bluuebunny/crossref_metadata_2025 huggingface dataset:
Shared learning for shared care*
Authors: Hutt Avis
Published: December 2006

This is an account of a pilot multidisciplinary course in geriatric care for medical, nursing and physiotherapy students at The Middlesex Hospital, London. The course organization, content and evaluation methods are described. A problem‐solving approach to shared learning is discussed and the author argues for the development of similar teaching programmes.
Development of a mental health programme in the Central Coast of New South Wales, Australia*
Authors: Gallagher Rex M.
Published: December 2006

The Central Coast Programme is considered to have begun in December 1969 with the arrival and commitment of Dr Donald Scott‐Orr (specialist psychiatrist) in the Central Coast, and with the parallel commitment of the then Medical Superintendent of Morisset Hospital, Dr Howard Gorton to support the development of a regional programme for the Central Coast. It was decided not to re‐establish any clinics and so avoid waiting lists. There was an emphasis on groups as a means of interaction and a family orientation in the work.

In the early years the role of the nurse was changing. Initially, the extramural role was expected by the hospital to be ‘following‐up’ patients. However, the service was based on commitment to a community rather than hospital. Increasingly the nurses’ work was directly referred to them independently of hospital admissions. Staff visited general practitioners (GPs) on the Central Coast in their surgeries and regular letters were sent keeping the GPs informed of changes in the service. Consultations and transactions were recorded on referral forms and files were opened on all persons concerning whom the service was consulted. A client's name was always linked with the name of their general practitioner who was encouraged to make telephone contact freely to seek consultative support in connection with problems in their practice.

Priority for crisis intervention and orientation towards family and group was backed up by domiciliary visits and widespread communication and consultation. The attempt was made to use therapeutic community principles for the in‐patient programme. The processes of care were seen as being as important as the content of care in assuring an optimum quality care.

There is a continuing need to focus on the flexible interchange between intra‐ and extramural staff in providing continuity for clients in care and integration with primary care services and agencies. In January 1978 Dr Max Chapman was appointed director of the psychiatric and mental health services on the Central Coast and he is currently in that position.
Commitment by the nurse as the foundation of cancer nursing*
Authors: Tiffany Robert
Published: December 2006

To consider commitment by the nurse requires reflection upon what is the unique and particular role and function of nursing in achieving optimum support for patients requiring the help of health care agencies.

Excellence in this role and function can only be judged by the quality of care actually delivered to patients. It is useless to boast of excellent teaching programmes, a first class nursing management structure or a flourishing nursing research unit if the standards of nursing practice do not directly reflect the contribution of such agencies.

In this paper the author considers the present, apparently subordinate role, of the clinical nurse and suggests that if nurses have a commitment to nursing then they must begin to re‐establish the position of the clinical nurse as equal to that of her colleagues in other spheres of nursing. Possible ways in which this can be achieved are outlined together with the support that will be required from colleagues in nursing education, management and research.
Hospital sisters: work attitudes, perceptions and wastage
Authors: Redfern Sally J.
Published: December 2006

This study attempts to describe the attitudes and perceptions that hospital sisters have towards their work and the relationship, if any, of these attitudes and perceptions to absence, leaving intent and wastage. The theoretical approach adopted was based on the Minnesota Theory of Work Adjustment and the role stress theory originally developed at the University of Michigan, and the measures used included rating scales developed in these centres. The results indicated that most of the sisters were, in general, satisfied with their jobs, although a substantial minority were dissatisfied with and experienced role conflict and ambiguity from certain features of their working environment. Comparison of the leavers with the stayers revealed no difference between the groups on intrinsic satisfaction, absence and role ambiguity, but the leavers were less satisfied with extrinsic features of the job, and experienced more tension and role conflict than the stayers. The fairly strong ‘mobility culture’ reported by other research was supported and it was tentatively concluded that after a year or two, the job fails to provide the sister with sufficient challenge, and her propensity is to leave for more stimulating work. The implications of this conclusion are discussed.
Imogene King's conceptual framework: a proposed model for continuing nursing education
Authors: Brown Sylvia T. , Lee Belinda T.
Published: December 2006

This paper presents a proposed model for continuing nursing education based on Imogene King's conceptual framework. The rationale for using King's conceptual framework as the foundation underlying this proposed model is three‐fold: the concepts–social systems, health, perception, and interpersonal relationships–are relevant in every nursing situation; the interacting levels of operation–individuals, groups, and society–depict a reciprocal relationship between human behaviour and the environment; and the triad of elements–continuity nursing education, nursing practice, and nursing research–are interrelated in the nursing profession. The authors contend that this approach to continuing nursing education is beneficial to participating nurses, the health care consumer, and to the advancement of the nursing profession.
A case for community psychiatric nurses
Authors: Dawe Anne‐Marie
Published: December 2006

