bluuebunny/crossref_metadata_2025 huggingface dataset:
Vital pulpotomy in the primary dentition: attitudes and practices of Specialists in paediatric dentistry practising in the United Kingdom
Authors: Hunter M. L. , Hunter B.
Published: December 2004

Summary.Objectives.This study was designed to examine the attitudes and practices of Specialists in Paediatric Dentistry practising in the United Kingdom in relation to vital pulpotomy in the primary dentition.

Design.Data were collected by postal questionnaire.

Sample and methods.All dentists whose names were entered on the General Dental Council's Specialist List in Paediatric Dentistry, and who were resident and practising in the United Kingdom, were asked to complete a questionnaire consisting of nine questions.

Results.Questionnaires were returned by 184 (86·8%) of the eligible Specialists in Paediatric Dentistry. These yielded a sample group of 179 Specialists practising the primary vital pulpotomy technique. The most commonly used medicament was formocresol, with a 1 : 5 dilution being used by 66·5% of the sample. More than half (54·2%) of the Specialists practising the technique expressed concern regarding their preferred medicament. Without exception, their concerns related to the potential adverse effects of formocresol and formaldehyde. Seventy‐five respondents (41·9% of the sample) were considering changing their technique. One hundred and thirty‐seven Specialists stated that they routinely took preoperative radiographs, while postoperative radiographs were routinely taken by 107 Specialists (76·5% and 59·8% of the sample, respectively). Rubber dam isolation was used by 62·6% of the sample.

Conclusions.The majority of Specialists are adhering to the UK national clinical guideline for pulp treatment of the primary dentition. However, significant numbers are considering changing their chosen technique. There is a lack of consensus on the use of pre‐ and postoperative radiographs; specific guidance with respect to their use is required.
Psychiatric nurses' satisfaction: the effects of closure of a hospital
Authors: Sammut Robert G.
Published: December 2004

A survey by questionnaire was carried out to examine the level of nursing staff satisfaction with the acute psychiatric services. Comparisons were made between views of older psychiatric hospitals and newer district general hospital units, and before and after the closure of Friern Barnet Hospital, London, England when the service was reorganized to include fewer beds. The importance of nurses having their say is emphasized, and areas in which improvements can be made are suggested.
Learning from errors in nursing practice
Authors: Meurier C.E. , Vincent C.A. , Parmar D.G.
Published: December 2004

Little attention is paid to the issue of errors in nursing practice. Staff are reluctant to discuss or publicize them. However, as clinical audit and quality management become more important and established in the health service, there is now a greater need to investigate and monitor the incidence of errors. The purpose of this study was to examine the causes and consequences of errors as well as the potential for errors to initiate changes in practice. One hundred and twenty‐nine nurses answered a 22‐item questionnaire relating to an error they had made. Nurses reported that the most common causes of errors were lack of knowledge or information, work overload, stressful atmosphere and lack of support from senior staff. Nurses were found to have recourse to a number of coping strategies in the aftermath of the error. Accepting responsibility and planful problem‐solving were found to lead to positive changes in practice, whereas distancing and self‐controlling strategies were associated with defensive changes, particularly with a tendency not to divulge the error. The findings also showed that errors had the potential to effect learning. The study suggests the need for staff to be encouraged to accept responsibility for their error within the framework of support. Strategies should be developed so that errors can be managed in a more constructive manner.
The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension
Authors: Erci Behice , Sayan Ayşe , Tortumluoǧlu Gülbu , Kiliç Dilek , Şahin Olcay , Güngörmüş Zeynep
Published: December 2004

Background.  Nurses caring relationships with hypertensive patients can have a positive effect upon their blood pressure and may increase quality of life and prolongation of life. Hypertension affects a large number of people. It is important that those affected receive, in addition to the best available medical treatment, nursing care that best meets their needs and adds to the quality of their lives. Watson's Caring Model is one nursing approach consistent with needs of persons with hypertension, and was used in this study to guide both research and practice.

Aim.  To determine the effectiveness of a nurse's caring relationship according to Watson's Caring Model on the blood pressure and the quality of life of patients with hypertension.

Methods.  The design of the study was a one‐group pretest and post‐test. The study included 52 patients with hypertension in four health care units in Erzurum, Turkey in 2000. These patients had been diagnosed with hypertension and invited to participate in a research project involving nursing care. After acceptance, patients were given questionnaires consisting of demographic characteristics; their blood pressure was measured, and a quality of life scale was administered. Each of the participating nurse researchers was prepared in the use of Watson's Theory and Model of Caring (and the 10 Carative Factors). This training formed the basis of the caring process used by the nurse researchers who then visited the patients and their families once a week for blood pressure measurement for a 3‐month period. At the end of care, the quality of life scale was applied to patients, and blood pressures were measured as the post‐test.

