that perioperative nurses develop new skills and roles that will enhance the quality of genetic health care they provide to patients, particularly with regard to managing genetic information. Perioperative nurses expand their scope of practice to incorporate a genetic focus into health assessment, patient education, and patient support as they assimilate new genetic information into their daily lives. Perioperative nurses familiar with genetic counseling services--and how and when to refer patients for such services--will ensure that all patients have access to the most current and appropriate genetic information with which to make informed health choices.     

No passport is required to incorporate cultural appreciation into perioperative nursing practice

As you read this issue of the Journal and celebrate OR Nurse Week, think about your daily opportunities to practice the principles of international nursing. Look for chances to appreciate cultural values different from your own as you provide patient care and interact with visiting international colleagues. Adopt a global perspective to perioperative nursing.     

Women's depression: nursing theory and practice

This theoretical paper argues that a range of social factors are relevant to the genesis of depression in women. These include stressors which particularly pertain to gender, and include poverty, limited practical and social supports and resources, violence against women and childhood sexual assault. After explicating an interpersonal model for the etiology of depression, the paper outlines approaches that nurses can draw on to take sex-based factors into account when assessing and working with women experiencing depression. Nursing strategies which emphasise hope, use group approaches and deal with emotions and unconscious issues are deemed to be especially important.     

The practice of nursing theory in the operating room

Nursing theory is a set of ideas, experiences, or observations regarding how and why nurses engage in certain activities and exhibit various behavioral attributes in providing patient care. The individualized caregiving activities perioperative nurses express during all phases of the surgical experience are supported by nursing theory.     

Applying current research to influence clinical practice

The benefits of anti-hypertensive drug treatment have been established by clinical trials demonstrating significant reductions in cardiovascular morbidity and mortality. Thiazide diuretics predominated in these trials but it is reasonable to conclude that the benefits were attributable to the blood pressure (BP) reduction per se and not to specific pharmacological characteristics. Furthermore, it can be calculated that even greater benefits would probably have accrued if the magnitude of the BP reduction had been greater. On first principles, therefore, the basic requirement for any anti-hypertensive drug is confirmation of its ability to reduce BP. The angiotensin II antagonists constitute an important new class of drug, with a low incidence of adverse effects, but early studies with the prototype, losartan, have raised some doubts about its anti-hypertensive 'potency' in the clinical setting. For example, in several different comparative studies there were consistently lesser BP reductions with losartan compared to enalapril. This applied to both the trough and peak BP reductions. Furthermore, dose-response relationships have not always been clearly defined: for example, in one study diastolic BP reductions (trough) fell in the range 4.1 to 4.8 mm Hg with 50, 100 and 150 mg losartan. Although the preliminary results with newer angiotensin II antagonists suggest that they may have greater efficacy, there is only limited information about the definitive identification of the clinically relevant dose ranges for many of these drugs.     

The theory and practice of health education applied to nursing: a bi-polar approach

Because CD1-restricted T cells lack CD4 but produce IFN-gamma in response to nonpeptide mycobacterial antigens, they could play a unique role in immunity to tuberculosis. We studied CD1-restricted T cells in the context of HIV infection by expanding CD4(-) T cell lines from 10 HIV-infected patients. Upon stimulation with Mycobacterium tuberculosis antigen or upon exposure to macrophages infected with M. tuberculosis, these T cell lines proliferated, produced IFN-gamma, and showed cytolytic T cell (CTL) activity against macrophages pulsed with mycobacterial antigen, findings consistent with a protective role against M. tuberculosis. Anti-CD1b antibodies abrogated T cell proliferation, IFN-gamma production, and CTL activity, demonstrating that these T cells are CD1 restricted. IFN-gamma production in response to M. tuberculosis was enhanced by antitransforming growth factor-beta in 8/10 lines, and by IL-15 in 2/10 lines. IFN-gamma production was augmented in a nonantigen-specific manner by IL-12 in 4/8 lines. When live HIV was cocultured with CD1-restricted T cell lines, p24 antigen and proviral DNA were not detected, indicating that the T cells were not infectable with HIV. Vaccination strategies aimed at activation and expansion of M. tuberculosis-reactive CD1-restricted T cells in HIV-infected patients may constitute a novel means to provide protection against tuberculosis, while minimizing the risk of enhancing HIV replication through stimulation of CD4(+) cells.     

Changing practice to primary nursing

Primary nursing is now seen as popular method of delivering nursing care. The process of introducing this system requires prior planning, involving all members of nursing staff. A change in philosophy, culture and roles occurs with the introduction of primary nursing. Evaluation of this change is necessary, to determine if it is beneficial both to patients and the multidisciplinary team.     