The author reviews the development of community psychiatric nursing services since the Mental Health Act 1959. In particular, the community services to her own catchment population are discussed, analysed and evaluated. A claim is made that community care is cost‐effective and makes a contribution to prevention. It is also agreed that the presence of community psychiatric nurses in the community fosters greater tolerance and acceptance of the mentally sick by the community at large.
The effectiveness of clinical teaching: a model for self‐evaluation
Authors: Wong Shirley , Wong Julia
Published: December 2006

The effectiveness of clinical teaching: a model for self‐evaluation

The most widely med process for evaluating teachers' effectiveness is student ratings. Although student ratings of teachers are vitally important in the evaluation process, self‐evaluation and that of peers are equally important in accurately defining an individual's effectiveness in his/her teaching role.

The model for self‐evaluation of clinical teaching presented in this paper is adapted from the analysis in Jacobson's model of instruction evaluation. This model comprises three steps: the pre‐active, interactive, and post‐active. The pre‐active step in clinical teaching includes such activities as preparing objectives for both teacher and students, and communicating them to the students before clinical practice. The interactive step in clinical teaching may be seen as the actual process of teaching in the clinical area, with its central activity as being the preparation and presentation of clinical assignments to the students. It is in this step when the teacher‐student relationship is put to a real test. The post‐active step is a process for finding out the extent to which the teacher has achieved the desired results. This step also entails such activities as grading assignments, evaluating students' clinical performance, and conducting post‐experience clinical conference. A check list for self‐evaluation of clinical teaching is included.
Successful ‘normalizing’ tactics of parents of chronically‐ill children
Authors: Krulik Tamar
Published: December 2006

To be or to parent a chronically‐ill child is a difficult experience. Parents can initiate ‘normalizing’ tactics that alleviate the child's feeling of being different and enable a sense of control with the possibility to influence the quality of life of the child and the family. Following up among 20 parents of chronically‐ill children, the author was able to identify a number of principles which underlined the ‘normalizing tactics. These principles, it is suggested, should be helpful to nurses and other health workers when guiding and advising parents and others who come into daily contact with chronically‐ill children.
A model for establishment of educational programmes in developing countries: the nursing paradoxes in Kuwait
Authors: Meleis Afaf Ibrahim
Published: December 2006

While American nursing attempts to deal with the multitude of dilemmas that have been plaguing it for decades, many developing countries look to the USA for a nursing model to emulate, and then become lost in this confusion of its nursing profession. However, these countries continue to reach out and seek consultants with educational and practical experience in nursing in the USA, as well as in other developed countries. A paradigm is proposed for use by educators and consultants to help delineate the major issues a developing country has to confront in establishing a stable nursing service. This paradigm is explicated by applying it to the situation in Kuwait, a Fourth World country with many social paradoxes (e.g., rich in economic resources but poor in human resources). Four major paradoxes in nursing are identified by using the proposed paradigm. They are: I educational needs vs. educational reality; 2 locals vs. cosmopolitans; 3 role congruency vs. role incongruency; and finally 4 medical vs. nursing conceptual models. Although these paradoxes became manifest through work done by the author in Kuwait, any international health care professional will quickly realize that the paradoxes are not unique to Kuwait but have parallels in many other countries which are at different stages of development.
Improvement of quality of nursing care: a goal to challenge in the eighties
Authors: van Maanen Hanneke M. Th.
Published: December 2006

Some general thoughts on the use of the quality concept as a means to structure critical reflection on patient–client care and health services are discussed The continuous request for more health care facilities and quality of services occupies not only the minds of the health workers, but also of the consumer who is becoming more aware of his rights and privileges. Health care should not be identified with curative care only. It involves prevention and promotion of people's status of health as well. Nurses have an important contribution to make in the promotion of health. The paper deals also with the evaluation of quality of care. If nurses become involved in the evaluation of nursing care they should have a clear concept of what nursing is. The nursing profession has a responsibility to develop standards and criteria for the evaluation of nurses’contribution in patient care. An example of a well‐tested monitoring quality instrument is given. In the last part of the paper some practical suggestions for managers who are responsible for the quality care improvement in their own health care institutions are given.
The abdication of the role of health education by hospital nurses
Authors: Syred M.E. J.
Published: December 2006

As nurses are in a unique position to influence patients and so carry out health education to their‘captive audience’, it is pertinent to discuss why so many nurses appear to abdicate this role. Reasons are suggested that the nurses’own education has failed to equip her with the skills necessary for the fulfilment of this role. Even basic communication skills appear to be poorly developed, let alone the more complex and analytical skills required by the nurse in order to effectively deliver a planned programme of health education to either individual patients or groups. A Health Belief Model (HBM) has been discussed and is proposed as a useful framework around which the nurse can formulate her health teaching. Variables to be considered include motivation, value of illness threat reduction, probability that compliant behaviour will reduce the threat of illness, and modifying and enabling factors. The HBM should be incorporated into an individualized nursing care plan, so that health teaching is an integral part of the patient's planned care in hospital. The ward sister is the key figure in implementing such procedures, and it is to her that education should also be directed
The accuracy of nurses’knowledge about survival rates for early cancer in four sites
Authors: Elkind Andrea Knopf
Published: December 2006

