Intracanal medicaments: evaluation of the antibacterial effects of chlorhexidine, metronidazole, and calcium hydroxide associated with three vehicles

According to the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) code of conduct (1992), nurses in Britain are expected to act as patient advocates. An advocate is someone who 'pleads for another' (Concise Oxford Dictionary 1982). However, it has been shown that advocacy is a complex issue and it is debatable as to whether or not it is a legitimate attribute of the role of the nurse (Gates 1995). Mallik (1997) also finds that advocacy can be a risky career option. Professional codes of conduct spell out duties, but do not give moral guidance. Phrases such as 'promote and safeguard the well-being of the patient' (UKCC 1992) are used, but although undoubtedly well-intentioned, this is platitudinous and these codes commonly shed little light on how to define an action that is to the patient's benefit or detriment. It is tempting to suggest that they are used as a drunken man uses a street lamp; more for support than illumination. Castledine (1981) identified a number of factors that would make a nurse an inappropriate advocate and these will be discussed within the context of intensive care units (ICUs).     

Reflecting on the knowledge used when caring for an intensive care patient and his/her family

Carper's four ways of knowing are used to structure a reflection on the knowledge used by an associate nurse in intensive care when caring for her patient, his wife and son. John, the patient, had previously undergone a sex change operation as well as cardiac surgery. His current period in intensive care was due to pancreatitis and involved numerous returns to theatre. He eventually died following multi-organ failure. The reflection focuses on the associate nurse's feelings when trying to act as an advocate for both John and his wife at the time of the patient's pending death.     

Preventing verbal harassment and violence toward gay and lesbian students

School nurses (as well as other school personnel) have a role and a responsibility to help prevent verbal harassment and violence toward gay and lesbian students. The literature about verbal harassment and violence toward students in schools is scant, and there is even less written about the school nurse's role in addressing such concerns. This article points out the potential role of school nurses in addressing this issue if they will put aside personal biases and get involved in, or initiate, homophobia awareness programs and advocate for gay and lesbian students.     

Long-term analysis of conventional coronary balloon angioplasty and an initial "stent-like" result. The NHLBI PTCA Registry

Researchers examining clinical decision-making often explored the role of the nurse's experience. In these studies, experience was conceptualized as either the time spent in nursing or the knowledge which came from practice. This paper reports on the conceptualization of the nurse's experience emerging from a grounded theory study describing one decision-making process: 'knowing the patient'. Data included in-depth interview text, participant observation fieldnotes, and documents. Data were analysed using the constant comparative method and open, axial and selective coding techniques. In the analysis, the nurse's experience was conceptually defined as 'the application of that learned from previous practice situations'. Three attributes of the nurse's experience emerged. These included a focus on the patient, confidence in practice, and knowledge of antecedents and consequences of similar patient situations. Each aspect enhanced the individualization of nursing interventions. The findings are related to other investigations in nursing and insights for practice are offered.     

The increase in angiotensin type-2 receptor mRNA level by glutamate stimulation in cultured rat cortical cells

Advanced practice nurses are challenged to assess comprehensively the value of their role and the impact of their practice. Value is defined as quality divided by cost. The correlations among the structure, strategies of care (process), and their objectives (outcome) are key to the assessment of the quality of care and the impact of the advanced practice nurse's role. Advanced practice nurses are challenged to provide high quality care for a competitive or decreased cost. For the profession of nursing, outcomes are the result of interventions based on the nurse's clinical judgment and theoretical, practical, or scientific knowledge. An evaluation model is presented that comprehensively measures the impact of advanced practice nurses on patients and families, and an example is presented. Using the model will give credibility and validity to the APNs' positive impact on the quality and financial outcomes of care for each patient and for entire patient populations.     

Self-advocacy and self-esteem.

Explored the utility of treating self-esteem as an attitude that might be vulnerable to the same kinds of experimental manipulations usually directed at more traditional, less consequential attitudinal issues. Within an attitudinal advocacy paradigm, 109 undergraduates wrote 3 essays either about their personality attributes or about social propositions. Half the Ss writing on each of these topics were told to advocate a positive position (i.e., self-laudatory or proposition supporting) in their essays. The remaining Ss, although induced to advocate positive positions, were led to believe that they could elect to write negative (self-deprecatory or issue-opposing) essays. As anticipated, Ss who wrote the self-laudatory essays subsequently rated themselves more favorably than did Ss who wrote in support of social propositions. The latter Ss showed a corresponding advocacy effect with regard to the social proposition that they had espoused. The manipulation of perceived choice did not influence the magnitude of the advocacy effect. The results are regarded as encouraging with respect to the application of laboratory-derived attitude change procedures to issues of high personal relevance and clinical importance. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discharge planning for the patient requiring home intravenous antimicrobial therapy

Home intravenous (IV) antimicrobial therapy is a well accepted and widely practiced form of home infusion therapy. Orthopaedic-related infections, often requiring long courses of therapy, are commonly treated in the home setting after a brief hospitalization. Hospital orthopaedic nurses play an important role in preparing patients for home care. This article addresses patient selection for home IV therapy, the discharge planning process, and educational preparation of the patient. The role of the home care nurse is briefly presented to enhance the orthopaedic nurse's knowledge of the continuum of care.     