Results.
 There were statistically significant differences between mean scores of general well‐being (
t
 = 3·097, d.f. = 51,
P
 = 0·003), physical symptoms and activity (
t
 = 2·994, d.f. = 51,
P
 = 0·004), medical interaction (
t
 = 2·127, d.f. = 51,
P
 = 0·035). There were also significant differences between blood pressure (systolic:
t
 = 4·830, d.f. = 51,
P
 = 0·000; and diastolic:
t
 = 3·51, d.f. = 51,
P  = 0·001) in pre‐ and post‐test.

Conclusion.  This study demonstrated a relationship between care given according to Watson's Caring model and increased quality of life of the patients with hypertension. Further, in those patients for whom the caring model was practised, there was a relationship between the Caring model and a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life.
Limit‐setting and decision‐making in the management of aggression
Authors: Lowe Trevor , Wellman Nigel , Taylor Richard
Published: December 2004

Background.  Several published research studies have suggested that inpatient aggression against nursing staff may be directly precipitated by common nurse–patient interactions. This study sought to examine the structure of nurses' judgements in situations of conflict.

Method.  Seventy practising United Kingdom psychiatric nurses were presented with a number of conflict scenarios and were asked to rate a range of intervention options for each scenario according to how appropriate they perceived those interventions to be. Their responses were analysed using multidimensional scaling techniques.

Results.  The results suggest that issues associated with limit setting and autonomy were perceived as most important by the nurses and that these issues are most likely to lead to disagreements in judgement between nurses of different status. Nurses of higher grades (levels) showed a significantly greater preference for respectful and autonomy‐confirming interventions than their more junior nurses. These results have training and policy implications and further research should examine the effects of such nursing judgements on patient care.
Effectiveness of home‐based cardiac rehabilitation for special needs patients
Authors: Warrington Darrell , Cholowski Krystyna , Peters David
Published: December 2004

Background.  The benefits of cardiac rehabilitation programmes have been well documented including reductions in mortality, improved physical performance, and improved quality of life. However, a large number of special needs patients often fail to access these programmes. Of particular concern are elderly patients with chronic illness and disability.

Aims.  To evaluate the effectiveness of a home‐based cardiac rehabilitation programme in improving health outcomes and rehabilitation access for special‐needs patients.

Design.  Using a one‐group pre and post‐test quasi‐experimental design 40 elderly patients recently discharged from hospital following a cardiac event completed the Short Form Health Survey, the Angina Quiz, and the Exercise Assessment Questionnaire prior to undertaking home‐based rehabilitation. The rehabilitation programme consisted of four community nursing contacts over a 9‐week period primarily aimed at individual patient education and carer support.

Analysis.
 Descriptive statistics provided analysis for demographic data. Repeated measures multivariate analysis of variance (
manova ) were computed to examine changes in health‐state and practices.

Results.  Significant positive changes were found for measures of quality of life, knowledge of angina, and exercise tolerance. Additionally, the higher levels of participation and completion by older women was encouraging. Development of carer competence through an improved knowledge base and nursing support was also evident.

Limitations.  While theoretically defensible positive outcomes were found these results need to be replicated in a larger study. Similarly, the limitations imposed by a single group pretest, post‐test design suggest that claims of generalizablity need to be limited to the specific variables measured in this study.

Conclusion.  The study demonstrated medium term positive health outcomes. These positive findings suggest that home‐based rehabilitation using larger samples of older patients with comorbidities, and using randomized comparative group designs, may be a fruitful area in future research.
Poorly served? Eating and dementia
Authors: Manthorpe Jill , Watson Roger
Published: December 2004

Background.  People with dementia encounter problems in eating and these have been reported in various studies. Many of these studies focus on individual difficulties and neglect the social, environmental and cultural aspects of meals and eating. Studies often centre on the problems of providing food instead of the experience of those receiving food. Less is known of the perspectives of family carers and residential or domiciliary care staff than of nurses’ perceptions. Only recently are the perspectives of family carers and people with dementia joining nurses’ discussions.

Aim.  The present paper considers feeding and eating in the context of enhancing support of life for people with dementia. Drawing on a range of literature, it highlights themes that are well developed and aims to identify areas of little knowledge and potential investigation.

Conclusions.  In the United Kingdom, the areas of feeding and eating are likely to assume greater importance in attempts to promote rehabilitation, in moves to offer training to unqualified staff and in enhanced vigilance of the experience of people with dementia. Their problems with respect to food and its consumption need to be interrogated and informed by interventions that are ethical, socially inclusive and acknowledge the importance of food to well‐being.
Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan
Authors: Heh Shu‐Shya , Fu Yu‐Ying
Published: December 2004

Aim. The aim of the study was to investigate the effectiveness of informational support in reducing the Edinburgh Postnatal Depression Scale (EPDS) scores in Taiwan.