To consider the role of nurse education in the development of a body of professional knowledge about cancer, trained nurses (n= 372), learners (n= 160) and auxiliaries (n= 238) were asked, by means of a postal questionnaire, to estimate the 5‐year survival rates for early cancers in four sites: breast, cervix, skin and lung. Among trained nurses only a minority had accurate knowledge; four to five out of ten answering accurately for breast, cervix and lung, but only two in ten for skin All three grades were less well informed about skin cancer. For all sites trained nurses were more likely to be accurate than learners or auxiliaries, but the variations were statistically significant only for skin and cervix. Taking auxiliaries as a baseline the degree of differentiation between their knowledge and that of the SRNs was disappointing. Nurses’reliance on bedside experience as their major source of information about cancer is suggested as one explanation for their levels of knowledge. The implications both for the nurse's role in health education and for nursing education are discussed.
Territoriality as a universal need 0
Authors: Hayter Jean
Published: December 2006

Three aspects of territoriality are important to consider when planning nursing care: a physical space of one's own, a personal space, and the territory of expertise or role. Territoriality serves four functions: it provides security, privacy, autonomy, and self‐identity, all of which are important for well‐being. Many factors, such as age, sex, culture, and health status, affect the way people relate spatially to one another. The nurse should assess territorial needs routinely by asking the patient questions and by observing him in his environment. If the patient is in his own home, she should avoid invading his territory without his permission and should help him maintain and protect his territory. If the patient must leave his own home to be hospitalized, she should help him establish a temporary territory elsewhere and help him adapt to the loss of his own physical space, personal space, and/or territory of expertise and role. Careful attention to territorial needs, particularly when the person is ill, at a vulnerable age, or is facing a move, can contribute a great deal to his health and well‐being.
The effect of instruction on control of blood pressure in individuals with essential hypertension
Authors: Tanner Gloria A. , Noury Dianne J.
Published: December 2006

This exploratory study examined the effect of structured teaching about essential hypertension on control of the diastolic blood pressure in individuals with a diagnosis of essential hypertension. Using the pre‐test, post‐test design, study participants were measured on knowledge about essential hypertension and diastolic blood pressure before and after intervention. Six hypotheses were tested, three related to control of blood pressure, and three related to knowledge about essential hypertension. There was no significant difference between the experimental and control groups on diastolic blood pressure readings at the conclusion of the study. There was a significant difference between the experimental and control groups on post‐test scores on knowledge of essential hypertension. It was concluded that structured teaching had no significant effect upon control of the diastolic blood pressure. Instruction increased knowledge, but not blood pressure control.
Perspectives on attitudes to nursing in Australian nursing students
Authors: Roberts Kathryn L.
Published: December 2006

At a hospital school of nursing in Australia, a pilot study was carried out on first year students’images of nursing and work values. Students were found to accept most items on the College of Nursing (Australia) Inventory as characteristics of nursing and as work values. Background factors had minimal effect on their attitudes to nursing and work values, although age, type of secondary school attended, and religion had minor effects. Responsibility for decisions, individuality, job security, maintaining personal identity, and flexibility, were more highly rated as work values than as characteristics of nursing. No difference between students with and without previous psychiatric nursing training was found on the attitude scales. Limitations of the study and suggestions for further research are discussed.
Indicators for nursing practice: the use of research findings*
Authors: Hunt Jennifer
Published: December 2006

Until recently discussion about nursing research centred on the need to get it carried out. Attention is now being focused on how to get nursing research used, since so far, such research findings have not, on the whole, been assimilated into practice. Until this occurs the practice of nursing will not and cannot be research‐based in any meaningful way. It is postulated that nursing research findings provide nurses with indicators for practice. This assumes that such findings are available and that the main barrier to their use is the poor communication of this research, (in a form they can understand) to nurse practitioners. However recent research into the use of research findings casts doubt on this assumption and it can be argued that such a view is too simplistic. In this paper therefore, three questions are asked: (1) Are relevant nursing research findings available which provide indicators for practice? (2) What indicators do such findings provide? (3) Are such findings used by nurse‐practitioners?

