Transcultural nursing ethics: a framework and model for transcultural ethical analysis

Sex determination is the commitment of an embryo to either the female or the male developmental pathway. The ratio of X chromosomes to sets of autosomes is the primary genetic signal that determines sex in Drosophila, by triggering the functional state of the gene Sex-lethal: in females (2X;2A) Sxl will be ON, whereas in males (X;2A) Sxl will be OFF. Genetic and molecular studies have defined a set of genes involved in the formation of the X:A signal, as well as other genes, with either maternal or zygotic effects, which are also involved in regulating the initial step of Sex-lethal activation. We review these data and present new data on two more regions of the X chromosome that define other genes needed for Sxl activation. In addition, we report on the interaction between some of the genes regulating Sxl activation.     

Multicultural issues and ethical concerns in the delivery of nursing care interventions

Targeted mutagenesis was used to investigate the roles of the CsmA and CsmC proteins of the chlorosomes of the green bacteria Chlorobium tepidum and Chlorobium vibrioforme 8327. Under the photoautotrophic growth conditions employed, CsmA is required for the viability of the cells but CsmC is dispensable. The absence of CsmC caused a small red shift in the near-infrared absorption maximum of bacteriochlorophyll d in whole cells and chlorosomes, but chlorosomes were assembled in and could be isolated from the csmC mutant. The doubling time of the csmC mutant was approximately twice that of the wild-type strain. Fluorescence emission measurements suggested that energy transfer from the bulk bacteriochlorophyll d to another pigment, perhaps bacteriochlorophyll a, emitting at 800-804 nm, was less efficient in the csmC mutant cells than in wild-type cells. These studies establish that transformation and homologous recombination can be employed in targeted mutagenesis of Chlorobium sp. and further demonstrate that chlorosome proteins play important roles in the structure and function of these light-harvesting organelles.     

Continuity of care: a challenge for ambulatory oncology nursing

Continuity of care has many facets and challenges both as a philosophy and in practice. In an abstract sense, it represents an ideal to which health care professionals strive. It is becoming a professional and consumer expectation that each health care professional contribute to continuity of care. Although a variety of organizational models for providing continuity of care have been established in which nursing plays a prominent role, recent research suggests that some frontline nursing personnel may not fully understand their responsibility to continuity of care. There is a need for nursing curricula in both basic and continuing education programs to address continuity of care concepts, models, and methodologies to strengthen awareness of patient care needs across the disease continuum and across care settings. Performance expectations that include professional accountability for continuity of care also encourage greater attention to this issue.     

Observation and nursing care of female patients with schizophrenia during their menstrual period]

Seventeen cases of hypertensive nephropathy with azotemia (test group) treated with Zhengan Xifeng Decoction (ZGXFI) and routine regimen of Western Medicine were observed. The result was compared with that of 15 cases treated with routine regimen alone (control group). After 3 months of treatment, the blood pressure, sodium excretion, blood urea nitrogen and creatinine were all reduced, while creatinine clearance rate (CCr) and residual renal function index (RRFI) were improved significantly in both groups. Compared with control group, the treatment on test group showed a more prominent effect on lowering of diastolic blood pressure, elevating the hemoglobin, reducing the blood level of triglyceride and creatinine as well as improving on CCr and RRFI, suggesting the deterioration of residual renal function could be restrained by ZGXFD, through improve the disorder of lipid metabolism, osmolality gradient and creatinine kinetics.     

The transition from hospital to long-term institutional care

The focus of this article is user and carer involvement in the transition of older people from acute hospital to continuing institutional long-term care. The policy context and research of relevant studies are reviewed. Findings from an action research project currently in progress further elucidate the concerns of older users and carers.     

Nursing students' responses to ethical dilemmas in nursing practice

In literature as well as in nursing practice a growing concern about nurses' ethical competence can be observed. Based on the cognitive theory of moral development by Kohlberg, this research examined nursing students' ethical behaviour in five nursing dilemmas. Ethical behaviour refers not only to the ethical reasoning of nursing students but also to the relationship between reasoning and behaviour. Kohlberg's definition of morality was refined by adding a care perspective. The results show that the majority of students can be located in the fourth moral stage according to Kohlberg's theory, that is, the conventional level of moral development. This finding implies that students are still guided by professional rules, norms and duties, and have not (yet) succeeded in making personal ethical decisions on the basis of their own principles and acting according to such decisions.     

Heart transplantation and the nursing care of transplant patient]

Cultural and religious beliefs in Jordan do not allow male nursing students to practice in the female patients' wards, especially in maternity units. Yet a maternal and infant care nursing course is a required component of Jordan's four-year undergraduate nursing curriculum. Below, how a maternal/infant care course specific for male nursing students with the aim of teaching related but culturally appropriate nursing skills was developed.     

Merger management: a challenge to nursing leadership

Intravascular ultrasound (IVUS) represents a new method to assess vessel lumen and wall morphology. To prospectively evaluate the usefulness of IVUS for further therapeutic decisions in left main stem (LM) lesions with unclear angiographic definition, this study was launched. We studied 56 patients with significant stenosis of the LAD and/or LCX arteries and questionable LM morphology. 30-MHz IVUS catheters with 2.9 or 3.2 F outer diameters were used. A significant luminal reduction of the left main stem was defined as an area stenosis greater than 50% or a minimal luminal diameter smaller than 3 mm as determined by IVUS. 36 of 56 patients (61%) fulfilled these criteria. Additionally, 12 patients showed a ruptured plaque within the LM. 30 of these 36 patients were originally thought to be candidates for angioplasty. After positive IVUS 34 of these 36 patients were sent to surgery. No perioperative ischemic complications occurred. In angiographically unclear left main stem findings. IVUS establishes a definitive diagnosis. After IVUS confirmation of significant left main stem pathology operative management should be the preferred approach as compared to transluminal coronary interventions. However, prospective randomized studies are needed to define the most efficient approach.     

