Splenic epithelial cysts and splenomegaly: diagnosis and management

Little consideration has been given to the philosophical tenets that underlie existing family nursing theory and practice and that ultimately influence the content and process of family nursing education. This article emphasizes the importance of students and faculty engaging in a critical analysis of family nursing theory and practice. A pedagogical approach that employs phenomenology, feminism, and critical social theory as observational lenses for examining the ontology and epistemology of family nursing is described. While family nursing is coming to be recognized as an essential element of any nursing curriculum, family nursing pedagogy is in its infancy. Family nurse educators are currently working toward developing curricula and educative processes that will furnish students with a theoretical (scientific) base for family nursing practice and will provide them with opportunities to develop the practice skills they need to work with families (Hanson & Heims, 1992; Wright & Bell, 1989). However, little consideration has been given to examining the philosophical tenets that underlie existing family nursing theory and practice and that ultimately influence the content and process of family nursing education (Richards & Lansberry, 1995). This article asserts that critical analysis of family nursing theory and practice is integral to family nursing pedagogy and must be a primary consideration in the advancement of family nursing education. The discussion is in two parts. Part I highlights the importance of a critical analysis of family nursing theory and practice including both ontological and epistemological inquiries. Part II describes a critical pedagogy of family nursing that addresses both ontology and epistemology.     

The framework of systemic organization applied to older adults as family caregivers of persons with chronic illness and disability

The Framework of Systemic Organization by Friedemann, according to which families as open systems strive for congruence, a dynamic state of equilibrium, is presented to offer a way to bridge the gap between grand and mid-range theory, between theory and practice. Theoretical tenets composed of system targets of stability, growth, control, and spirituality and the process dimensions of system maintenance and change, coherence, and individuation are suggested for nursing assessment for older adults, individuals, and families. Simple practice application examples of these tenets are delineated for older adult family caregivers of persons with chronic illness and disability within a family system context. Nurses who practice within the Framework of Systemic Organization can assist elders, as family caregivers, in a meaningful way to adjust to the realities of their situation.     

Understanding Huntington's disease: an overview of symptomatology and nursing care. Nurses must balance safety, quality-of-life issues, the need for personal choice, and the meaning of human dignity when caring for patients with Huntington's disease

Patients and families who have been affected by HD deserve high-quality and dignified nursing care. The complexity and extent of losses and uncertainties imposed by this illness challenge nursing. We have briefly reviewed the current state of knowledge regarding the illness and the nursing interventions appropriate for working with people with HD. What is missing is an empirically validated body of interventions to guide nursing practice. Nursing research is needed to validate existing care practices, generate new interventions, and to begin to build theoretical explanations that assist nurses in providing care to people with Huntington's disease.     

On-line polymerase chain reaction (PCR) monitoring

Outcomes management has received increased attention in the current health care environment, but nursing participation has been limited due to the lack of standardized data about the effects of nursing practice. The Nursing Outcomes Classification (NOC) provides a standardized language that can be used to measure the effects of nursing practice on patient outcomes. An overview of the classification and implementation methods is provided.     

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.     

A novel method for the determination of T-cell proliferative responses in patients with uveitis

In 1969, at the first Nursing Theory Conference, Hildegard Peplau proposed a research methodology that would guide the development of nursing knowledge. To direct nurses in the development of practice-based theory, Peplau proposed a three-step process that would assist in this pursuit. The purpose of this paper is to describe the use of Peplau's process of practice-based theory development as it has directed a program of research in the area of depression. Peplau's ideas related to practice-based theory development came at a time in nursing when grand theories were being developed and theoretical nursing was highly valued. Peplau, ahead of her time, proposed an approach that valued the development of nursing knowledge in practice, while also combining both qualitative and quantitative methods. This research methodology deserves recognition today, as one that can guide knowledge development in psychiatric nursing.     

Autonomy in practice: are nurse practitioner students being prepared for reality?

This article reports on a study examining the relationship between nurse practitioner students' expectations of future professional autonomy and the level of autonomy experienced by certified nurse practitioners. The findings indicate that practicing nurse practitioners experience a greater sense of autonomy than student nurse practitioners perceive. As autonomy is an issue of continuing importance in nursing, and for advanced practice, further research is needed to assist schools of nursing in devising reality-based curricula for nurse practitioner programs.     

Glycosylated low density lipoprotein is more sensitive to oxidation: implications for the diabetic patient?

The requisite theoretical base of nursing administration has been defined as a synthesis of knowledge from nursing and other disciplines. The purpose of this paper is to explore the contribution made by nursing knowledge to the distinctive epistemology of nursing administration. The value of nursing theory to administration practice is articulated as well as levels of theory development and their relationship to the knowledge base of nursing administration practice.     