Using specific examples from nursing research, ideas and suggestions are put forward which provide a basis for possible answers. Finally the paper discusses the interdependence of research and practice and the need for them to develop together.
Smoking among new student nurses
Authors: Murray M. , Swan A.V. , Mattar N.
Published: December 2006

Smoking is very common among nurses. Various explanations have been offered for this but the reasons for it are still unclear. To investigate some aspects of this problem and prepare for a longitudinal study, an intake of students to a large nursing school was surveyed. Information was obtained on their smoking behaviour, social background and preconceptions of nursing.
The public health nurse as a guide in infant child‐care and education
Authors: Lauri Sirkka
Published: December 2006

The prime aim of the study was to develop the child‐care and education guidance provided by public health nurses at health centres for parents of children aged 1 or 2. The research was partly carried out according to the principles of action research. The researcher's purpose was to influence the public health nurses' child‐care and education guidance by designing measures and forms for the documentation and evaluation of the development, environment, and care practices of children aged 1 or 2. Methods were improved by the collaboration between the researcher and the nurses in the course of the research. In addition, the investigator designed a child‐care and guidance programme for parents of such children. The premise of the public health nurse's action was the WHO's process model for nursing.

The study focused on public health nurses and on children aged 1–2 and their parents. The overall action model of the public health nurses (needs assessment, goal‐setting, implementation of action and evaluation) improved in the course of the experiment. The methods facilitated the implementation of action and provided it with clear objectives. The reliability and validity of the methods were reasonably high. The parents of the experimental group felt significantly more often than those of the control group that they had obtained information about the development, care, and education of the child aged 1–2 from the public health nurses. The guidance had also helped the parents solve child rearing problems. The level of development in the children of the experimental group was higher than that of the control group at 24 months, in certain areas.
Adaptation problems with nursing home application for elderly persons: an application of the Roy adaptation nursing model
Authors: Farkas Ludmilla
Published: December 2006

This study sought to identify adaptation problems on the part of elderly persons and significant others that were associated with nursing home applications for elderly persons. Within the framework of the Roy Adaptation Nursing Model, an ex post facto research design was utilized to identify these adaptation problems. The four adaptive modes in this model are: physiological, selfconcept, role function, and interdependence. The study group (n= 22) and a control group of elderly persons living in Calgary, as well as their significant others, were administered a structured questionnaire.

Five hypotheses relating to overall adaptation problems, powerlessness, role reversal, guilt, and knowledge and utilization of services were formulated and tested. Only the hypothesis indicating role reversal on the part of the significant others w as accepted. Adaptation problems encountered by the elderly which were associated with nursing home applications occurred in the self‐concept and interdependence adaptive modes. The adaptation problems perceived by the significant others, which were associated with nursing home applications for their elderly, occurred in the self‐concept, role function, and interdependence modes. Adaptation problems from the significant others’ perception rather than from the elderly persons’ perception appear to be more significantly associated with nursing home applications.
Frontiers of nursing in the twenty‐first century: development of models and theories on the concept of nursing*
Authors: Crow Rosemary
Published: December 2006

Theories and models on the concept of nursing are reviewed briefly and their contribution then assessed in terms of their potential to advance the scientific basis of nursing practice. The constructs are acknowledged to have moved the focus of nursing from disease to patient need and provided different ways of looking at the nurse's contribution. Yet, despite this advance, the constructs have not been put to the rigours of scientific testing and so remain at the level of speculation. Therefore, towards the developments for the twenty‐first century it is proposed that these ideas should be put to the test to establish their relevance in the real world of nursing care. This requires: a framework from which the nature, extent and purpose of care can be specified; independent criteria which can be used to judge effectiveness of care; knowledge as it relates to the different and varied core concepts underlying the practice of nursing; and a working definition of need. In addition, the extent of care for the community needs to be made explicit through research. Together, this represents a challenge to develop theories which are logically related to single core concepts which themselves represent specific areas of actual nursing practice.
Psychotherapy by nurses – some special characteristics
Authors: Strang John
Published: December 2006

On an inpatient drug dependency unit, the nursing role was recently extended to include structured individual interviews. Each new patient was allocated to a particular nurse. The success of the scheme is discussed and some of the difficulties encountered are described. A new framework, the Friend role and the Therapist role, is outlined and some benefits of the use of this framework are detailed.
‘The nurse should consider.’ Critical care ethical issues*
Authors: Lawrence Jeanette A. , Farr E. Helen
Published: December 2006

A hypothetical dilemma on resuscitation of an intensive care patient was presented to nurses at a workshop on ethics of critical care nursing. Nurses responded to separate questionnaires about what a charge nurse should do, and what they themselves would do in relation to ten considerations arising from the dilemma.

