bluuebunny/crossref_metadata_2025 huggingface dataset:
Theory of nursing: creating effective care*
Authors: Weatherston Lesley
Published: December 2006

Aspects are identified which are to be considered when attempting to identify those activities we wish to call nursing. Using conceptual analysis by means of borderline and model cases, an exposition of the nature of nursing is reached. The process of theory building, the function of theories and their application to what has been identified as the sphere of nursing are explained. The relationship of ‘micro theory’ and ‘paradigmatic theory’ are described. The application of theory to nursing education are linked by the use of Peters'(1966) criteria for education. A model attempts to demonstrate the relationships pointed out in the text.
Nursing and the process of scientific inquiry
Authors: Orr J.A.
Published: December 2006

Nurse education has to confront the problem of developing in students an understanding of the different perspectives put forward in nursing. However, all the perspectives adhere to the scientific method and it is therefore necessary to examine the process of scientific inquiry. As nursing occupies a position at the interface between physical and social sciences, it is also necessary to offer students an examination of the different paradigms which exist within the social sciences.
An evaluation of a workshop for teachers of nursing on an individualized teaching and learning strategy
Authors: Sheahan John
Published: December 2006

This paper is concerned with the evaluation of a workshop for teachers of nursing devoted to an individualized teaching and learning strategy. The paper gives a brief account of the history of such workshops and continues by defining individualized teaching. Following this the characteristics of the Keller Plan strategy are outlined. This is followed by details of the course organization; its aims and objectives, and the characteristics of the course members. Finally, the method of evaluation is described and results are discussed.
Attitudes towards mental illness: a comparison of post‐basic nursing students with science students
Authors: Olade R. A.
Published: December 2006

Two groups of Nigerian university students were compared in terms of their attitudes towards mental illness.

Responses on the OMI scale questionnaire items on attitudes towards mental illness were examined. Subjects were 37 registered general nurses from the Faculty of Medicine and 15 science students from the Faculty of Science.

Differences between the nurses and science students not attributable to age were observed in Factors A: Authoritarianism, B: Benevolence and D: Social restrictiveness. The nurses scored lower on the above mentioned factors while they scored higher on Interpersonal etiology and Mental hygiene ideology.

Also intercorrelation between the five factors was done. Positive correlation was found between Authoritarianism and Social restrictiveness and also between these two factors and Benevolence.
The audio‐visual revolution: do we really need it?
Authors: Townsend Ian
Published: December 2006

In the United Kingdom, the audio‐visual revolution has steadily gained converts in the nursing profession. Nurse tutor courses now contain information on the techniques of educational technology and schools of nursing increasingly own (or wish to own) many of the sophisticated electronic aids to teaching that abound.

This is taking place at a time of hitherto inexperienced crisis and change. Funds have been or are being made available to buy audio‐visual equipment. But its purchase and use relies on satisfying personal whim, prejudice or educational fashion, not on considerations of educational efficiency.

In the rush of enthusiasm, the overwhelmed teacher (everywhere; the phenomenon is not confined to nursing) forgets to ask the searching, critical questions: ‘Why should we use this aid?’, ‘How effective is it?’, ‘And, at what?’.

Influential writers in this profession have repeatedly called for a more responsible attitude towards published research work of other fields. In an attempt to discover what is known about the answers to this group of questions, an eclectic look at media research is taken and the widespread dissatisfaction existing amongst international educational technologists is noted. The paper isolates out of the literature several causative factors responsible for the present state of affairs. Findings from the field of educational television are cited as representative of an aid which has had a considerable amount of time and research directed at it. The concluding part of the paper shows the decisions to be taken in using or not using educational media as being more complicated than might at first appear.
The British National Health Service 1948–1978: should we start again?*
Authors: Clark June
Published: December 2006

The author concludes that since the British National Health Service is the product of a complex history, it is impossible to start again: however, the removal of three factors and the development of one would greatly improve it.

The factors to be removed are: (i) the witch hunt against management, which has become the scapegoat for other ills; (ii) the medical model of health care, which is no longer relevant or practical; (iii) the industrial model, which has forced the NHS into an inappropriate style of management, trade unionism and employment patterns.