Methods. Five hundred Taiwanese women were screened during the fourth week after giving birth and those with a score of over 10 on the EPDS were considered to be at risk of postnatal depression. Seventy postpartum women were randomly allocated to the experimental or control group. Only those in the experimental group received informational support about postnatal depression during the sixth week postpartum. Two groups were assessed by the EPDS at 3 months postpartum to explore their depressive status.

Results. Taiwanese women who received informational support about postnatal depression 6 weeks after giving birth experienced lower EPDS scores at 3 months postpartum than those who did not receive this information.

Conclusions. The findings suggest that informational support about postnatal depression given to women in the postnatal period may contribute to psychological well‐being.
Perceiving risk in dangerous situations: risks of violence among mental health inpatients
Authors: Trenoweth Steve
Published: December 2004

Background. Violence in British psychiatric hospitals appears to be escalating, with nursing staff the most frequent victims of assault. There is also public concern about violence on the part of individuals with mental health problems. In this climate, assessing a patient's risk of violent behaviour has become an important part of mental health care. However, little research has been published into how mental health nurses undertake such assessments in their day‐to‐day clinical practice.

Aim. The study focused on how mental health nurses make assessments of risk in clinical crisis situations where there is a perceived likelihood of imminent violence. The study sought to identify skills, cognitive processes or any other mechanisms which nurses draw upon to assist in such assessments.

Method. Ten experienced mental health nurses working in a secure mental health environment were interviewed and data generated was analysed using a grounded theory approach. An in‐depth literature search was also undertaken.

Findings. It was found that, in their risk assessments, nurses rely extensively on their personal knowledge of their patients (in particular, previous history of violent behaviour; biographical data; and impact of the mental health problem on violent behaviour). Nurses ‘tune in’ to potentially violent situations by observing a scenario as a whole, as well as specific aspects of a patient's behaviour, whilst also searching for causes of the violent behaviour. In making clinical risk assessments, nurses often make rapid, intuitive judgements in which various possibilities are considered regarding the likelihood of violent behaviour (such as the capacity and capability of a patient to be violent and the potential in the situation). It was also found that the ability to intervene successfully in potentially violent situations reduced the level of risk that nurses felt exposed to, and here nurses draw on their knowledge of a particular patient. They also perceive lower levels of risk when working in a skilled team.

Conclusion. The study indicates that the development of nurse–patient relationships and working in a supportive team are perceived as protective factors against risk. Implications of the research are discussed in relation to nurse–patient relationships, particularly in the context of the current nursing climate and the way in which violent behaviour may lead to an erosion of these relationships. The importance of ‘working in a team’ is discussed, as is the consequence of the findings for education and development. Methodological limitations of the study are also discussed.
Sexuality after hysterectomy: a review of the literature and discussion of nurses' role
Authors: Katz Anne
Published: December 2004

Aim. To review the literature on studies of sexuality after hysterectomy and to identify barriers to nursing assessment of this aspect of human functioning.

Methods. Articles published between 1970 and 2002 on female sexuality, hysterectomy, and nursing assessment of sexuality were located using MEDLINE, CINAHL, Psychlit and Sociofile databases. Study findings were reviewed in relation to the effect of hysterectomy on sexuality, as well as women's perspectives on hysterectomy. Barriers to nursing assessment of sexual functioning are described with suggestions for inclusion of this topic in practice.

Conclusions. There are very few nursing studies on the topic, which may reflect the lack of inclusion of sexual assessment and education in clinical practice. Reasons for this are discussed, and instruments used in sex research are described. There are a number of gaps in the knowledge base on to this topic. Future research in this area is needed to provide direction for nurses in this aspect of clinical practice.
Feeding nursing home patients with severe dementia: a qualitative study
Authors: Pasman H. Roeline W. , The B. Anne Mei , Onwuteaka‐Philipsen Bregje D. , Van Der Wal Gerrit , Ribbe Miel W.
Published: December 2004

Aim. To describe the nature of problems nurses face when feeding nursing home patients with severe dementia, and how they deal with these problems.

Background. In our study on starting or withholding artificial nutrition and hydration for nursing home patients with dementia, we found that many problems in feeding arose (long) before any decision was made about artificial feeding, namely from the first moment a patient needed help with meals. Because ‘ordinary feeding’ was experienced as a daily recurring problem for nurses, we decided to investigate this within the study.

Methods. Participant observation by two researchers in two Dutch nursing homes.

Findings. Nurses interpreted the aversive behaviour of patients differently, and a link between interpretation and responses (stop or continue feeding) was observed. Differences in interpretation with regard to the same patient were observed in nurses in five of the seven units. Only in three units did nurses discuss their different interpretations in an attempt to find out why a patient avoided food and fluids and how to deal with these problems.

