Orbital aspergillosis. A fatal masquerader

The limited contribution of nursing research and the utilisation of research findings in the field of bone marrow transplantation (BMT) in Europe have been identified as issues needing further attention. Reasons behind these issues include the lack of nursing training in research techniques, problems with funding nursing research, staff shortages and language barriers. An overall research strategy for nurses has been suggested as well as academic research support for those nurses who do not feel confident carrying out research projects. A small scale study in four European BMT centres identified that the main nursing research priorities included isolation techniques, psychosocial and quality of life issues, staff issues, central line catheter care and mouth care/management of oral mucositis. The same study also showed that only 20% of the BMT units regularly use research and research findings in their day-to-day nursing practice.     

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.     

'Bending the truth': professionals' narratives about lying and deception in nursing practice

The purpose of this study was to capture an insight into the phenomenon of lying as part of the deception employed by a group of practising nurses from a variety of clinical settings. The importance of this research is that it adds to the limited knowledge of the range of situations in which nurses use deception. A case study research approach was utilised. The findings presented in this article emphasise the complexity of the subject within a dynamic social context. The article describes the nurses' intention, role, the nature of relationships and context and how institutional culture impacts on disclosure to clients. Additionally, it describes how nurses' distinguish lying from other deceptive practices. These findings have relevance for clinical practice and continuing applied ethics research.     

Reflections on performance

This qualitative study looked at the value of appraisal for nurses. It was conducted with clinical staff in one health district at a time when the NHS was in the middle of the drives towards efficiency and effectiveness. Although participants in the study identified ways in which appraisal could help them in their work, they also highlighted a culture of suspicion and indifference that limited their effectiveness. The findings of the research emphasise the value of, and need for, appraisal for nurses, and offer suggestions for methods of ensuring success in the enterprise.     

Preceptorship: a model to empower nurses in rural health settings

Continuing education and staff development help nurses meet new needs and demands caused by rapid changes in society, demography, technology, politicoeconomic structure, and disease patterns. Rural nurses have a unique, generalist role within their practice but are disadvantaged in accessing professional development because of geographical and professional isolation. A preceptorship program was developed to empower individual nurses in rural health units in South Australia. This program equipped them with the knowledge, skills, and attitudes necessary to make changes in their health units. At the same time, it enabled participants to act as mentors to colleagues in collaborative partnerships designed to meet the complex health needs of their rural clients.     

A team approach to geriatric case management

Monash Medical Centre, a large major hospital in Melbourne Australia, recently opened a high dependency unit (HDU) at its Moorabbin campus. The present study was designed to examine two patient groups admitted to the unit after major and non-major surgical procedures. Another aim in the study was to describe the services required by these patients and to compare the two groups with regard to length of stay in the HDU, severity of illness, and pain control. The results of this study indicate that the HDU provided a valuable and needed service to a population of patients who have been identified as at risk of postoperative complications. The findings appear to agree with other research which suggests that nurses consistently rate patients' pain as less severe than patients' own ratings of pain indicate. Thus nurses appear to overestimate patients' perception of pain control. This study again indicates that even though it is generally recognised by nurses that patients are in pain the management of it is such that pain continues to be inadequately controlled.     

Validation of a Caco-2 cell monolayer culture for drug transport studies

The advancement of nursing knowledge to improve clinical plastic surgical nursing practice was identified as a priority for the American Society of Plastic and Reconstructive Surgical Nurses (ASPRSN). The purpose of this investigation was to determine the specific research priorities and perspectives of practicing plastic surgical nurses. In addition, nurses were asked to rank their current concerns for the future of plastic surgical nursing.     

J95-EPINATO based planning parameters for medical support to Operations Other Than War (OOTW)

Canada is a vast country with great diversity in its landscape, industry, culture and communities. The healthcare issues and concerns of people living in rural and remote areas are as fully diverse as the people and the landscape. This article describes the context of rural and remote nursing practice in Canada and discusses issues of health status and the social determinants of health, geographical isolation, professional isolation and cultural safety. It concludes with current initiatives in practice, education, research and policy. Particular issues facing nurses in rural and remote First Nations communities are highlighted.     

An exploration of anticipatory grief: the lived experience of people during their spouses' terminal illness and in bereavement

Anticipatory grief has been the subject of much debate since Lindemann first coined the term to describe premature mourning. Much of the research in this area takes a positivist approach focusing on the effect of anticipatory grief on bereavement. In contrast, this study, explores anticipatory grief through a Heideggerian phenomenological approach to elicit the experience of anticipatory grief. Unstructured interviews were conducted with four participants. The resulting data were interpreted using hermeneutics and evaluated using the criteria identified by Madison. The themes arising from this interpretation identify the change the participants experienced. Although these findings are limited to four participants, they are offered to raise awareness of the impact of multiple role loss and the impact of diagnosis on supporting partners. The findings also raise ways in which nurses might support people experiencing loss.     

University-based psychiatric nursing education: a promise for the future?

University-based nursing education was introduced in Victoria, Australia, to redress the deficiencies attributed to the system of hospital-based training. The narrow and restrictive focus, maintenance of the subservient position of nurses, the employee status of students, an inadequate relationship between theory and practice and failure to keep pace with changes in the role of the nurse were the main deficiencies identified. This paper refers to a qualitative research study which examines the differences between graduates of a university-based and hospital-based psychiatric nursing program during the year following graduation. The findings suggest that the tertiary-based course had the potential to significantly redress some inadequacies of the hospital-based course to produce different qualities within its graduates.     

