Retaining registered nurses in rural community hospitals

In rural practice settings where the task of recruiting new employees is exceedingly difficult, the first step in surviving the nursing shortage should begin with maintaining existing resources. Based on a survey of 2,488 staff registered nurses working in rural community hospitals, the authors compare personal, demographic, and practice characteristics of nurses by their self-reported intentions to stay in their present positions. Specific areas of job dissatisfaction that best distinguish those who anticipate leaving in 1 year from those committed to remaining in their present job for 5 years or more are identified.     

What do registered nurses and midwives feel and know about research?

This research is in the form of a quantitative study aimed at discovering 'What registered nurses and midwives feel and know about research'. Data were gathered on a fixed response questionnaire, with open spaces for comments to support the results with written factual qualitative evidence. The questionnaire was directed towards obtaining results associated with 'Attitudes' towards research; 'Understandings' about research, and 'Obstacles' to implementing research. A sampling technique was used in which a total population of 765 registered nurses and midwives working in this district general hospital were involved in the study. The results demonstrate (inferential statistics chi-square and correlation tests) that registered nurses and midwives are largely in agreement with research based practices, although understanding about research is minimal and dependent on grade, length qualified, shifts and numbers of hours worked.     

Preretirement planning of female registered nurses

Knowledge of preretirement planning among women has not been a major focal point for researchers. The purpose of this study was to test a model for understanding preretirement planning among working women and to describe and explain preretirement health and financial plans. A multivariate method of analysis was used with a sample of 145 working female registered nurses, 40 years of age or older, from a major health sciences institution. Data were collected with a mailed questionnaire that measured knowledge, beliefs, and attitudes of women regarding health and financial preretirement planning. The results of this study indicated that formal and informal methods of planning for retirement were limited. Knowledge of health maintenance issues and economic issues were found to be helpful in making plans for the retirement years. This study identifies strengths and weaknesses in the preretirement planning process of working women and contributes to the expansion of knowledge to reduce problems during retirement.     

A profile of rural surgeons in Australia

Primary HIV infection is usually paucisymptomatic, although 30-40% of patients show a mononucleosic syndrome of variable intensity and different manifestations. An increasing number of heterosexual HIV infection in Spain, and the fact of more severe manifestations in this subset of patients make necessary a deeper understanding of this complex clinical picture. We report a case of heterosexual primary HIV infection in a female patient without any known risk factor. This care evolued in an exceptionally severe form with meningitis and pancreatitis, to the best of our knowledge, this is the first reported care of pancreatitis complicating primary HIV-1 infection.     

Staff attitudes to oral health care. A comparative study of registered nurses, nursing assistants and home care aides

The diagnosis of early ectopic pregnancy remains challenging for the gynecologist. Although early detection of a suspected pregnancy has been facilitated by quantitative beta human chorionic gonadotropin studies and ultrasonography, a patient subgroup remains with an ambiguous presentation. In this group of patients, the clinician must rely on microscopic examination of products of conception in a uterine curettage specimen to rule out the presence of an extrauterine pregnancy. The presence of an implantation site, chorionic villi, or trophoblastic tissue in uterine curettage samples is conventionally held as definitive evidence of an intrauterine pregnancy. We present a series of four cases that challenge this convention. In these cases, chorionic villi or an implantation site were identified in uterine samples of pregnant women who each ultimately proved to have an ectopic pregnancy. If clinical suspicion is high, the finding of either chorionic villi or an implantation site should not preclude further workup of a possible ectopic pregnancy. In cases where only a few villi or a single chorionic villus are identified, other signs of intrauterine implantation such as intermediate trophoblastic cells, hyalinized vessels, and a fibrinoid matrix should be sought to establish firmly the diagnosis of an intrauterine pregnancy.     

Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.     

Water quality in rural Australia

The comet test is a reported method for measuring DNA damage in individual mammalian cells. In the present report, the ability of this test to detect multidrug resistance (MDR) was evaluated. For this purpose, two human leukemia, well-characterized parental cell lines, HL60 and CEM, and their derived multidrug-resistant cells, HL60/DNR and CEM/VBL, were cultured with or without different anti-cancer agents. To evaluate the comet test, two DNA-damaging agents were used: daunorubicin (DNR), which is involved in MDR, and ambamustine (AMBA), which is independent from MDR. Moreover, in order to evaluate the specificity of the comet test, the activity of vinblastine (VBL), an MDR-related, DNA-independent anti-cancer drug, was also tested. Finally, the specificity of the comet test in detecting MDR was confirmed by culturing parental or resistant cells with DNR with or without the revertant agent verapamil (VER). Results confirm that the comet test is able to predict cellular chemoresistance when DNA damaging agents are tested. Finally, experiments on the role of the comet test in evaluating certain aspects of DNA repair are discussed.     