A nursing perspective on the interrelationships between theory, research and practice

Recessive dystrophic epidermis bullosa is ultrastructurally characterized by the absence of anchoring fibrils, and genetic analyses have revealed that recessive dystrophic epidermolysis bullosa results from mutations in the type VII collagen gene (COL7A1). The mutations disclosed thus far are largely family specific, with no evidence for mutational hotspot(s). In this study, we report a recurrent premature termination codon mutation detected in two apparently unrelated Italian families in different regions of the country. This mutation, 497insA in exon 4 of COL7A1, was found in combination with two different premature termination codon mutations in these families. Haplotype analysis suggested a shared genetic background in the allele containing the mutation 497insA, suggesting that this genetic lesion may represent an ancestral mutation within the Italian gene pool.     

Effective peer responses to impaired nursing practice

Subplate neurons, the first neurons of the cerebral cortex to differentiate and mature, are thought to be essential for the formation of connections between thalamus and cortex, such as the system of ocular dominance columns within layer 4 of visual cortex. To learn more about the requirement for subplate neurons in the formation of thalamocortical connections, we have sought to identify the neurotransmitters and peptides expressed by the specific class of subplate neurons that sends axonal projections into the overlying visual cortex. To label retrogradely subplate neurons, fluorescent latex microspheres were injected into primary visual cortex of postnatal day 28 ferrets, just prior to the onset of ocular dominance column formation. Subsequently, neurons were immunostained with antibodies against glutamate, glutamic acid decarboxylase (GAD-67), parvalbumin, neuropeptide Y (NPY), somatostatin (SRIF), or nitric oxide synthase (NOS). Retrograde labeling results indicate that the majority of subplate neurons projecting into the cortical plate reside in the upper half of the subplate. Combined immunostaining and microsphere labeling reveal that about half of cortically projecting subplate neurons are glutamatergic; most microsphere-labeled subplate neurons do not stain for GAD-67, parvalbumin, NPY, SRIF, or NOS. These observations suggest that subplate neurons can provide a significant glutamatergic synaptic input to the cortical plate, including the neurons of layer 4. If so, excitation from the axons of subplate neurons may be required in addition to that from lateral geniculate nucleus neurons for the activity-dependent synaptic interactions that lead to the formation of ocular dominance columns during development.     

The power of environmental adaptation. Florence Nightingale''s original theory for nursing practice

Although generally recognized as the founder of modern nursing, Florence Nightingale has been criticized for her apparent lack of support of women's issues, including suffrage. This article examines the primary and supporting literature surrounding this topic. Findings indicate that Nightingale developed a complex set of beliefs that supported women as individuals rather than from a gender perspective. She did, in fact, support the concept of women's suffrage but did not give it priority. Victorian women suffered from lack of legal status, education, financial independence, and support from either the family or church as social institutions. Therefore, Nightingale's conception of nursing as a secular, educated profession cannot be overemphasized as a benchmark in the developing importance of women in the social system.     

Promoting nursing practice through nursing research

ICN is convinced of the importance of nursing research as a means of improving professional education and practice and generating health policies and systems that assure cost-effective use of resources. To this end, ICN is investing heavily in programmes and projects that strengthen the capabilities of ICN and its members to exercise research leadership. Below, three dimensions of research leadership that are important in today's health environment: 1) Fostering research-based practice; 2) Documenting the work and worth of nursing: and 3) Enhancing public understanding of nursing work.     

Nursing science research to support nursing care practice

It is stated in this article that nursing is a professional science the goal being to utilize the nursing practice. New theories are formed or existing theoretical hypotheses are tested by nursing research. The difference between these two approaches is introduced. Nursing research for health promotion, prevention from illness and rehabilitation is discussed. The subject is viewed by the basic concepts of nursing: person, environment, health, nursing interventions. It seems to be essential to develop nursing theory for practise. It means to accept the point of view in which clinical nurses are theorists like academic researches.     

What five regulatory trends mean to nursing practice

Officials from the National Council of State Boards of Nursing report how developments in key areas will affect nursing practice.     

Bridging the gap between theory and practice: a supervision programme for nursing students

This paper describes nursing students' views of a supervision programme provided during the second semester of their education, which was their first period of nursing practice. A form with open questions and a 24-item questionnaire were completed by the 28 nursing students. The analysis of their responses was a combination of factor analysis and grounded theory approach, based on comparative analysis. The results indicate two specific effects of the programme: personal growth and integration of knowledge. The process of creating knowledge includes four stages: awareness of concepts and phenomena, development of a 'language of caring', development of a 'model' of communication, and reflection gained as an effect of the intervention. The nursing students reported that reflection was a way to bridge the gap between theory and practice. Their views of the effect of the supervision showed high values for the following three factors: improved interpersonal skills, improved professional skills, and improved communication skills.