Conclusions. Nurses' interpretations of aversive behaviour of patients differ. No definite conclusions can be drawn about the causes of the aversive behaviour observed, because they cannot be verified. We recommend that interpretations of the behaviour of particular patients should be discussed by nurses with physicians, other disciplines and the patient's family to obtain more insight into all its possible causes and to determine together the most likely interpretation and appropriate way in which to deal with the aversive behaviour. This would give nurses more confidence and improve the quality and continuity of care provided. To structure the search for possible causes of aversive behaviour, we developed a framework of causes of aversive behaviour and domains of functioning.
Meaning of life for adolescents with a physical disability in Korea
Authors: Kim Shin Jeong , Kang Kyung Ah
Published: December 2004

Background.  Korean views and attitudes towards disabled people are generally negative. Because of this, living with life‐long disabilities in Korea means pain for oneself and one's family. Also family members think that the disability is detrimental to their social standing and try to hide the disabled person. Koreans believe that having disabilities is the result of the geomantic system of topography, used in choosing auspicious sites for graves and houses, sins committed in a previous existence, the fault of an ancestor, or a wicked ghost.

Aim.  The objective of the study was to provide an understanding of how adolescents with physical disabilities see meaning in their lives, with the ultimate aim of encouraging these adolescents to find their own values and meanings of life.

Design.  An inductive and descriptive study to understand the perspective of adolescents with physical disabilities.

Methods.  Eighty‐eight adolescents with physical disabilities were interviewed in depth and content analysis was used for analyzing the data.

Findings.  Adolescents with physical disabilities in Korea experience meaning in their lives when society accepts their existential problems and allows them to live a normal life. This normality includes helping others (as a friend or as a volunteer) and creating opportunities to achieve their own goals in life. The main categories in the findings were ‘accomplishment’, ‘social adaptation’, ‘improvement of the quality of life’, ‘good deeds’, ‘sincerity’, ‘satisfaction’, ‘having a relationship’, ‘achievement of self’, ‘perception of one's own usefulness’, ‘rehabilitation’, and ‘gain recognition by others’.

Conclusion.  Adolescents with physical disabilities can understand the meaning of their lives when meaning is framed in the context of being a social issue, and when they are allowed to clarify their own values. Nursing intervention programmes need to be developed to improve the quality of physically disabled adolescents’ lives.
Transition experiences of qualified nurses moving into hospice nursing
Authors: Rosser Megan , King Lindy
Published: December 2004

Background.  Over a short period of time a number of nurses had joined the staff at a hospice. Many of these nurses were palliative care novices, and thus their transition into hospice nursing constituted a move both to a new workplace and a new clinical specialism.

Aim.  The aim of the study was to gain a deeper understanding of the experiences of qualified nurses making the transition into hospice nursing in order to support future nurses in this transition.

Method.  A constructivist approach was used; data were collected through semi‐structured interviews with four new nurses, three mentors and four team leaders. Data were analysed using a constant comparative method.

Findings.  Five major themes were identified: expectations, personal and professional development, professional respect, mentorship and support. Nurses came to the hospice with individual expectations, some of which were realized. All identified areas of personal and professional development. Whilst it was acknowledged that new nurses brought transferable skills, there was consensus that they needed to develop palliative care knowledge and skills. Professional respect was demonstrated by the degree of acceptance or questioning of new nurses by established staff. New nurses experienced a variety of emotional responses to hospice nursing. Mentorship enhanced the transition experience and strong support was also gained from each other.

Conclusions.  New nurses need individual support during their transition into hospice nursing in response to their own expectations, experiences and learning needs. Mentors need preparation and support in their role in order to maximize their positive influence on transitions.
Expert qualitative researchers and the use of audit trails
Authors: Cutcliffe John R. , McKenna Hugh P.
Published: December 2004

Background. Determining the credibility of qualitative research findings remains a contested area and leaves the way open for additional theoretical and methodological discussion.

Aims. In this paper we focus on audit trails and confirmability, within the context of ‘expert’ qualitative researchers. Having outlined the audit trail process, we develop existing arguments about the ‘expert’ qualitative researcher. We then juxtapose the two, highlighting a number of issues in an attempt to advance the debate.

Discussion. These issues discussed are: (1) The shifting sands of methodological orthodoxy – the historical context in which audit trails emerged. (2) The individual construction of logic. (3) ‘Grounded in the data’ or ‘going beyond the words’– the key differences between descriptive and interpretive findings. (4) The singular relationship between qualitative researcher and their data. (5) The growing acknowledgement that method alone is insufficient. (6) The challenging example of visionaries.