A needle type therapeutic system incorporating laser light and lumin for immunotherapy of cancer growing in deep organs

The dynamic interactions of the client, service provided, and payer are complex relationships in today's health care environment. An advanced practice nurse's abilities to care physically and psychosocially for clients and their families are essential within the case management framework. With a holistic view of clients' health status, the nurse case manager develops and carries out advanced practice functions that help achieve the best outcome for the client through effective interactions with clients, payers, and providers. Those functions, illustrated by the Star Case Management Model, include interpretation, advocacy, and surveillance.     

Capnography: assessing end-tidal CO2 levels

The purpose of this article is to describe the nurse's role in caring for patients with capnography. Capnography provides a continuous and non-invasive measure of arterial partial pressure of carbon dioxide (PaCO2) throughout the entire respiratory cycle. Used correctly, this technology assists the critical care nurse in providing adequate oxygenation and ventilation to the unstable patient.     

Current practices and advances in pediatric neurosurgery

Advances in the field of neuroscience are enhancing outcomes for pediatric neurosurgical patients. Innovative diagnostic tools that include ventriculoscopy for hydrocephalus; long-term monitoring with subdural and epidural electrodes for seizures; and intraoperative computer-assisted, three-dimensional imaging for tumors are currently aiding neurosurgeons. These advances in the care of pediatric patients require the perioperative nurse to reevaluate and expand the nurse's role to optimize patient outcomes.     

When the severely ill elderly patient refuses food. Ethical reasoning among nurses

Forty registered nurses (RNs) regarded as "good and experienced" in either cancer or dementia care, were asked about their decision to feed or not feed a severely ill elderly woman (a hypothetical case). In order to compare ethical reasoning in the two groups of nurses and to illuminate what it means to RNs to face a situation where the patients can/cannot decide for themselves, a phenomenological hermeneutic approach was used for the analysis. Both groups saw themselves as the advocate for their patients but in different ways. The RNs who talked about a mentally alert patient emphasized that they encouraged their patient to speak up for herself, while the RNs who talked about a severely demented patient emphasized that they tried very hard to interpret their patient's vague and unclear communicative cues and to act as her advocate, especially in relation to physicians. Transcending experiences of dying relatives and patients as well as role models helped them to achieve their ambition of putting themselves in the patient's shoes in order to respect and understand her or his wish and/or what was best for them. The majority of RNs strongly rejected active euthanasia.     

Service quality in dentistry: the role of the dental nurse

Patients judge the dental service they receive by the interaction with the service providers-the dentist and his or her staff-as they are unable to judge the technical quality of the service. To perform well as a service provider, employees such as dental nurses have to be well motivated and satisfied with their position. A study of the role of the dental nurse in contributing to service quality in dentistry was carried out through interviews with dentists and nurses at 20 dental practices in the South Thames region in 1995. The results revealed that while dental staff believed that the role of the dental nurse was important in terms of the patient's view of the practice, perceptions of the nurse's role differed. The majority of dentists felt that the nurse's role should be to anticipate their needs, while the nurses' opinions were evenly divided between putting the needs of the patient first or those of the dentist. Nurses also felt that their role was stressful and reported a lack of praise and recognition of their efforts by dentists. Few practices had written contracts or performance appraisals. The results indicated a lack of effective communication in many dental practices, producing role strain for the nurse and reducing job satisfaction. Increasing job satisfaction reduces staff turnover, resulting in more consistent service quality and reducing associated costs. In order to achieve this, several recommendations are made with the aim of improving communication between staff in dental practices.     

Enhancing family advocacy networks: an analysis of the roles of sponsoring organizations

Family participation in shaping system reforms in children's mental health has increased over the past ten years. In 1990 the National Institute of Mental Health funded the development and enhancement of 15 statewide advocacy organizations that were to be controlled and staffed by families of children who have serious emotional disorders. These family advocacy organizations had three major goals: to establish support networks, to advocate for service system reforms, and to develop statewide family advocacy networks. Seven family advocacy networks worked with sponsoring organizations because they needed assistance and/or could not receive funding directly. State and local chapters of the National Alliance for the Mentally Ill and the National Mental Health Association served in this capacity. Because there were no guidelines to educate sponsoring organizations about their interorganizational roles and responsibilities, staff of some sponsoring organizations used approaches that were supportive and effective, while staff in other organizations used methods that were counterproductive. The information and recommendations discussed in this paper are based on evaluation data and observations of the relationships between seven sponsoring organizations and family advocacy groups over a three-year period. This paper proposes a conceptual framework that includes: (1) a clear definition of the sponsoring organization's roles, and (2) an analysis of the advantages, limitations, and critical issues for the sponsoring organization.     