Testing a model of absence and intent to stay in employment: a study of registered nurses in Malta

This review presents the major animal models usually used for the study of the pathological processes related to insulin-dependent diabetes mellitus (IDDM), non-insulin-dependent diabetes mellitus (NIDDM) and to the main diabetic complications. These models can be observed spontaneously or can be obtained by selective cross-breeding or toxic exposure (chemical or viral), as well as genetically induced. They reproduce some aspects of the human pathology without combining them all in a single model. Consequently, a pertinent pharmacological approach may compare the results obtained with several models. The examination of the recent results obtained with transgenesis does not allow these animal models to replace more classical ones but they may constitute a future challenge for gene therapy despite the multifactorial aspect of diabetic disease.     

A controlled evaluation of a lifts and transfer educational program for nurses

The role of the parasympathetic autonomic nervous system (ANS) in digoxin intoxication was investigated in atropine pretreated conscious rabbits. Both the electrocardiographic registration and the histologic analysis indicated possible prevention of lethal arrhythmias by atropine pretreatment. The hearts of animals pretreated with atropine appeared less damaged, since they presented only a light cytoplasmic vacuolization. It was evident that the administration of digoxin without atropine pretreatment provoked dramatic signs of digitalis intoxication followed by animal death. Myocardia of these rabbits were highly damaged. On the other hand, our experimental data indicated that the abolishment of the vagal tone by atropine blockade caused only signs (i.e. inversion of the T wave) due to myocardial ischemia, to which the light cytoplasmic vacuolation could be correlated. Myocardial ischemia could be caused by constriction of coronary blood vessels, which could be consequential to both the prevalent activity of the orthosympathetic ANS, following parasympathetic blockade, and direct digoxin effects on vascular fibrecells, which both produce vasoconstriction. Therefore, it is reasonable to assume that the parasympathetic ANS plays a major role in digitalis intoxication in rabbits.     

The roller coaster supply of registered nurses: lessons from the eighties

The strong labor demand of the eighties for nurses has evaporated under reform proposals and cost constraints. In this study, the 1984 and 1988 National Sample Surveys of Registered Nurses (NSSRN) were used to examine the labor supply of nurses. Ordinary least squares and logistic regression analyses indicated that the responsiveness of registered nurses to the wage was greater than previous research has indicated. If wage growth is slow relative to other occupations due to a decreased demand for nurses, registered nurses will in turn reduce their supply of labor more than previous research has indicated. Whether the response by nurses will balance the reduction of demand by employers remains to be seen.     

Transcultural nursing practice described by registered nurses and baccalaureate nursing students

Using Leininger's Theory of Culture Care Diversity and Universality as a framework, this research examined transcultural practices of nurses and students. A survey was administered to a convenience sample of registered nurses and senior baccalaureate students with 767 usable questionnaires returned. Neither group expressed confidence in their ability to care for culturally-diverse patients. Registered nurses (RNs) reported assessing cultural factors and modifying practices more frequently than did students. Respondents reported their beliefs about transcultural nursing were influenced by being with people of other cultures, their own personal values, and education. Analysis of the open-ended questions revealed two major themes. First, both nurses and students perceive an overwhelming need for transcultural nursing. Second, nurses and students respond to cultural challenges by modifying their care. Modifications are based on language and communication, pain perception and relief, religious and spiritual dimensions, gender and family roles, and other values. Results suggest that nurses and students are aware of culture, recognize that culture influences the care they provide, and modify their health teaching and nursing care based on culture. The use of a conceptual framework to help make modifications in care was not mentioned.     

Application of supervised and nonsupervised microcounseling paradigms in the training of registered and licensed practical nurses.

Studied the effect of supervision on the learning of interviewing skills within the microcounseling format, using 18 female registered and licensed practical nurses at the psychiatric ward of a midwestern Veterans Administration hospital. Ss were randomly assigned to a supervised, nonsupervised, or no-training control condition. Trained coders categorized 32 trainee utterances from pretraining and posttraining videotaped interviews as one or more microcounseling skills, opposite skills, or a miscellaneous skill. Analyses revealed a significant main effect indicating significant improvement in only the supervised group's combined use of opposite and microcounseling skills. A significant double interaction demonstrated significantly higher Ideal Therapeutic Relationship Scale ratings as a function of training condition and time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of student personnel and educational research facilities.