Nurses were agreed that legal consequences, patient wishes and rights, and physician authority should and would be considered, and that peer influence should not. Nurses were divided in their attitudes to following procedure and personal moral beliefs, and to job risk. The most contentious issues were related to the nurse's role as a decision‐making member of the health care team. Implications for regarding nurses as independent decision‐makers are discussed.
The effects of brief psychiatric training on the attitudes of general nursing students to psychiatric patients
Authors: Wilkinson D.
Published: December 2006

The attitudes of an unselected sample of general nursing students to a series of matched medical and psychiatric case‐examples were assessed before and after they received 9 weeks training in either a general hospital psychiatric unit or a geriatric unit. The major component in cluster analyses of construct ratings of case‐ descriptions by both groups before and after training was a factor of fear, or distrust, on which students differentiated clearly between medical and psychiatric cases, tending to expect the psychiatric patients to be more frightening, less likely to cooperate, more likely to be violent and dangerous and to need strict control. Psychiatric training, therefore, did not eliminate students’ distrust of psychiatric patients. This highlights the importance, during training, of attending to issues of trust and responsibility, and the problems of fear and prejudice caused by psychiatric labels. The attitudes of permanent psychiatric staff are highly relevant in considering how students will be affected by psychiatric work experience.

Some benefits of contact with psychiatric patients were found, and the implications of these are discussed. These benefits support the value of the training experience, overall, and it is suggested that students should work with psychiatric patients earlier in their course (in the first year). The scope of psychiatric training should be broadened and improved to make this a more attractive, worthwhile option.
A method of estimating nursing workload
Authors: Henney C. R. , Chrissafis I. , McFarlane John , Crooks James
Published: December 2006

A real‐time nursing computer system operational on six medical wards allows the automatic data capture of all nursing procedures carried out for all patients.

Each nursing procedure has been graded by an experienced nurse on a 5‐point scale (Ninewells Index I), with grade 5 representing the greatest workload. A Delphi type survey was carried out by a questionnaire involving 115 medical charge nurses in Scotland who graded the same procedures on a 5‐point scale (Delphi Index I). Good agreement with the two indices was found. The Delphi Index I was transferred from the original ordinal scale to an interval scale (Delphi Index II) to facilitate statistical handling of data and conversion to timings.

The conversion of Delphi Index II to timings (Ninewells Index II) was achieved by using data from three extensive work studies. It is suggested that Ninewells Index II is a practical problem of staff allocation in medical wards.
Community nursing and civil liberty*
Authors: Dingwall Robert
Published: December 2006

The normative consensus which makes community nursing possible in its present form has come under increasing strain in recent years. Collectivist and individualist criticisms have grown in strength but these are equally antithetical to the Edwardian compromise between family liberties and state supervision which created community nursing and has dominated its organization and practice for 70 years. These critics imply either the extinction of community nursing or its transformation into a social police. If the status quo is indeed worth protecting, community nurses may need more aggressively to defend the moral and political values embodied in their work rather than presenting it as a purely technical matter.
Patient centred teaching: a future role for the psychiatric nurse teacher?
Authors: Reynolds William
Published: December 2006

It was suggested by Reynolds & Cormack (1982), that psychiatric nursing skills could be taught more realistically, if there was a greater concentration of teaching resources in the clinical areas, in order to make fuller use of the learning opportunities to which learners are exposed. They expressed the view that this was essential in order to clarify the psychiatric nurse's role and to shift the emphasis of psychiatric nurse education away from psychomotor skills to inter personal skills.

This paper describes a trial teaching programme which was designed to gain access to, and utilize, ‘live’ patient centred teaching opportunities in the clinical area more effectively. It involved the writer and four nurse learners, who were allocated to a long‐term ward during a 12‐week psychiatric nursing module within a comprehensive modular system of nurse training. The main teaching method involved structured interaction with the patients.
Assessment of family stress
Authors: Packard Clarissa
Published: December 2006

Given the many sources of stress which affect family life in today's world, it is important for provides of family‐focused care to be able to assess the stress a family experiencing, and plan stress management programmes. This article describes different types if stressors prevent for families and present a variety of assessment aids for the health professtional.
Attitudes of nursing staff in general medical wards towards activation of stroke patients
Authors: Hamrin Elisabeth
Published: December 2006

The attitudes and motivation of the nursing staff towards activation of stroke patients were studied. Staff members from two experimental wards received an educational programme on stroke. Concurrently the patients on their received an individually adapted nursing programme with emphasis on activation. The attitudes of the nursing staff on these wards and on two identical control wards in the same hospital were examined at 3‐month intervals with the help of a 24‐item questionnaire. There was a significant change in staff was a significant change in attitudes, judge on a scale constructed from 14 items, among the staff of the experimental wards during a 6‐month period. There were also positive change in individual items such as attitudes to trained staff. The high rate of turnover, especially among the untrained staff, led to certain difficulties in the collection and interpretation of data. In conclusion, the educational programme and also perhaps, the other activities of the experimental wards seemed to have affected the attitudes of the staff to some extent in a positive direction.
Some aspects of the relation between theory and research in nursing
Authors: Johnson Martin
Published: December 2006