The factor to be developed is the clinical skill of the nurse; such development requires improved educational opportunities and a clinical career structure.
Breast feeding in Cambridge, England: factors affecting the mother's milk supply
Authors: Whichelow Margaret J.
Published: December 2006

Smokers were more likely to have given up breast feeding between 2 weeks and 3 months than non‐smokers but smoking was not associated with any particular weaning reason. Women taking a contraceptive pill during lactation more often experienced a diminution of milk supply than non‐pill‐takers.

Sustained lactation benefits the mother since those who were still breast feeding were less likely to suffer from depression or fatigue at 3 months, and were more likely to have lost weight. The early introduction of solids was less frequent among infants being breast fed at 3 months.
Nursing in a changing society*
Authors: Auld Margaret G.
Published: December 2006

In this paper the technological, demographic, social and disease‐pattern changes in British society are considered and their implications for the nursing and health services discussed.

The influences of major nursing reports as well as the consequences of the growth of professionalism in nursing and the potential outcome of the spread of political consciousness among nurses are also highlighted.

Nurses are admonished to come to terms with the ‘real’ diseases of today; those resulting from affluence and senescence.

Although conceding that nurses have unique and professional roles, a plea is made for the importance of good team work in health care.

The paper ends with the recognition that by building up the body of knowledge of nursing, not only will the planning of nursing care be enhanced but also the ability to change as the needs of society change.
The evolution of a token economy programme for female chronic schizophrenic patients
Authors: Butler Richard J.
Published: December 2006

Token economy programmes are becoming an increasingly familiar sight in British psychiatric hospitals, yet many remain inflexible and prone to breakdown after a period in operation. This paper describes the evolution of a token economy for female chronic schizophrenic patients, where the nursing staff with minimal ‘psychological’ support and in dealing with a programme free of research constraints, aimed to increase the therapeutic potential of the system.

The major developments arose from the need: (i) to extinguish the emergence of undesirable behaviour; (2) to develop a more individualized approach to treating patients' problems; (3) to keep consistent adequate records; (4) to re‐establish contact with the community and (5) to cater for patients' varied responses to treatment.
Behaviour therapy in psychiatric and mental handicap nursing
Authors: Barker Philip
Published: December 2006

This paper presents an overview of the evaluation study conducted between November 1977 and December 1978. The study involved twenty nurses who had completed the Behaviour Therapy Course of the Scottish Committee for Clinical Nursing Studies.

It provides an overview of the former students’ engagement in behaviour therapy on completion of the course. The study was conducted approximately 6 months after each student had returned to their parent hospital, unit or to new posts. The information was collected by circulation of a questionnaire. The report summarizes the returns presented by the individual nurses. Additional information or comments were supplied by several of the former students: unsolicited communications of this nature are acknowledged where they appear in the text, by the indication of an asterisk (*).
Representation of racial minority students in selected Canadian university schools of nursing
Authors: Wong Shirley , Wong Julia
Published: December 2006

Several studies have suggested that the problem of inequality in educational opportunity for minority students, manifested by under‐representation, prevails in American higher education. Under‐representation of minority groups in schools of nursing is not an unusual problem. The dearth of information on representation of ethnic minorities in baccalaureate programmes in Canada provided the impetus for the investigators to conduct this study to: (I) explore the racial and ethnic composition of the student population in selected Canadian University Schools of Nursing; (2) determine the total number of withdrawals and graduations; and (3) establish baseline data for a follow‐up study. This study was exploratory in nature.

A questionnaire was designed to elicit information on enrolment, admission, withdrawal and graduation of six ethnic minority groups in the 5 year period, 1974–1978. Out of 18 schools surveyed, nine schools responded with the requested statistical information.