Conclusion. We argue that using audit trails as a means to achieve confirmability of qualitative research findings is an exaggeration of the case for method, and may do little to establish the credibility of the findings. We also introduce a preliminary case for testing the credibility of theory induced by expert qualitative researchers, in part by means of its usefulness; its ‘fit and grab’, rather than by the researcher's adherence to contemporary methodological orthodoxy. In other words, the absence of audit trails does not necessarily challenge the credibility of qualitative findings, particularly if an expert qualitative researcher produced the findings.
Nurses’ autonomy: influence of nurse managers’ actions
Authors: Mrayyan Majd T.
Published: December 2004

Background.  Autonomy plays an important part in nurses’ job satisfaction and retention, but the literature shows that they are often dissatisfied with this aspect and want better working conditions and greater autonomy in decision‐making.

Aims.  The aim of this study was to examine the role that nurse managers have in enhancing hospital staff nurses’ autonomy.

Methods.  The study used a comparative descriptive survey design. Data collection took place over the Internet through the use of selective listservs in the United States of America (USA), Canada, and the United Kingdom. Of the 317 hospital nurses participating, 264 (83·3%) were from the USA. Differences relating to nurses, nurse managers, and hospital settings were controlled in the analysis.

Results.  Nurses were more autonomous in making patient care decisions than unit operational decisions, and they perceived their autonomy to be at a moderate level. Those who were autonomous in patient care decision‐making were also likely to be autonomous in unit operation decision‐making. Nurse managers’ actions had a strong relationship with nurses’ autonomy in deciding on patient care and unit operation decisions, and with total autonomy. The three important variables that were reported by staff nurses to increase their autonomy were supportive management, education and experience. The three most important factors that were reported to decrease nurses’ autonomy were autocratic management, doctors and workload.

Discussion.  Technical issues such as the availability of listservs, valid e‐mails, viruses, and familiarity with the Internet and its applications were the major limitations of this study. Nurses’ autonomy over patient care and unit operations decisions needs to be enhanced, and nurse managers should promote this. Similarly, there is a role for nurse education, both in preregistration programmes and in continuing education for managers. Further research needs to explore the barriers that nurses face in autonomous decision‐making and how nurses’ participation in unit operational decisions can be promoted.

Conclusions.  Hospital staff nurses have moderate autonomy which could be increased by more effective support from nurse managers. The use of electronic questionnaires is a promising data collection method.
Enhancing critical thinking in the preceptorship experience in nursing education
Authors: Myrick Florence , Yonge Olive
Published: December 2004

Background.  To date no research has been conducted to examine the process used in the preceptorship experience to enhance critical thinking at the graduate level. This study provides data that could revitalize the preceptor/learner relationship and in turn influence future preceptorship programmes in graduate nursing education.

Aim.  The purpose of this study was to examine the preceptorship experience and its role in the enhancement of critical thinking in graduate nursing education.

Design.  A grounded theory approach was employed, through semi‐structured, tape‐recorded interviews. Overall, 45 interviews were completed with graduate nursing students ranging in age from 26 to 53 years, and master's and doctorally prepared preceptors who ranged in age from 47 to 58 years. In addition, a journal of personal reflections was kept by each of the researchers. Analysis of data included the process of open coding, theoretical coding, selective coding, reduction and comparison.

Findings.  Data revealed that a process, designated The Relational Process, occurred in the preceptorship experience to enhance the critical thinking ability of graduate nursing students. This process was found to be a complex, ongoing interpersonal dynamic between the graduate student and assigned preceptor.

Conclusions.  The relational process that emerged from this study indicates that specific preceptor behaviours are pivotal to the enhancement of critical thinking of graduate nursing students and ultimately impact on the success or failure of the preceptorship experience.
Cancer‐related pain in palliative care: patients’ perceptions of pain management
Authors: Boström Barbro , Sandh Marie , Lundberg Dag , Fridlund Bengt
Published: December 2004

Background.  Pain is still a significant problem for many patients with cancer, despite numerous, clear and concise guidelines for the treatment of cancer‐related pain. The impact of pain cognition on patients’ experiences of cancer‐related pain remains relatively unexplored.

Aim.  The aim of this study was to describe how patients with cancer‐related pain in palliative care perceive the management of their pain.

Method.  Thirty patients were strategically selected for interviews with open‐ended questions, designed to explore the pain and pain management related to their cancer. The interviews were analysed using a phenomenographic approach.

Findings.  Patients described 10 different perceptions of pain and pain management summarized in the three categories: communication, planning and trust. In terms of communication, patients expressed a need for an open and honest dialogue with health care professionals about all problems concerning pain. Patients expressed an urgent need for planning of their pain treatment including all caring activities around them. When they felt trust in the health care organization as a whole, and in nurses and physicians in particular, they described improved ability and willingness to participate in pain management. While the findings are limited to patients in palliative care, questions are raised about others with cancer‐related pain without access to a palliative care team.