It is suggested that theory can be generated in three principle ways, these being induction, deduction and speculation. The use of these methodological approaches in nursing research and theory construction is briefly examined. The usefulness of theories and models is not doubted, but the extent to which some ‘theorists’ claim scientific status for their speculations (e.g. Martha Rogers) is deprecated. Finally it is argued that a brief overview of the central problems of epistemology is of value to students of theory and research.
Concept of nursing literacy: an energizing force in health care
Authors: Smith James P.
Published: December 2006

In 1976 the editor of the Journal of Advanced Nursing coined the ‘concept of nursing literacy’ in an editorial. In this keynote address at the College of Nursing, University of Tennessee, Knoxville, USA, he developed his ideas on his concept further. The concept entails intellectual, political, philosophical, analytical, practical, humanitarian, artistic and scientific skills.
Attitudes towards mental illness: effect of integration of mental health concepts into a postbasic nursing degree programme
Authors: Olade Rosaline A.
Published: December 2006

A 2‐year assessment of the effect of integrating mental health concepts into a postbasic nursing degree programme was done with two classes of students who had minimal psychiatric preparation in their diploma programme. These two groups of students were studied as they progressed from first to second year and from second to third year at the 3‐year postbasic nursing degree programme at the University of Ibadan, Nigeria. A questionnaire on Opinion about Mental Illness (OMI Scale) was used to note if there was any change in the five attitudinal factors measured, as these students progressed from one class to the next. Results show changes in both groups in terms of their authoritarianism and social restrictiveness.
Implementation of the intersystem patient‐care model in clinical practice
Authors: Artinian Barbara M.
Published: December 2006

An intrasystem‐intersystem model developed by Alfred Kuhn has been integrated into the nursing process model to serve as a model for patient‐nurse interaction. In this conceptual model the patient and the nurse represent intrasystems with three components, the detector, selector and effector, which act to supply information about the environment, analyse internal values and preferences and initiate action. The intrasystems are connected through a specified set of relations as the patient and nurse interact to communicate information, transact values and organize a plan of care. An example is presented of how this model can be used to implement the nursing process in the community health setting.
The American Nurses' Association's position statement on nursing and social policy: philosophical and ethical dimensions
Authors: Silva Mary Cipriano
Published: December 2006

This article analyses the American Nurses' Association's position statement on nursing and social policy. Specifically, its purpose is to highlight three themes suggested within the position statement: nursing as duty, nursing as moral art and nursing as autonomous profession. Questions are raised about the nature and significance of these themes as they relate to philosophical and ethical dimensions within nursing.
The consumer's voice: nursing implications*
Authors: Altschul Annie T.
Published: December 2006

Winifred Raphael pioneered survey research into nursing problems. In particular she was interested in what patients thought about their care. Her sympathetic approach and her trust in the motivation of nurses resulted in ready acceptance of her findings and an eargemess of nurses to use these findings as a basis for improving their performance. This article discusses the paradox of patients wanting to talk, but staff being reluctant to listen, especially where emotionally charged topics are concerned. Recognition that it may be therapeutic for patients to discuss painful expyeriences and an increasing willingness by nurses to listen to patients may call for a system of providing support for the nurses themselves. Unaided, nurses may find the strain excessive and therefore, in spite of the best intention, may feel obliged to cut the patient off. There is evidence that a change has occurred in recent years in nurses' attitudes to researchers. Whereas early reports reveal a defensiveness and a rejection of critical comments by researchers, recent studies show that patients are less critical of nursing care than the nurses are themselves, and that nurses welcome investigations into their work. Lack of communication with patients is most frequently criticized by patients and by nurses. Because of this nurses increasingly believe that patients may need help to make their views known and increasingly incorporate patient‐advocacy in their role.
Curriculum revision: making the process work
Authors: Neufeld Anne
Published: December 2006

This paper presents the experience of one nursing faculty in revising a baccalaureate programme for registered nurses. Mechanisms used to facilitate the process of curriculum revision and to promote involvement of community agencies as well as faculty members and students are discussed. These mechanisms include use of a core co‐ordinating group (curriculum co‐ordinator, consultant in instructional development, administrative support person) to guide the process, acceptance of a draft; of nursing theory content before proposing specific courses and student and community agency representation on course‐development committees. The revision process is then analysed in relation to change theory. Particular attention is given to the concepts of involving all those affected by the change, maintaining open and effective communication and factors which minimize resistance.
Nurses and cigarette smoking: a literature review
Authors: Spencer J. K.
Published: December 2006