Findings of this study supported findings of other research studies conducted in the United States in that the ethnic minorities were under‐represented, and their academic survival rates were low. Statistics presented in this study should not be interpreted as conclusive. Many questions crucial to exploring and understanding the pattern of representation of racial and ethnic minority nursing students are still unanswered. A better designed, long‐term study is needed.
A critique of the ‘objectives model of curriculum design’ applied to the education and training of district nurses
Authors: Gibson Sheila
Published: December 2006

In 1976 the Panel of Assessors for Nurse Training published the ‘Report on the Education and Training of District Nurses SRN/RGN'. This recommends an extended form of training based on an outline curriculum. The new scheme of training will be implemented in 1981, and responsibility for developing the detailed curriculum will rest with district nurse tutors and will be undertaken at local level. One method that might be used by district nurse tutors is the ‘objectives model of curriculum design', which requires educators to (a) consider sources for the derivation of objectives; (b) identify and express objectives, preferably in behavioural terms; (c) utilize the objectives to identify skills, attitudes and learning experiences required to produce desired learning outcomes and (d) evaluate whether or not objectives have been achieved. It is generally acknowledged that this particular model, which has been tested and tried in the spheres of general and vocational education, has strengths and weaknesses. Some of these are identified in this paper and applied to the education and training of district nurses. District nurse tutors might, therefore, consider both the strengths and the weaknesses of this approach as they prepare to develop the outline curriculum.
Developing effective institutionai managers in the 1980s‐Part 1: A current analysis
Authors: Lees Stanley
Published: December 2006

Two dominant themes are developed in this two part paper. One is that the organizational behaviour of nurse managers has its origins in the social defence system learned during early nursing; the other is that many of the assumptions which underpin current thinking on management training can do little either to help unlearn these early behaviours or to enable managers to be more innovative in their roles. In part one management training is examined in some detail from the three perspectives of the institution, the management trainers and the nurse managers, and in particular the widely differing assumptions and expectations which each have about the management training process. The social defence system of nursing is then analysed and tentative evidence is offered to illustrate how nurse managers transfer this system to managerial positions, with dysfunctional consequences. Although primarily concerned with nurse management training, there are implications for managers and management trainers in a much wider range of institutions and professions.
Organization development in a psychiatric hospital: creating desirable changes
Authors: Cope D. , Cox S.
Published: December 2006

The organization of the way in which hospitals and hospital staff provide a service to patients is obviously of critical importance to their effectiveness, yet it is clear that rigidities and inappropriate and ineffective procedures frequently intrude. It is commonly held that changing hospitals as organizations is difficult to accomplish, and indeed, reported attempts at such change reflect this. The project reported here was a successful attempt at changing a number of different aspects of the culture of a psychiatric hospital which included managerial practices and structure, aspects of patient care, multidisciplinary team work, and staff development. The present paper concentrates on some specific outcomes at ward level.

The general pattern for bringing about change involves the collection of (valid) data and then feeding this back to the staff involved so that they can take appropriate action. The data discussed here concerned ward nursing staff's attitude to the ‘climate’ of the hospital, their job satisfaction and aspects of patient care. This was fed back to nursing, managerial and medical staff, and action plans were agreed to overcome the difficulties highlighted. Outcomes have included the production of ward and unit objectives and changes in treatment programmes and aspects of patient care on the wards.
Setting performance goals In geriatric nursing
Authors: Davles Ann D. M. , Crisp A. G.
Published: December 2006

Behavioural techniques are increasingly being applied in the geriatric field as part of a broader emphasis on psychological and social treatments in the care of the elderly. The nurse is in the best position to analyse a patient's performance and manage an intervention programme; however, some nurses have had little experience of autonomously diagnosing problems and setting performance goals.

The authors argue that it is important to set such goals and give examples of how performance may be objectively specified, prerequisites made explicit, criteria for success defined and the consequences of goal attainment or non‐attainment discussed with those most concerned.

A complex situation drawn from the geriatric setting which was used as part of a teaching workshop to help nurses define suitable targets for intervention is described in the Appendix.
Training for team care
Authors: Milne M. Ann
Published: December 2006

The aim of this paper is to highlight some of the findings of a research study concerned with the perception of general practitioner trainees, health visitor, district nurse and social work students towards the primary health care team. Areas of role understanding; role restriction/role euphoria and high referral of problems to others are illustrated. The results suggest a need for role learning experiences during training which are subsequently extended and reinforced by interdisciplinary participation in simulated patient management experiences.