Treatment in the stroke unit reduces mortality, disability and need for institutional care]

The care of acute stroke patients at a stroke unit is "evidence-based" treatment associated with reductions in mortality, functional disability and hospitalisation rates comparable to those obtained in general hospital care. There are various models of stroke unit treatment and documented results are available for all of them except intensive care and stroke team models. In the combined acute-rehabilitation unit model, the efficacy of which has been shown particularly in Scandinavian hospitals, the emphasis is on constructive teamwork and a combination of systematic, standardised acute treatment and early mobilisation and rehabilitation. These units have shown that they can provide effective services for the acute stroke patient, and that the approach is also associated with economic gain to the community.     

The institutional review board as a mirror of scientific and ethical standards

Decisions by institutional review boards (IRBs) are presumed to reflect the norms and standards of the scientific community. Such criteria have shifted as changes have occurred in experimental interventions and protocols, codes of federal regulatory agencies, norms among investigators, and expectations of participants. The tension created by shifting norms and standards raises two questions: (a) Should IRBs evaluate the scientific (e.g., design) features of the proposed research, and (b) should consistent standards be expected even in areas that are in constant flux (e.g., AIDS research)? We discuss these questions and propose a mechanism to keep IRBs abreast of emergent issues and sensitized not only to the costs of doing research but also to the costs of not doing it.     

Nonsexual posttherapy relationships: A conceptual framework to assess ethical risks.

Psychologists sometimes enter into nonsexual posttherapy relationships with former clients. These relationships may occur for a host of reasons, and psychologists have different views regarding the ethicality of these relationships. The American Psychological Association ethics code provides little specific guidance. This article proposes a collaborative and practical model to assess the ethical risks of nonsexual posttherapy relationships that is grounded in normative ethical principles and is drawn from literature about the therapeutic process and social role theory. The role of virtue ethics is discussed as a basis for developing character traits that help psychologists make difficult ethical decisions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Finding value in nursing care: a framework for quality improvement and clinical evaluation

Fiscal constraints have heightened attention to health care costs and patient outcomes as measures of health care system effectiveness. Determining which patient and costs outcomes nurses may be held accountable for requires differentiating the impact of dependent, independent and interdependent nursing activities. A nursing role effectiveness model that includes a number of structural variables is offered to help track quality improvement and research activities. Some of the nurse-sensitive patient outcomes that have been identified include: freedom from complications, clinical outcomes, functional health outcomes, knowledge outcomes, perceived health benefit (or satisfaction), and costs outcomes. This model can be used to evaluate the effectiveness of current as well as evolving nurse roles, processes, and structural changes.     

Another response to "Homosexuality: The ethical challenge."

Discusses the ethical integrity of accepting a voluntary patient's wish to change his sexual orientation, emphasizing G. D. Davison's article (see PA, Vol: 56:Issue 6) which argues that homosexuality is not pathological state. The problem of how a therapist can discriminate between his/her own values and what is a set of symptoms elicited by environment (e.g., social pressures) is examined. Four tasks must be accomplished before a therapist can attempt a sexual orientation change in a homosexual--deciding how the patient's biological state, past learning, access to information, and the impact of the current environment affect him or her. A therapist, behavioral or otherwise, is obligated to engage in a dialogue involving a scrupulous, nonmystical, time-consuming information exchange with the patient, such interchange being directed toward the clarification in the patient's mind of whether in fact he or she really wants to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of nursing care in patients with myasthenia gravis

A retrospective study was made of 35 periods of hospital admission between January 1985 and September 1995, of 17 patients diagnosed in the Hospital Josep Trueta, Girona, as having myasthenia gravis. These were all the patients diagnosed as having myasthenia gravis in this ten year period. We studied the characteristics of their stay in hospital and evaluated the planning and practice of nursing care during these 35 periods. Nursing problems or diagnostic difficulties were found on 15 occasions, probably due to lack of knowledge of myasthenia gravis. When a patient had dysphagia, nursing care was increased and any problems identified. 29.4% of the patients were admitted to the intensive care unit. Since this disorder may be very serious, we consider that special training should be given to the nurses attending these patients. An understanding of this disorder and the possible treatments, complications, drugs, etc. would make it possible to give specific, individualized attention which would result in a higher standard of care.     

Making anthropology clinically relevant to nursing care

Transcultural nursing is generally seen as the interface between anthropology and nursing. A prime objective of transcultural nursing has been the translation of concepts from anthropology and nursing into the nursing process to guide a culturally informed clinical practice. To date, there has been a general inability of transcultural nursing to operationalize the concept of culture to develop culturally competent clinicians; that is, nurses who are capable of knowing, utilizing, and appreciating the effects of culture in the resolution of an individual, group, community, and/or family problem. A model of transcultural nursing is described, for incorporating the concept of culture into patient care. It includes the concepts of cultural brokerage, simultaneous dual ethnocentrism, multiple clinical realities, the patient as cultural informant, and cultural assessment of patient views of clinical reality. The problems of making anthropology and transcultural nursing clinically relevant through the transcultural nursing model are presented and methods are recommended for addressing such problems.