This brief literature review covers forty‐eight references from the English‐speaking world and is concerned with three subject areas or questions, which are: In what way are nurses heavy smokers? What particular aspects of nursing may cause nurses to smoke? What influence does a nurse's smoking behaviour have on the effectiveness of the use of nurses in health‐education campaigns specifically designed to decrease smoking? The first part of the article critically examines the assumptions underlying some of the evidence which has already been collected on the question of nurses' supposed heavy cigarette‐smoking consumption. The general point which is made is that few of the social‐research studies concerned with nurses' smoking behaviour seem to be correctly focused. The second part of this review is concerned with some of the issues which may need to be clarified. For example, it is proposed that a distinction should be made between the starting, continuing and stopping of cigarette smoking. Similarly, it is argued that nursing cannot account for the cigarette‐smoking behaviour of nurses who begin nursing as smokers, nor (obviously) for those who never smoke. It is therefore suggested that the emphasis of research could initially be on those who become cigarette smokers while they are becoming nurses. Finally, having accepted Farrell's definition of health education as only including information‐giving, and not behavioural changes, it is argued that any ideas of the use of nurses as health educators in smoking‐cessation work in hospitals will need to be clarified and translated into practical and sensible options which take account of the limitations within the nurse training process, and also the heavy work load of nurses.
Review and replications of a ‘core‐course’ in behaviour therapy for psychiatric nurses
Authors: Milne Derek , Burdett Charles
Published: December 2006

The advent of the nursing process and the success of behaviour therapy in psychiatry have created a need for a revised emphasis on nursing practice and education. This paper outlines an in‐service, ‘core‐course’ in behaviour therapy which addresses this need. The results from an initial and very comprehensive evaluation of the course are presented in terms of the attitudes, knowledge and skills of 65 nurses. We then give a summary of seven subsequent replications of the course in different British National Health Service psychiatric hospitals. These involved nurses in the organization and running of the core‐course, and, together with the very favourable results, they illustrate one strategy for developing nurses' proficiency in behaviour therapy.
Macrophages are comprised of resident brain microglia not infiltrating peripheral monocytes acutely after neonatal stroke
Authors: Denker Sheryl P. , Ji Shaoquan , Dingman Andra , Lee Sarah Y. , Derugin Nikita , Wendland Michael F. , Vexler Zinaida S.
Published: December 2006

Macrophages can be both beneficial and detrimental after CNS injury. We previously showed rapid accumulation of macrophages in injured immature brain acutely after ischemia‐reperfusion. To determine whether these macrophages are microglia or invading monocytes, we subjected post‐natal day 7 (P7) rats to transient 3 h middle cerebral artery (MCA) occlusion and used flow cytometry at 24 and 48 h post‐reperfusion to distinguish invading monocytes (CD45high/CD11b+) from microglia (CD45low/medium/CD11b+). Inflammatory cytokines and chemokines were determined in plasma, injured and contralateral tissue 1–24 h post‐reperfusion using ELISA‐based cytokine multiplex assays. At 24 h, the number of CD45+/CD11b+ cells increased 3‐fold in injured compared to uninjured brain tissue and CD45 expression shifted from low to medium with less than 10% of the population expressing CD45high. MCA occlusion induced rapid and transient asynchronous increases in the pro‐inflammatory cytokine IL‐β and chemokines cytokine‐induced neutrophil chemoattractant protein 1 (CINC‐1) and monocyte‐chemoattractant protein 1 (MCP‐1), first in systemic circulation and then in injured brain. Double immunofluorescence with cell‐type specific markers showed that multiple cell types in the injured brain produce MCP‐1. Our findings show that despite profound increases in MCP‐1 in injured regions, monocyte infiltration is low and the majority of macrophages in acutely injured regions are microglia.
Rapid modulation of long‐term depression and spinogenesis via synaptic estrogen receptors in hippocampal principal neurons
Authors: Mukai Hideo , Tsurugizawa Tomokazu , Murakami Gen , Kominami Shiro , Ishii Hirotaka , Ogiue‐Ikeda Mari , Takata Norio , Tanabe Nobuaki , Furukawa Aizo , Hojo Yasushi , Ooishi Yuuki , Morrison John H. , Janssen William G. M. , Rose John A. , Chambon Pierre , Kato Shigeaki , Izumi Shunsuke , Yamazaki Takeshi , Kimoto Tetsuya , Kawato Suguru
Published: December 2006