The idea of team care in the United Kingdom was first mooted as early as 1920 when a committee under the chairmanship of Dawson proposed that doctors should work in teams from health centres. This suggestion was destined to lie dormant until the 1960s, when due to a more favourable poltical, social and economic chimate, the idea was rejuvenated. District nurses and health visitors became associated with doctors in general practice and such terms as ‘attached’, ‘aligned’, ‘linked’ and ‘in liaison with’ were in vogue (C.E.T.H.V. 1977). However, the bringing together of personnel was only the first small step in what should have been a dynamic drive to progress from an individualistic effort to that of a concerted team approach. In recent years however, there has been increasing controversy about the effectiveness of the team as a unit.
Course evaluation in post‐basic education
Authors: Jones Elizabeth Layton , Bridge Will , Chatfield Kay , Finn Bernard , Rice Maureen
Published: December 2006

Course evaluation is defined‘as the collection and use of information in order to make decisions about an educational programme’(Cronbach 1963). The study described in this paper was undertaken by members of the professional and research staff of the Joint Board of Clinical Nursing Studies, London The paper describes how the need for work on course evaluation arose and how a package was developed and piloted in 15 course centres with a total of 205 students. The ways in which the package is being used by schools of nursing and colleges of higher and further education is also described The philosophy that evaluation has an important part to play in developing dynamic and sound educational systems is emphasized Evaluation should be an integral part of every course and planned at the outset with other parts of the detailed course programme, involving both students and teachers in measuring the effectiveness of the course.
Multidisciplinary teams in geriatric wards: myth or reality?
Authors: Evers Helen K.
Published: December 2006

This paper argues that the rhetoric of multidisciplinary teamwork is central to the provision of health care generally and geriatric care in particular. Yet the notion of teamwork is poorly defined, and the supposed benefits for patients are not always readily apparent. Looking at teamwork in practice, examples from research are used to illustrate how multidisciplinary decision making and work with patients can, under particular circumstances, take on the appearance of collaboration amongst a team of expert colleagues, which co‐opts patients and relatives to the status of team members. But very often, multidisciplinary work with patients is coordinated not by mutual collaboration amongst a team of equals, but by means of established work routines which are broadly applied to whole categories of patients, and by the operation of the traditional hierarchy of social relations in health care. For long stay patients, the pervasiveness of the teamwork mythology and the frequent concurrent withdrawal of other professionals can, at worst, leave the nurses in the invidious position of having responsibility, but no formal or legal authority for caring for their patients: work which no other professional is anxious to do. This leads to negative outcomes for patients as well as for nurses.

Finally, it is stressed that analysis of multidisciplinary teamwork both in theory and in practice is vital if we are to understand the conditions under which multidisciplinary teamwork both flourishes, and can be demonstrated to be a necessary condition for the creation of positive care outcomes for geriatric patients in hospital. This paper seeks to raise some of the issues which must be confronted in this endeavour.
A comparison of mothers' concerns regarding the care‐taking tasks of newborns with congenital heart disease before and after assuming their care
Authors: Pinelli Janet M.
Published: December 2006

This exploratory study sought to identify, during the newborn's hospitalization, mother's concerns regarding the care‐taking tasks of their infants with congenital heart disease and to determine, 1 month subsequent to discharge, whether the mother's concerns had changed. The sample consisted of ten mothers of infants aged up to 2 months at the time of the first interview which was conducted in hospital. A second interview was conducted in the home of the subjects 1 month subsequent to discharge. The content of the responses to the interview questions was analysed and presented under the major headings of selected characteristics of the sample, developmental tasks of parenthood and selected maternal attributes. The largest number of concerns in both interviews related to the tasks of learning how to anticipate and to recognize the needs of the baby. A significant difference was found between the total number of concerns reported by each mother in the two interviews. There was an overall increase of 61%. Implications and recommendations are presented in light of the small non‐random sample.
Recording patients blood pressure: a review
Authors: Thompson David R.
Published: December 2006

This paper reviews the proper technique which should be adopted by the nurse in order to obtain accurate blood pressure measurements. Although this is difficult using conventional instruments, statistics uniformly confirm the harmful significance of an elevated blood pressure. Any nurse delivering high quality care must be able to carry out nursing procedures skillfully and accurately. The methodology of blood pressure recording is discussed, analysed and evaluated.