Conclusion.  The opportunity for patients to discuss pain and its treatment seems to have occurred late in the course of disease, mostly not until coming in contact with a palliative care team. They expressed a wish to be pain‐free, or attain as much pain relief as possible, with as few side effects as possible.
Coping and stress: a conceptual analysis
Authors: Keil Ruth M.K.
Published: December 2004

Background.  Much work has been done towards the classification of clinical concepts in nursing. However, there is a comparative lack of analysis of non‐technical terms, which nevertheless bear closely on professional practice in nursing. Within nursing classifications, the term ‘coping’ functions as an element in more complex conceptual structures, the term itself being left relatively undefined. The case is similar for the term ‘stress’– the set of circumstances with which the individual is attempting to cope.

Aims.  The aim of this paper is to arrive at grounds for consensus over the use and meaning of the widely used terms ‘stress’ and ‘coping’.

Methods.  A conceptual analysis of the terms ‘stress’ and ‘coping’ was carried out, looking at etymology, ordinary usage and theoretical contingencies, in order to generate paradigmatic cases. A range of nursing and non‐nursing literature was examined in order to illustrate further the range of the terms.

Conclusions.  ‘Stress’ and ‘coping’ are terms which are widely used in nursing; their significance has varied overtime and in the literature, and there continues to be lack of clarity over their precise meaning and use.
Ryanodine‐ and cyclopiazonic acid‐sensitive components in human vas deferens contractions to noradrenaline
Authors: Amobi N. I. B. , Smith I. C. H.
Published: December 2004

The role of calcium stores in noradrenaline‐ (NA) and caffeine‐induced contractions of human vas deferens were investigated using ryanodine and cyclopiazonic acid (CPA) in the presence of the calcium antagonist, nifedipine (1 μM) or in calcium‐free/EGTA (1 mM) medium.

In either media, NA (100 μM) evoked biphasic contractions of longitudinal muscle and tonic circular muscle contractions. Caffeine (20 mM) evoked longitudinal but not circular muscle contractions.

Ryanodine (1–30 μM) or CPA (1–30 μM) inhibited contractions of circular muscle, and the initial but not secondary component of longitudinal muscle contraction to NA.

In the presence of nifedipine, pre‐exposure to caffeine caused a potentiation of circular muscle, and the initial but not secondary longitudinal muscle contractions to NA. The presence of ryanodine or CPA during the caffeine pre‐exposures effectively blocked the potentiation of the initial component and reduced the secondary component of the subsequent responses to NA in longitudinal muscle.

In calcium‐free media, caffeine pre‐exposures had little effect on subsequent NA‐induced contractions in circular muscle, but reduced both components in longitudinal muscle. The presence of ryanodine or CPA during caffeine pre‐exposures produced no further effects on either component of the subsequent NA‐induced contraction in longitudinal muscle.

In the presence of nifedipine or in calcium‐free media, repeated applications of caffeine evoked contractions in longitudinal muscle which were not blocked by either ryanodine or CPA.

These results suggest that circular muscle contraction by NA and the initial component of longitudinal muscle to NA both utilize an intracellular pool of calcium that is triggered via a ryanodine‐sensitive mechanism and replenished via a CPA‐sensitive Ca2+‐ATPase.

In longitudinal muscle, both the secondary component of its response to NA and contraction to caffeine appear to involve an unusual but pharmacologically distinct (ryanodine‐ and CPA‐ insensitive) pathway.

The quiescence to caffeine of circular muscle may be caused by a relative absence of the ryanodine‐ and CPA‐insensitive pathway.
Pharmacology of neurotransmission to the smooth muscle of the rat and the guinea‐pig prostate glands
Authors: Lau W. A. K. , Ventura S. , Pennefather J. N.
Published: December 2004

Histochemical studies carried out on sections of rat and guinea‐pig prostate glands revealed the presence of acetylcholinesterase‐ and noradrenaline‐containing nerve fibres in the fibromuscular stroma. Positive staining for acetylcholinesterase but not for noradrenaline was also seen in the epithelium.

Electrical field stimulation with trains of 0.5 ms pulses, dial setting of 60 V, delivered at 130 Hz for 10 s at 5 min intervals, was applied to nerve terminals within the rat and guinea‐pig isolated prostate glands. The evoked contractions were frequency‐dependent. Tetrodotoxin (1 μM) abolished contractions evoked by short pulse repetitive stimulation (trains of 20 0.5 ms pulses at 10 Hz every 100 s) in tissues from both species.