Lower limb amputation 2: once the decision to amputate has been made

This is the second of four articles on lower limb amputation. The first article (Vol 6(17): 970-7) discussed the indications for amputation and briefly outlined the treatment options that may be tried before the amputation stage is reached. This second article examines the factors that need to be addressed once the decision to amputate has been made. It stresses the importance of preparing the patient and his/her family both psychologically and physiologically for the operation. The techniques and rationale for selecting the optimum level of amputation are then discussed. Finally, the specific levels of lower limb amputation are outlined. The next article in this series will explore the nurse's role in preparing the patient for an amputation, and the final article will address the issues raised when a patient decides that death is preferable to living as an amputee.     

Staying ahead financially. Reimbursement tips for a changing environment

Case management is a key role for school nurses to employ in effecting positive outcomes for students in both health and education. The purpose of this paper is to describe the Omaha System and demonstrate its usefulness as a tool for school nurse case management. A case study model was used to analyze the practice of a single school nurse. During the 1995-1996 school year, the Omaha System helped a school nurse to identify students' health problems utilizing the Problem Classification Scheme, and the Intervention Scheme helped identify the nursing interventions employed. The Problem Rating Scale for Outcomes is also discussed in relation to this particular school nurse's practice.     

Clients, roles, and functions of the school psychologist.

The basic credo held by American school psychologists is that of child advocacy. Yet, with most school psychologists being employed by local school systems—where administrators often place institutional needs over individual student needs—the practitioner role is usually conflict-laden. Even though the preferred practitioner role is generally direct service to children through counseling or indirect student help via teacher consultation or parent counseling, at this time the school practitioner's major role in many settings is that of "gate keeping," which involves testing and certifying pupil eligibility for special education. If we look forward to the time when inappropriate gatekeeping—that is, formally labeling the mildly handicapped as eligible for special education—is eliminated, other functions performed must be strengthened and made more desirable to make the role of the school psychologist more viable. In addition to competent counseling skills, the ability to provide effective teacher consultation within schools is essential, not only for dealing with behavior, but instruction as well. The upgrading of school psychologists' skills is essential to ensure that, regardless of possible conflicts engendered, there will be at least one highly skilled child advocate working in the schools. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Complications of rhytidectomy

In a recent study of rhytidectomy patients, the most common complications were hematoma, inflammation, crusting, hypertrophic scars, hair loss, and changes in ear lobe appearance. The nurse's role in early detection and prevention cannot be overlooked. This article will review these complications and less common ones, emphasizing the known etiologies, signs and symptoms, and the nurse's role in assessment and intervention.     

Mediational lawyering in the civil commitment context: A therapeutic jurisprudence solution to the counsel role dilemma.

A mediational lawyering role is proposed as a therapeutic jurisprudence alternative to the two traditional lawyering roles in civil commitments: client-centered-expressed interests (adversary/advocacy) model (lawyers advocate positions that clients favor and allow clients to make ultimate decisions in litigation) and best interests (nonadversarial) model (lawyers join in seeing that clients obtain the help that clients would want if only they knew what is in their own best interests). With a client who has mental disabilities, the adversarial lawyer operates under a presumption that client wishes release from mental health facility or not to be committed; the presumption of the best interests lawyer is that client needs protection, habilitation, and/or treatment. The mediational model is more therapeutic for clients with mental disabilities because it combines the therapeutic aspects and avoids the antitherapeutic aspects of the traditional roles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Legal and ethical considerations of informed consent

The law of informed consent remains ineffective at resolving patient comprehension issues primarily because differing interpretations exist regarding who is responsible for the duty to inform. Court cases continue to set precedents for practicing physicians and other health care providers; however, other measures can be applied for effectual patient advocacy. Health care personnel should rewrite typical consent forms in simpler terms, use larger print, and create duplicate copies. If patients are given copies of the permits they sign, the can reread the forms at home when they are more comfortable. For true autonomy to exist in informed consent for surgical procedures, consent forms should contain patients' primary languages whenever possible, or an adequate interpreter should be made available. Surgeons, nurses, and other health care providers must become aware of their responsibilities related to informed consent for treatment. It is necessary for health care personnel to develop and use effective communication techniques and remember that although some patients are more visually attuned to new information, other patients may benefit more from listening or reading. The cases in this article show that a patient's autonomy is part of the informed consent process and the duty to inform the patient lies with the person performing the procedure. A more important issue, however, involves the patient's comprehension of the information given, because without it, the patient cannot achieve true autonomy in making decisions. Ensuring that all elements of informed consent are met to obtain informed consent will result in fewer malpractice claims, greater patient satisfaction, and an improved professional image. Nevertheless, nurses should make themselves aware of the state laws in which they practice, including their nurse practice acts. They then should advocate for patient rights by encompassing all elements of informed consent.     

The physician as advocate

Health-care advocacy extends beyond the understanding of environmental, social, and economic factors that affect health. Patient advocacy is more than a role--it is a principle that governs the patient-physician relationship and the practice of medicine. Physicians should be reminded that the healing power of medicine is not self-appointed. The authority of medicine derives from the principle of patient advocacy--that is, for 3,500 years society has identified, separated, and commissioned physicians for the sole purpose of providing care to sick and suffering patients. If we physicians compromise on patient advocacy, we will surely surrender this commission.