It is well‐documented that there are many potential sources of error in recording blood pressure, including poor technique and observer bias. The paper deals with these and highlights some of the dilemmas that this technique presents to the nurse. A claim is made that many nurses are often inadequately trained in blood pressure measurement, and with increasing reliance on the nurse for records, much more attention needs to be focused on this area.
Working women and breastfeeding in Israel*
Authors: Bergman Rebecca , Feinberg Dalia
Published: December 2006

Two‐hundred and ninety‐one working women in Israel were interviewed 7–9 months after childbirth. The mean number of months that they had breastfed was 2.03. The duration of breastfeeding increased with religiousity and higher education. Women born in Europe, primiparas and grandparas (4+ children) and those over the age of 40 breastfed longer. Most of the women returned to work only after completing breastfeeding. Duration of breastfeeding was reduced when the mother suffered from stress, tiredness, encountered feeding problems, or if the baby cried excessively.
An investigation of distress and discontent in various types of nursing
Authors: Nichols Keith A. , Springford Veronica , Searle John
Published: December 2006

It has been claimed that nurses in intensive therapy units are prone to high levels of distress and discontent A questionnaire was designed to assess nurses' reactions to intensive therapy work and thus provide an objective check on these claims. Nurses from eight intensive therapy units in England took part in the survey together with comparison groups from two renal units, a medical ward and a surgical ward. High levels of job satisfaction were registered in all the intensive treatment units with very few nurses indicating distress or a wish to leave their job. Some features of the work did attract criticism though, in particular the large fluctuations in work load, the level and adequacy of support, and the sparse amount of feedback given to nurses by senior staff.

Much the same pattern was recorded with the medical and surgical nurses, and from one of the renal units. The second renal unit was known to be in a state of crisis at the time and it was predicted that a high level of discontent would be registered there. This proved to be the case and was taken as confirmation of the validity of the questionnaire, and also as giving insight into the psycho‐social conditions which may foster distress in nurses.
Quality assurance programme for nursing*
Authors: Padilla Geraldine V. , Grant Marcia M.
Published: December 2006

This article describes a conceptual and methodological framework for evaluating nursing care quality. The conceptual framework is based on Orem's theory of self‐care which emphasizes the importance of decisions in the selection of nursing process based on patient status and problems. The primary outcome criteria is self‐care. The methodological framework is based on Greenfield's criteria maps methodology for linking patient status (problems or diagnoses) to decisions about nursing interventions and linking these specific nursing intervention criteria to desired outcomes for self‐care.

The article further describes a multiagency quality assurance programme for nursing. The programme includes: a definition of criteria and standards across agencies; nursing care management protocols that define standards of care; continuing education courses for nursing based on management protocols; the maps method of auditing actual and recorded nursing process and patient outcomes as defined in the management protocol.
Workshops in personal relationships
Authors: Strehlow Marion S.
Published: December 2006

This paper describes the planning, implementation and evaluation of a series of workshops for practising health visitors, as one aspect of continuing professional education. The history demonstrates response to stated need. Planning was intensive and extensive, resulting in one broad educational objective and a flexible approach to teaching/learning, contributions of expertise from several disciplines proved valuable.

Prior to full implementation, experimental workshops were organized and evaluated both objectively and subjectively. The variety of methods of evaluation permitted isolation of some factors which mitigate against success and their avoidance when possible. The objective evaluations used three criteria which appeared to demonstrate positive outcomes to a great extent.

Evaluations of 17 workshops demonstrate the continuing value of this form of education, and the summarized response shows, inter alia, that impetus does not necessarily reduce with time. Of significance is the evidence that the results include improved professional practice and that there were increases in depth and breadth of knowledge. Additionally, there were developments of self‐help and professional interest groups. Finally, the sequel should lead towards a model of training resource personnel within the NHS, the trial of the model being early in 1982.
The effect of care programmes on the dependency status of elderly residents in an extended care setting
Authors: Hardy Val M. , Capuano Elaine F. , Worsam Bernard D.
Published: December 2006