The field stimulation‐induced contractions of the prostatic smooth muscle were markedly attenuated by guanethidine (10 μM) and prazosin (0.1 and 1 μM) indicating that neurotransmission to the prostatic smooth muscle in both species is predominantly sympathetic and noradrenergic, and that noradrenaline released during field stimulation acts at postjunctional α1‐adrenoceptors.

Atropine (0.1 and 1 μM) caused a slight but significant reduction of the field stimulation‐induced contractions of prostate smooth muscle from both the rat and the guinea‐pig. In the guinea‐pig, cholinesterase inhibition by physostigmine and neostigmine, both at 10 μM, enhanced the field stimulation‐induced contractions of the prostatic smooth muscle. This enhancement was reversed by atropine (0.1 μM) but not by hexamethonium (0.1 mM). These data are compatible with some participation of acetylcholine, acting at muscarinic receptors, in neurotransmission to prostatic smooth muscle.
Cognitive therapy integrated with life review techniques: an eclectic treatment approach for affective symptoms in older adults
Authors: Puentes William J.
Published: December 2004

Background.  An important aspect of nursing theory development has been the adaptation of theory from other disciplines within the metaparadigm of nursing. This eclectic approach to theory development enhances the broad humanistic theory base on which effective, professional nursing practice is based.

Aims and objectives.  The aim of this article is to describe the process of integrating two distinct psychotherapeutic approaches into one coherent mental health nursing intervention for the treatment of affective symptoms in older adults. Guidelines for using this integration process in psychiatric mental health nursing clinical practice are presented and illustrated through the case study approach.

Methods.  A case study is presented describing a clinical situation in which life review techniques were used to enhance the outcomes of a cognitive therapy experience for older adults enrolled in outpatient psychotherapy treatment for acute adjustment disorder with an affective component.

Conclusions and relevance to clinical practice.  The advanced practice psychiatric mental health nurse who approaches psychotherapeutic interventions with older adult clients from an eclectic approach can achieve successful outcomes by having a clear understanding of (i) the dynamics of the various psychotherapeutic approaches, (i) the skill level of the practitioner, (iii) the psychosocial sophistication of the client, and (iv) the pathology being treated. In addition, active involvement by the client in a treatment process that matches his/her psychosocial skill and coping resource level will contribute to effective resolution of pathology. A cognitive therapy approach supplemented by life review techniques is an excellent example of an effective, eclectic treatment approach of affective disorders in older adults.
Midwifery care: development of an instrument to measure quality based on the World Health Organization's classification of care in normal birth
Authors: Sandin Bojö Ann‐Kristin ‘Fia’ , Hall‐Lord Marie‐Louise , Axelsson Ove , Udén Giggi , Wilde Larsson Bodil
Published: December 2004

Aims and objectives.  The aim of the study was to develop an instrument to measure midwifery care in relation to World Health Organization's classification of care in normal birth and to test the instrument for content validity and inter‐rater reliability.

Methods.  The Delphi method was used for development of the instrument and to elicit evidence of content validity. Six experts from three different geographical regions in Sweden, representing clinically working midwives, lecturers in midwifery and obstetricians, participated in the first part of the study. The instrument was tested for inter‐rater reliability in an exploratory study by two midwives and one of the authors. Data were analysed using percentage of agreement level and the Kappa coefficient.

Results.  Five expert rounds were needed to reach consensus for content validity. The inter‐rater reliability test showed high agreement levels (95.9, 94.2 and 95.7%) and good to very good Kappa coefficients (0.74–1.0). The final instrument consisted of 78 items divided into five sections: background (five items); practices which are demonstrably useful and should be encouraged (55 items); practices which are clearly harmful or ineffective and should be eliminated (five items); practices for which insufficient evidence exists to support a clear recommendation and which should be used with caution while further research clarifies the issue (four items); and finally practices which are frequently used inappropriately (nine items).

Conclusions and relevance to clinical practice.  The instrument can be used at a labour ward to measure documented care and quality of midwifery care. The results can be used to identify areas for improvements, to develop guidelines towards evidence‐based care and to improve documentation. However, the present study should be regarded as an exploratory study and the feasibility of the instrument remains to be tested in empirical studies.
Improving networks between acute care nurses and an aged care assessment team
Authors: Robinson Andrew , Street Annette
Published: December 2004

Background.  Acute care nurses have an important role in the discharge planning of older people from hospital to home. However, few nurses understand the changing aged care system or the consequences of poor referral on the lives of older people postdischarge.

Aims and objectives.  This paper reports the findings of a research project, which aimed to investigate the possibilities for facilitating the transition of older people from hospital to home through improving the working relationship between nurses and members of a multidisciplinary aged care assessment team (ACAT).