Sublethal effects of an organophosphate insecticide on the European eel, Anguilla anguilla

Recent research has found that family caregivers do not discuss their caregiving in terms of tasks but instead describe their care as shaped by concerns, commitments and goals. The purpose of this paper is to challenge the ways in which nurses approach the family caregiving process and to explore possibilities for evolving nursing knowledge by questioning existing practice in the light of developing insight into the ways in which being a family caregiver is meaningful. A critique of the philosophical orientations of rationalism and empiricism provides a platform to discuss the merits of a Heideggerian phenomenological approach in assisting nurses to better understand family caring experience. Such critique serves to support the notion of displacing the traditional scientific view as the prime means of disclosing truth, acknowledging alternative ways of knowing.     

Cadmium suppresses delta 9 desaturase activity in rat hepatocytes

This paper challenges contemporary portrayals in the nursing literature of the spaces within which care of patients in hospital settings is conducted. Within the wider discourse of fiscal restraint on health care spending, professional nursing has cast its disciplined eyes on details of the nurse-patient relationship for the ostensible purpose of repairing that which is treated as individual failings of nurses to practice in ways prescribed by nursing theories. Set aside in this approach to the so-called 'problems' of nursing practice has been an examination of the conditions within which nurses come in contact with patients, and a critical recognition that such contacts represent skilled accomplishments of social action. In this paper, these conditions are treated as resources available to both nurses and patients to generate accounts for the nurse's presence as well as the nurse's absence. Examples from an ethnographic study of nursing practice are used to illustrate how the spaces operating between nurses and patients are not empty voids but are social spaces through which particular meanings about nursing care can be conveyed.     

The importance of geriatrics to family medicine: a position paper by the Group on Geriatric Education of the Society of Teachers of Family Medicine

The role of geriatrics and geriatricians in family medicine remains unsettled. Despite a rapidly aging population, a tremendous shortage now exists of faculty with interest and expertise in geriatrics. Relatively few family practice residents choose to enter geriatric fellowship programs, and federal funding for such programs has been reduced. Despite accreditation requirements, residency programs are not always able to provide the range of geriatric experiences needed to properly prepare graduates to provide care for the broad range of older patients. Medical students' exposure to geriatrics remains limited. The Group on Geriatric Education of the Society of Teachers of Family Medicine believes that family medicine faculty must recognize and be committed to the notion that geriatrics is integral to family medicine. Both undergraduate and residency training programs should emphasize experience with geriatric patients in multiple settings. In particular, the nursing home should not be the main focus of geriatric training. The small number of certified geriatric faculty will be able to provide leadership, but a broad range of faculty must become involved in teaching geriatrics. Faculty development activities and continuing education programs to foster the necessary expertise will be essential to the accomplishment of this task.     

Isotopic ventriculography in healthy young volunteers. Their response to different types of stress

BACKGROUND AND OBJECTIVES: This study determined the perceived characteristics of family practice residency training programs that produce a high percentage of graduates who provide maternity care. METHODS: We surveyed a Delphi panel of 28 family practice maternity care experts. RESULTS: Consensus was reached after the third survey. The characteristics of the family medicine faculty and teaching service were rated as most important. Other essential characteristics were an adequate obstetrical training volume; mutual respect between obstetric and family medicine faculty and residents; support for family practice maternity care from obstetricians, administration, and nursing staff; and family physicians being accepted in the community as maternity care providers. CONCLUSIONS: Family practice residency programs that produce a high percentage of graduates who provide maternity care have a unique, family practice maternity care-friendly environment. Residency programs wishing to increase the percentage of their graduates who provide maternity care should ensure that their faculty support family practice maternity care, are competent in maternity care, and model maternity care in their own practices. They should strive to ensure an adequate volume of obstetrical cases for resident education and work toward educating patients and local obstetricians, nursing staff, and hospital administration regarding family practice maternity care.     

Preliminary electrochemiluminescence studies of metal ion-bacterial diazoluminomelanin (DALM) interactions

Over the past 10 years there has been a growing body of literature on family nursing. Although the term 'family nursing' is not one which is in common use in the UK, a significant amount of literature has appeared which discusses issues relating to the nursing support of families with a member who is ill. This paper will review the concepts involved and will then discuss the appropriateness of such an approach within the specialty of intensive care. As the paper concludes that family nursing could be an appropriate approach to nursing the patient in this type of area, it would seem logical to consider what needs the family may have. The research concerning the identification of the needs of families when they have a member in intensive care is discussed in part two.     

Resident training in nursing home care: survey of successful educational strategies

OBJECTIVE: To identify educational strategies for resident training in nursing home care deemed successful by a large number of programs. DESIGN: A mail survey with three follow-up mailings. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs. MEASUREMENTS: Open- and closed-ended questionnaire eliciting curricular content, instructional strategies, and evaluation techniques from programs offering a nursing home experience. Identification of barriers to implementation of a nursing home curriculum and recommendations for success were requested. MAIN RESULTS: Of the 814 surveys mailed, 537 were returned for a response rate of 66%. Nursing home experiences were required in 86% of family practice residency programs but in only 25% of internal medicine programs. Most geriatric medicine curricular content areas were taught in the nursing home; however, relatively little emphasis was given to rehabilitation, organization, and financing of health care, and coordination of care between acute and chronic settings. Direct patient care, bedside rounds, and lectures were the most common instructional strategies reported. Evaluation approaches included faculty observations, resident attendance, and chart reviews with written and skill-based examinations infrequent. Availability of faculty and conflict with other rotations were identified as the principal barriers to implementation of nursing home rotations. An organized nursing home curriculum supervised by enthusiastic faculty using a longitudinal rotation format with resident involvement in an interdisciplinary team was recommended. CONCLUSIONS: Educational strategies exist for successful implementation of a residency nursing home curriculum. Greater priority must be given to training residents in nursing home care and developing nursing home faculty to substantially increase the number and quality of physicians who practice in this setting.     