This paper presents data gathered in an operational research project undertaken in a geriatric centre providing care for approximately 400 long‐term residents. The centre supplies nursing, medical, paramedical, day hospital and home care services. Programmes of social and diversional activities are provided and residents are also visited by various community groups. However, the long‐term residents participating in this project represent a section of the population unable to utilize or participate in the social and diversional programmes usually offered. The aim of the study was to determine whether the dependency status of residents receiving long‐term care is affected by nursing and/or medical patterns of institutional management. The project was carried out in two stages: 1 a habit training toileting programme intended to improve continent status; 2 activity programmes at differing levels of intensity and specifically designed to increase mental, social and physical stimulation.
Development of the nursing process through action research
Authors: Lauri Sirkka
Published: December 2006

Implementation of the nursing process in practical nursing can be achieved in accordance with the principles of action research. A pre‐requisite of the action research is a knowledge of the basic principles and the component areas of the nursing process, and of the opportunities for applying the nursing process to practical work. The documentation of the nursing of the patient is one clear object in which the model of the nursing process takes concrete shape. Another prominent form of action is the analysis of the content of the nursing, and on the basis of this framework the needs of individual patients can be determined and evaluated. Important methods in action research are consulting and work guidance. The researcher, together with the workers, endeavours to develop the work of nursing and to seek opportunities and methods to carry out the nursing process model.
Universities and nursing education
Authors: Hayward Jack
Published: December 2006

Trends reflected by Department of Health and Social Security statistics on the nursing workforce are examined and the ratios between grades discussed. Recruitment into nursing degree courses in the UK is considered in relation to overall recruitment into nursing.

The somewhat ambiguous position of nursing degree courses in the UK leads into consideration of policy statements by the universities and the nursing profession. The importance of such policies is emphasized in the current financial climate, as are the potential contributions of university departments to professional debate, for example standards of care.

Comparisons are drawn between the goals of courses involving full‐time studentships as opposed to part–time apprenticeships and the present boundaries between these noted, especially in relation to the expanding roles of courses.

On–going research into the preparation of nurse–tutors in the UK is mentioned, together with a preliminary analysis of the academic basis in the biological sciences possessed by learners and tutors. Out of this is derived a suggestion that the present–day shortage of nurse teachers could be helped by varying the existing patterns of recruitment, especially involving subject specialists in the biological, behavioural and social sciences.
Reality orientation for the elderly: a critique
Authors: Burton Mark
Published: December 2006

Outcome studies of reality orientation (RO) with confused elderly people, are reviewed. While there is evidence that RO can sometimes improve orientation to the environment, there is no evidence that this leads to any other behavioural changes. RO may also be criticized in terms of its appropriateness to the people and the settings for which it is used. Finally, an alternative, behavioural‐ecological approach to working with the elderly is outlined.
Preparing the patient for a barium enema: a comparison of nurse and patient opinions
Authors: Schuster Pamela , Jones Susan
Published: December 2006

The purpose of this research was to explore possible differences in nurse versus patient opinions about patient education information appropriate for the barium enema procedure. Twenty‐eight nurses and 30 patients participated in the study. Findings showed that nurses believed a patient should have more information than the patients believed a patient needs, and that patients wanted only minimal detailed information about events that will happen during the procedure. Rather, patients were interested in knowing the benefits and purpose of the procedure while nurses believed that this information should be provided by the physician and not the nurse. Finally, nurses were dissatisfied, in general, about their patient education information that they have given to patients in the past for a barium enema procedure.
Spoken language and small groups: a student experience in graduate nursing education
Authors: Saunders Joy B.
Published: December 2006

The study investigates student verbal activities in six small discussion groups. A total of 18 registered nurse graduate students from two schools participated. The content for their discussion was based on three nursing practice situations that focused on adult medical‐surgical nursing

The components that served as basic units of analysis for the data were four types of pedagogical move that characterized the verbal interplay of the students. [These include structuring, soliciting, responding and reacting. Within each pedagogical move four categories of meanings are identified. These categories include substantive‐discipline, method of inquiry (nursing process), substantive‐logical and digresion.]

The descriptive data suggest that the discussion pattern was characterized by a high proportion of cyclical reacting moves. The referential base for much of the substantive‐discipline meanings was the patient's disease processes, with discipline referenced content primarily in nursing, pathology, and psychology. The general character for the nursing process suggests frequent use of the assessment phase and minimal use of the remaining four phases, especially the nursing diagnosis and evaluation phases. Additionally, the collection of assessment data was guided by a perceptual emphasis on the pathophysiological manifestations of the patient.