Design and methods.  The paper reports one action research cycle from a larger project. Action research was chosen because its focus on knowledge development and action leads to practical solutions to clinical problems. The research approach included interactive forums designed to facilitate effective collaboration between the nurses and ACAT in the discharge planning of older people. Data collection strategies included audiotapes of ACAT research discussions, field notes, policy documents, referral forms and an evaluation tool.

Results and conclusions.  The findings illustrate that ward nurses have, at best, a limited knowledge and understanding of the aged care system, its function, or how to access services. They need assistance to develop their knowledge of services available to support older people following discharge. The conduct of interactive forums, which utilize a case study approach, facilitated such knowledge development and empowered the nurses to become more involved in discharge planning. Participation in the forums also facilitated new collaborative partnerships between the nurses and ACAT, which enhanced effective discharge planning.

Relevance to clinical practice.  The paper outlines practical strategies to support collaboration between ward nurses and community providers and/or multi disciplinary assessment services. It provides a list of key considerations for the development of effective ward/community networks to facilitate the discharge of older people.
The HRQoL of renal transplant patients
Authors: Suet‐Ching Luk Weety
Published: December 2004

Background.  After undergoing kidney transplant surgery, patients face many new challenges. For example, they face new pathologies associated with the complex medical regimens that they will need to follow rigorously for the rest of their lives. They live with the uncertainty and fear of organ rejection. They will also need to acquire new skills to take care of themselves, such as recognizing the signs and symptoms of impending infection and rejection. This suggests that once a transplant has been performed and the patient has been discharged with a functioning graft, the patient must continue to deal with a life of chronic illness.

Aim.  The aim of this study was to explore health‐related quality of life of Chinese kidney transplant patients in Hong Kong.

Methods.  Non‐structured interviews were conducted. The transcripts were analysed by qualitative content analysis. Codes were used to identify a passage of text that the researcher interprets as having a particular meaning. Data analysis is an iterative process. The codes emerging from each new interview were analysed together with the codes which had previously emerged. Across the dataset, codes were compared for similarities and differences, both within and across interviews. Codes of common property were clustered into categories. The transcripts were re‐read and checked against the categories until there was no more to be gleaned, and the titles of the categories reflected the totality of that experience. Interviews were conducted until unique categories were no longer identified. There were 31 participants.

Results.  The participants are complying with medication regimens and nursing recommendations. Although new symptoms related to the medication regime surfaced, participants commented that they improved markedly in physical and social functioning, and have a better quality of life as a whole. Participants expressed their needs regarding information on the side effects of medications, proper exercise and diet.

Conclusions.  To optimize post‐transplant quality of life, a follow‐up rehabilitation programme is recommended.

Relevance to clinical practice.  Rich and meaningful insights about the perceptions and experiences of renal patients after transplantion can be obtained in this study. Having known the real needs of patients, nurses can develop strategies to help patients to cope with the demands of life with a renal graft, from the early days of convalescence to re‐integration into work, family responsibilities and life beyond.
Breast cancer: evaluation of the Common Journey Breast Cancer Support Group
Authors: Zeigler Linda , Smith Patricia A , Fawcett Jacqueline
Published: December 2004

Background.  Most studies of cancer support groups have focused on the effects of groups established for research purposes, from the exclusive perspective of the group participants.

Aim.  This Roy Adaptation Model‐based programme evaluation project focused on identifying the experiences of both participants in and facilitators of a community hospital‐sponsored breast cancer support group.

Design.  Repeated measures survey methodology.

Methods.  Ten women with breast cancer and two Registered Nurse group facilitators participated in the programme evaluation project. Qualitative data were analysed using content analysis. Themes extracted from the data were categorized according to the Roy Adaptation Model modes of adaptation. The group participants completed Initial and End of Year Interview Guides and Group Voices Forms; the group facilitators completed the Facilitators’ Voices Form. The Institutional Review Committee of a community hospital approved the programme evaluation project.

Results.  The Common Journey Breast Cancer Support Group is a community hospital‐sponsored cancer support group established to meet the informational, emotional support, and social support needs of women with breast cancer who reside in a rural state in the New England region of the USA. Responses of participants and facilitators, which reflected all four of the Roy model modes of adaptation, indicated that the combination of information and emotional and social support was effective.

Conclusions.  Nurses and other health professionals who establish community‐based cancer support groups should consider formal evaluation of the outcomes, from the perspectives of both participants and facilitators, and should publish the results. The results of this programme evaluation project are limited to one breast cancer support group with a small number of female participants and two facilitators. Results cannot be generalized to support groups for other types of cancer or to cancer support groups for men.

Relevance to clinical practice.  Nurses and other health professionals should consider establishing and facilitating community hospital‐sponsored support groups for women with breast cancer, which have the potential to meet the women's informational, emotional support, and social support needs.