"In an effort to secure some understanding of the ways in which institutions of higher learning staff, organize, administer, and finance research activities in the branch of the behavioral sciences which we think of as education, the present writer surveyed 28 agencies in 10 universities." Information was obtained for most of these agencies concerning "a picture of the development of research activities within the agency, its present staff structure, administrative and policy control, amount and method of financing, and the nature of the research being carried on." Multiple staff appointments, temporary research personnel, basic, applied and service research, research talent in administration, and the impact of the work of research centers are briefly considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The practice of health education in acute care settings in Hong Kong: an exploratory study of the contribution of registered nurses

A multiple case study design was used to explore the practice of health education in acute care settings in Hong Kong. Two case studies, a medical ward and a surgical ward, were selected to reflect the real setting in which nurses carry out health education in acute care. Data collection methods involved the use of non-participant observation and semi-structured interviews. Seven nurses and eight patients were interviewed to explore their understanding of health education concepts, the use made in the wards of health education and the factors influencing such practice in the acute settings. Individual and cross-case analysis showed that respondents' understanding of the concept of health education was limited to patient information-giving. Although the importance of health education in acute patient care was acknowledged, the degree to which health education featured in nurses' practice was minimal. Many available opportunities for health education were missed and factors such as nurses' busy-ness and the associated lack of time and staff were identified as influencing health education practice in these acute care settings. Implications for practice and future studies were discussed in the light of these findings.     

Effectiveness and patient satisfaction with screening flexible sigmoidoscopy performed by registered nurses

CONTEXT: In December 1995, reported Salmonella enterica serotype Newport (SN) infections increased sharply in Oregon and British Columbia but not elsewhere in North America. Similar unexplained increases had been noted in 6 other states in the fall of 1995. OBJECTIVE: To determine the source of the outbreak(s). DESIGN: Case-control studies, environmental investigations, bacterial subtyping, and surveillance information review. SETTINGS: Oregon and British Columbia communities (winter 1995-1996) and Georgia, Oklahoma, Pennsylvania, Vermont, Virginia, and West Virginia (fall 1995). PARTICIPANTS: Oregon and British Columbia residents with culture-confirmed SN infections and onset from December 1, 1995, through February 29, 1996, and healthy community controls. MAIN OUTCOME MEASURES: Odds ratio (OR) of illness associated with exposures; distribution patterns and culture of alfalfa seeds and sprouts; subtyping of SN isolates. RESULTS: We identified 133 cases in Oregon and British Columbia; 124 (93%) occurred in patients older than 18 years; 87 (65%) were female. Case patients were more likely than community control subjects to report having eaten alfalfa sprouts in the 5 days preceding illness (41% [17/41] vs 4% [3/75]; OR, 17.0; 95% confidence interval, 4.3-96.0). Case isolates shared a distinctive pulsed-field gel electrophoresis (PFGE) pattern. The SN was grown from seeds and alfalfa sprouts. The distribution of 1 seed lot to multiple growers corresponded to the distribution of cases. Distribution of a second seed lot from the same European wholesaler corresponded to the location of the fall outbreak, which was characterized by a similar demographic profile. The PFGE pattern of fall outbreak isolates and confiscated sprouts and seeds was indistinguishable from the Oregon and British Columbia outbreak and differed from background isolates. CONCLUSIONS: The SN-contaminated alfalfa seeds were distributed to multiple growers across North America in 1995 and resulted in a protracted international outbreak scattered over many months. Current sprouting methods are inadequate to protect consumers from such events. Alfalfa sprouts may be an elusive but important vehicle for salmonellosis and other enteric infections.     

Issues for palliative care in rural Australia

A project funded by the Commonwealth Government's National Palliative Care Program examined rural (non remote) palliative care services in eight rural regions of Australia with the aim of identifying sound service delivery models. The research methodology included, development of a palliative care service baseline, postal survey of all services in the selected regions followed by field examinations, and section of four regions for in depth analysis using interviews and group sessions with medical practitioners, clinicians, former carers and service managers. The research established that patients and carers want palliative care services to first address symptom management and pain control. The service should then place experienced care as the next highest priority, in conjunction with the provision of family supports. Service models should aim to deliver services in the home or in environments which are home-like and located close to families. Research has demonstrated that even the smallest hospitals can incorporate a palliative care unit. Palliative care service planning in rural areas needs to make a distinction between the main provincial city in the region and the rural hinterland as different planning approaches will often apply. Palliative care teams should vary according to the nature of the service catchment. Particular attention should be given to the method of providing palliative care nursing expertise in a region. This project concluded that when active treatment is no longer beneficial, palliative services in rural regions are commonly of a high quality, although access to tertiary services remains as a limitation during the pre-palliative treatment phase.     

Through the looking glass: the labor market for registered nurses in the 21st century

From the 1950s through the early 1990s, nurses enjoyed employment security. Now supply outstrips demand and nursing student enrollments are declining. What are the forces at work and how can the rules of the marketplace be used to predict the future?     

Going the distance. Education for rural nurses

Following a research project commissioned by the NSW Health Department Chief Nursing Officer, to identify specific areas of concern regarding nursing vacancies, particularly in specialty areas, a Nursing Retention and Recruitment Taskforce was established by the Minister for Health. One of the issues identified by the Taskforce was that of professional isolation and access to education for nurses working in rural and remote areas. This issue of The Lamp looks at the support and education opportunities currently provided to rural and remote nurses.