Experimental teleradiology. Novel telematics services using image processing, hypermedia and remote cooperation to improve image-based medical decision making

Various reports draw attention to the deficiency of services available for critically ill children. In December 1993 the British Paediatric Association published a report by a multidisciplinary working party on intensive care. The Minister of Health has apparently promised to act on the recommendations the working party made. In fact, purchasers are being encouraged to act and ask questions about the provision of paediatric intensive care--but no extra funding is available to provide it. However, this will all take time and until more resources are available children are still being cared for on adult intensive care units by nurses who may not be experienced in caring for sick children. One of the main areas of concern nurses have when caring for children is the physiological differences between an adult and a child. This paper is designed to assist in identifying the differences and consequent nursing implications. In an attempt to prioritize the nursing care a systems/modified model has been used over 2 papers. The review of the systems demonstrates the differences between adults and children and, where possible, highlights the nursing care and medical treatment a child requires. All aspects of care have been included as well as the psychological problems (see Part 2 which will be published in the next issue) encountered by the family of a critically ill child. Where possible easy reference tables have been included and the author hopes to introduce the package into the existing orientation programme for established staff and staff new to the unit in the hopes of decreasing the stress when a child is admitted. Paediatric resuscitation has not been covered intentionally, as the information on the physiological differences seemed to grow like 'Jack's beanstalk'. Therefore, a flow chart for basic and advanced life support is included as an appendix in Part I. It is hoped this will stimulate readers' interest for more in-depth study.     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.     

Providing the Advanced Life Support in Obstetrics Course within the military family practice training system

"The Advanced Life Support in Obstetrics (ALSO) Course is designed to assist health professionals in developing and maintaining the knowledge and skills they will need to effectively manage the emergencies which arise in obstetrics." Given the fact that the vast majority of military family physicians provide maternity care, often in small overseas facilities without in-hospital obstetrician backup, inclusion of this course into the military family practice residency training curriculum would be very beneficial to the mission of family practice within the military. A brief background of the ALSO movement and the ALSO course curriculum are provided. Lessons learned to aid military family practice departments in providing quality ALSO courses are described, as are arguments for the inclusion of ALSO training into military family practice training curriculums.     

Nursing theory: everything the artist spits is art?

This paper explores the concept and utility of nursing theory in and for the practice of nursing. Working from the premise that many nurse practitioners appear uncertain as to the value of theory in relation to their everyday working experience, the paper investigates the contribution nursing theory makes in terms of sustaining and developing nursing as a practice discipline. The fact that nursing theory remains at once poorly evaluated, articulated or understood appears to be compounded by a general perception of nurse theorists as being removed from the realities of the practice setting and by the confusion precipitated, not least, by the semantic ambiguity engendered by their writings. The paper reviews the complex relationships extant between the development of nursing theory in regard to its utility for nursing practice, and concludes by suggesting a practice-led perspective by which nursing theory may be better articulated and assimilated within the discipline. In order to facilitate the study, it has been necessary to investigate the historical, theoretical and philosophical imperatives pertaining not only to the development of nursing theory but to nursing research and nursing practice per se.     

The investigation of the effectiveness of extended radiation depending on the dose and time of exposure based on the body''s reaction and the body''s individual systems in the near postradiation period

The need for sound research data to support regulatory decisions related to advanced nursing practice has never been greater. Although advanced practice nurses (APNs) are frequently exhorted to engage in research and to become involved in the political arena, there is little published evidence that nursing research has been used to influence health policy. This article presents two case examples of the effective use of research findings to influence regulatory policy in two different states. Factors involved in using research to shape policy are discussed, including recommendations for nursing policymakers and researchers. Research is a powerful tool that APNs can and should use to make a difference in regulatory legislation.     

Reaffirming the relevance of culture for nursing

This article reaffirms the relevance of the concept of culture for nursing and suggests the utility of recent developments in culture theory. Culture has long been considered to play an important role in the practice of nursing. The historical development of the concept of culture is reviewed with emphasis on nurse scholars and anthropologists who have addressed culture as an area of inquiry. The meaning-centered perspective of culture, to include embodiment, is reviewed and recommended as a means of addressing the current emphasis on cultural diversity in nursing. This perspective is seen as having broad implications for both advancing theoretical development in nursing and for nursing practice.