These data replicate earlier reports on the frequency with which students verbalize empirical meanings of fact‐stating and explaining more often than either evaluative or analytic meanings.

The findings support current concern with one of the major challenges still facing nursing, that of shifting from disease centred nursing to patient centred nursing. The aim of the shift is to encourage wholism in the nursing care of patients and avoid reducing nursing inquiry to only one discipline perspective, attainment of a balanced perspective for the nursing activities discussed by the students in this study was not evident.
Categories of self‐care needs of ambulatory patients with diabetes
Authors: Miller Judith Fitzgerald
Published: December 2006

Categories of needs of 65 ambulatory patients with diabetes were identified based on a self‐care nursing framework, using a participant‐observer methodology. The needs categories identified can be applied to other types of ambulatory patients who have chronic health problems. It is proposed that being able anticipate needs of all types of ambulatory patients will improve efficient delivery of professional nursing.
A descriptive study of pressure sores: the prevalence of pressure sores and the characteristics of patients
Authors: Ek Anna‐Christina , Boman Gunilla
Published: December 2006

A descriptive study was carried out within a public health services area in Sweden in order to determine the incidence of pressure sores in acute and long‐term care. Methods of prevention, treatment and the characteristics of patients were also noted. The criteria for the assessment of pressure sores were: skin discolouration, epithelial damage and damage to the full thickness of the skin. The data were collected by means of interviews during 1 week in February, 1980. It was found that within the public health services area there was a pressure sore frequency of 4%; i.e. 71 patients of a total of 1776 had pressure sores. Some of these patients had more than one pressure sore; the total number of sores was 109. The methods of prevention and treatment were numerous. The patients who developed pressure sores were predominantly women over 65 years of age, incontinent, and with poor mobility.
An ethnography: four public health nurses' perspectives of nursing
Authors: Field Peggy Anne
Published: December 2006

This paper examines one study of nursing practice that utilized ethnography as a research approach. The general overview of the ethnographic method and the symbolic interaction framework used are described. An overview of the specific approach is included. The findings of the study are presented. The strengths and problems of the approach for nursing research are then reviewed. Some potential uses of an ethnographic approach for clinical nursing research are outlined.
Psychology and nursing: the case for an empirical approach
Authors: Wattley Lesley , Müller Dave J.
Published: December 2006

The arguments presented concern the teaching of psychology to nurses. It is noted that psychology is regarded as an important component of nurse education, though the nature of this relationship can be considered elusive. In pointing out that the effect of learning psychology has yet to be measured in nursing practice, a case is put forward proposing a different approach to its teaching. The emphasis on content‐based courses in which nurses are expected simply to learn a body of knowledge and apply that to their nursing is considered. Instead it is argued that a process‐based course, that is one which emphasizes the methods and approaches used in gathering psychological information, is more appropriate. This, it is felt, should contribute to the aim of the nursing profession that its members be able to adopt a critical stance and develop research mindedness in the practice of their work.
Understanding the patient in all his human needs*
Authors: Bergman Rebecca
Published: December 2006

The ‘patient’ whether an individual, family or group has multiple human needs. These needs vary with the characteristics of the patient, the state of health/illness and the setting in which care is delivered. Needs may be of a psychological, physical and/or social nature, with dynamic interaction between and within these areas. The patient is part of a large system, the family and society, and here also mutual impact takes place. Time and space take on new meaning in periods of stress and the nurse must be sensitive to the humans needs which grow out of these changed perceptions. Factors which may contribute to meeting patient needs are a systematic method of learning about the patient, basing care on his specific needs, knowledgeable and skilled care givers and an appropriate environment.
Teaching Religion and Material Culture
Authors: Carp Richard M.
Published: December 2006