Rapid modulation of hippocampal synaptic plasticity by estrogen has long been a hot topic, but analysis of molecular mechanisms via synaptic estrogen receptors has been seriously difficult. Here, two types of independent synaptic plasticity, long‐term depression (LTD) and spinogenesis, were investigated, in response to 17β‐estradiol and agonists of estrogen receptors using hippocampal slices from adult male rats. Multi‐electrode investigations demonstrated that estradiol rapidly enhanced LTD not only in CA1 but also in CA3 and dentate gyrus. Dendritic spine morphology analysis demonstrated that the density of thin type spines was selectively increased in CA1 pyramidal neurons within 2 h after application of 1 nm estradiol. This enhancement of spinogenesis was completely suppressed by mitogen‐activated protein (MAP) kinase inhibitor. Only the estrogen receptor (ER) alpha agonist, (propyl‐pyrazole‐trinyl)tris‐phenol (PPT), induced the same enhancing effect as estradiol on both LTD and spinogenesis in the CA1. The ERbeta agonist, (4‐hydroxyphenyl)‐propionitrile (DPN), suppressed LTD and did not affect spinogenesis. Because the mode of synaptic modulations by estradiol was mostly the same as that by the ERalpha agonist, a search was made for synaptic ERalpha using purified RC‐19 antibody qualified using ERalpha knockout (KO) mice. Localization of ERalpha in spines of principal glutamatergic neurons was demonstrated using immunogold electron microscopy and immunohistochemistry. ERalpha was also located in nuclei, cytoplasm and presynapses.
Hydrogen sulfide attenuates lipopolysaccharide‐induced inflammation by inhibition of p38 mitogen‐activated protein kinase in microglia
Authors: Hu Li‐Fang , Wong Peter T.‐H. , Moore Philip K. , Bian Jin‐Song
Published: December 2006

The present study attempts to investigate the effect of H2S on lipopolysaccharide (LPS)‐induced inflammation in both primary cultured microglia and immortalized murine BV‐2 microglial cells. We found that exogenous application of sodium hydrosulfide (NaHS) (a H2S donor, 10–300 μmol/L) attenuated LPS‐stimulated nitric oxide (NO) in a concentration‐dependent manner. Stimulating endogenous H2S production decreased LPS‐stimulated NO production, whereas lowering endogenous H2S level increased basal NO production. Western blot analysis showed that both exogenous and endogenous H2S significantly attenuated the stimulatory effect of LPS on inducible nitric oxide synthase expression, which is mimicked by SB 203580, a specific p38 mitogen‐activated protein kinase (MAPK) inhibitor. Exogenously applied NaHS significantly attenuated LPS‐induced p38 MAPK phosphorylation in BV‐2 microglial cells. Moreover, both NaHS (300 μmol/L) and SB 203580 (1 μmol/L) significantly attenuated LPS‐induced tumor necrosis factor‐α secretion, another inflammatory indicator. In addition, NaHS (10–300 μmol/L) dose‐dependently decreased LPS‐stimulated NO production in primary cultured astrocytes, suggesting that the anti‐neuroinflammatory effect of H2S is not specific to microglial cells alone. Taken together, H2S produced an anti‐inflammatory effect in LPS‐stimulated microglia and astrocytes, which may be due to inhibition of inducible nitric oxide synthase and p38 MAPK signaling pathways. These findings may have important implications in the treatment of neuroinflammation‐related diseases.
Seventy microsatellite markers from Persea americana Miller (avocado) expressed sequence tags
Authors: BORRONE JAMES W. , SCHNELL RAYMOND J. , VIOLI HELEN A. , PLOETZ RANDY C.
Published: December 2006

Expressed sequence tags for Persea americana Mill. were investigated to expand upon the number of informative microsatellite markers available for avocado. Seventy informative loci were discovered using 24 P. americana var. americana Mill. accessions. The number of alleles detected ranged from two to 17 and averaged 7.1 alleles per locus. These primers successfully amplified products in different varieties of P. americana, hybrids and a related species, Persea schiedeana. These primers will be useful for characterizing germplasm, determining genetic relationships of cultivated accessions, and for marker‐assisted development of root rot‐tolerant P. americana var. americana rootstock material.
Transfer of the experimental methodology described in the FDA guidance for corticosteroid bioequivalence testing to pharmacodynamic effects caused by nicotinates
Authors: Remane Yvonne , Leopold Claudia S
Published: December 2006

Background  The measurement of the pharmacodynamic response allows the noninvasive quantification of cutaneous drug penetration.

Aims  The objective of this study was to investigate whether the experimental methods described in the US Food and Drug Administration Guidance for Industry “Topical Dermatologic Corticosteroids: In vivo Bioequivalence” may be transferred to other response parameters such as skin redness and surface temperature.

Methods  Drug penetration experiments with methyl nicotinate in two different lipophilic vehicles were performed according to the FDA guidance for corticosteroid bioequivalence testing measuring the cutaneous erythema and skin temperature response.

Results  The guidance methodology was transferred to the response parameters redness and temperature. Bioequivalence testing was feasible with these response parameters.

Conclusions  An open one‐compartment model could only be confirmed for skin redness data by a compartmental analysis of response vs. time profiles. The obtained temperature data can neither be described by an open one‐compartment nor by a two‐compartment model. A correlation between skin color and skin surface temperature could not be found.