Extended, expanded, multi-skilled or advanced practice?--rural nurses in Australia, 1991-1994

Rural nurses in Australia predominantly work in an advanced practice role and their scope of practice is determined by the number and type of health professionals who work full-time or part-time in the health service. This paper presents the results of a discourse analysis, using Foucault's framework, of rural nurses in Australia, 1991-1994. It argues that the use of the statements 'extended nursing practice', 'expanded nursing practice', and 'multi-skilled nurses' continues to subjugate rural nursing practice to more dominant discourses such as medicine, pharmacy and radiography. It proposes the term advanced rural nursing practice be used to refer to the generalist scope of nursing practice in rural areas.     

Preserving moral integrity: a follow-up study with new graduate nurses

The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.     

The lived experience of clinical educators

This phenomenological study was undertaken to discover the everyday meanings which clinical educators of pre-registration Bachelor of Nursing students attached to their experiences as clinical educators. The researcher employed a qualitative design using audiotaped in-depth interviews with four registered nurses employed as clinical educators in four different schools of nursing in Victoria, Australia. Using hermeneutics, thematic analysis revealed five themes of meaning central to the lived experiences of clinical educators. They are:(a) being human, (b) having standards, (c) developing own teaching style, (d) learn as you go, and (e) not belonging. The first three themes are described in the literature on clinical education, however, the latter two are unique to this research. The results of this study indicate there is need for extensive preparation and on-going support of clinical educators. The researcher, who is respectful of the enormity of the task which educators face in preparing students for practice, speculates whether clinical educators are the vanguards of student learning in the clinical field. It is evident that the participants of this study did not possess many of the role requirements of clinical educators identified in the literature. Further studies are needed which explore the link between student learning and clinical educator support.     

Exploring the potential of problem-based learning in nurse education

Despite the increased attention that problem-based learning has received as an appropriate pedagogical technique for educating adults for professional practice, reports that evaluate the process are rare and usually relate to professions other than nursing. A study was undertaken in order to discover the graduates' own perceptions of a problem-based learning programme and its effectiveness in preparing them for the reality of their chosen profession. Twelve practising graduate nurses who had completed the programme were interviewed according to the ethnographic method. Three categories were identified from the data: 'and all of a sudden...', which describes the transition from PBL student to staff nurse; 'not an unthinking assistant', where the characteristics that the PBL graduates believe make them different from traditionally trained nurses are described; and 'the buck stops here', which describes the sense of personal responsibility that the graduates experience in terms of their learning and actions.     

Retention of advanced cardiopulmonary resuscitation knowledge by intensive care trained nurses

The teaching and reinforcing of advanced cardiopulmonary resuscitation (ACPR) is an important part of the role of an intensive care nurse manager. This study highlights the need for a structured training programme, as well as regular updates in ACPR. Current research shows poor retention of CPR skills amongst nursing staff. A small study was undertaken amongst intensive care trained nurses at The Middlesex Hospital intensive care unit (ICU). 18 nurses took part in the study, and were each interviewed with regard to their knowledge of ACPR in December 1990. The period of time since last trained in ACPR ranged from 2 months-4 years. Those who had been recently updated in ACPR (up to 4 months prior to interview) scored higher than those who were updated more than 2 years ago. The results showed that most nurses interviewed were only able to answer correctly half the questions asked. These results indicate that the nurses in the study generally demonstrated a severe lack of knowledge of ACPR. This indicates the need for a structured training package in ACPR, followed by frequent reinforcement of ACPR knowledge and skills for nurses practising in an ICU environment.     

PRIME-MD and rural primary care: Detecting depression in a low-income rural population.

An efficient method for screening depression in primary care may ultimately facilitate referrals to and collaboration with psychologists. The current study extends previous research on the validity of the Mood Module of the Primary Care Evaluation of Mental Disorders (PRIME-MD; R. L. Spitzer et al, 1995) and used nurses as administrators in two rural public health units. Participants were 136 predominantly female (59% Caucasian, 38% African American) primary care patients. Results indicated that 40% were classified as depressed. Depressed participants reported significantly worse mental and physical functioning, even after controlling for age, severity of illness, and tobacco use. Routine screenings for mood disorders in rural primary care could serve as a means of facilitating collaboration between primary care physicians and psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Tanner Mandibular Appliance

The purpose of the study was to investigate whether the human and economic investment of resources in the further training of nursing and nursing assistants is justified. The study focused in particular on the transfer of knowledge from training course to working practice. It was carried out as a case study in Ringk?bing County, Denmark, during 1993/94. The population consisted of 49 nurses and 49 nursing assistants. The study showed that the participants took a keen interest in the courses. The learning process was found relevant by the nurses, but not by the nursing assistants. Neither group found that their expectations of getting more knowledge were satisfied. With respect to job-behaviour, the study confirmed the hypothesis that the practising of the content of the course will depend on the support and interest of the head of the department towards a goal-oriented development of competence and structure. If such support and interest is lacking, the course-participant will only change her own working practices, independent of the organizational structure.