Abstract.  Because religions discipline and interpret bodies; create and define sacred spaces; generate, adore and study images in all media; regulate the intake of food; structure temporal experience; and in general interpenetrate and are permeated by the cultural landscapes in which they exist, religious studies must engage material religion and religious materiality. We encounter bodily realities of other religions and cultures through our own disciplined bodies, which are both necessary and problematic for those encounters. This article connects theoretical and practical resources needed to help students discover the stuff of religion – flesh and blood, bread and wine, songs and sound, knives and body parts, movement and music, human bodies, time, space, cosmograms composed of and composing the bodies of the religious – uncovering the materiality of religion, existing underneath, alongside, without, and amidst religious textuality and verbal ideation.
Glutamate receptor activation evokes calpain‐mediated degradation of Sp3 and Sp4, the prominent Sp‐family transcription factors in neurons
Authors: Mao Xianrong , Yang Shao‐Hua , Simpkins James W. , Barger Steven W.
Published: December 2006

Sp‐family transcription factors (Sp1, Sp3 and Sp4) contain a zinc‐finger domain that binds to DNA sequences rich in G–C/T. As assayed by RT‐PCR analysis of mRNA, western‐blot analysis, immunofluorescence, and antibody‐dependent “supershift” of DNA‐binding assays, the prominent Sp‐family factors in cerebral neurons were identified as Sp3 and Sp4. By contrast, glial cells were found to express Sp1 and Sp3. We previously showed that the pattern of G–C/T binding activity of Sp‐family factors is rapidly and specifically altered by the calcium influx accompanying activation of glutamate receptors. Here, we demonstrate that Sp‐factor activity is also lost after a cerebral ischemia/reperfusion injuryin vivo. Consistent with its calcium‐dependent nature, we found that glutamate’s effect on Sp‐family factors could be blocked by inhibitors of calpains, neutral cysteine proteases activated by calcium. Purified calpain I cleaved Sp3 and Sp4 into products that retained G–C/T‐binding activity, consistent with species observed in glutamate‐treated neurons. These data provide details of an impact of glutamate‐receptor activation on molecular events connected to gene expression.
Increased mast cell density in invasive melanoma
Authors: Duncan Lyn M. , Richards Lisa A. , Mihm Martin C.
Published: December 2006

Mast cell participation in immune responses, tumor progression, and vascularization has been studied extensively in vitro. In situ investigation of mast cells in routinely processed tissues is hampered by difficulty in reliable detection of mast cells. We studied the tissue density of mast cells using a morphometric point‐counting technique in 1 μm‐thick, Giemsa‐stained, tissue sections from epon‐embedded samples of skin biopsies. This technique has been demonstrated to be an accurate and reproducible method for determining mast cell density.

Mast cell density in 15 cases of invasive melanoma was compared to that of 9 cases of benign melanocytic nevi and 4 cases of melanoma in situ. Mast cell density was greatest in invasive melanoma (mean density = 0.61 vol.%). The mean density of mast cells in nevi and in situ melanoma was 0.33 and 0.5 respectively. Six of 15 cases of melanoma had mast cell densities > 0.6, whereas mast cell density did not exceed 0.6 in any cases of melanoma in situ or benign melanocytic nevi (p < 0.02). Our findings confirm an increase in mast cell tissue density in some cases of invasive melanoma when compared to mast cell density in benign nevi and in situ melanoma.
Characterization of unmyelinated axons uniting epidermal and dermal immune cells in primate and murine skin
Authors: Egan Christine L. , Viglione‐Schneck Mary J. , Walsh Laurence J. , Green Barry , Trojanowski John Q. , Whitaker‐Menezes Diana , Murphy George F.
Published: December 2006

The present study was undertaken to characterize further the structure and function of cutaneous nerves which we have previously shown to associate with skin immune cells (Hosoi et al., Nature 1993: 363:159). Ultrastructurally, axons were prominent within the superficial dermis atid epidermis in neonatal murine skin, but they were inconspicuous in adult murine and primate skin. Immunohistochemical and immunoultrastuctural evaluation of normal adult human and simian skin for neural cell adhesion molecule (N‐CAM), however, defined a plexus of axons surrounding superficial dermal mast cells and extending as delicate, vertical branches into the overlying epidermal layer. Antibodies to neuropeptides substance P, calcitonin gene‐related peptide, and to nerve cell‐specific clathrin (LCb subunit) also reacted with this neural plexus. Double labeling disclosed intimate associations of N‐CAM‐positive axons with dermal chymase‐positive mast cells as well as with epidermal CD la‐positive Langerhans' cells by confocal scanning laser microscopy. Functionally, capsaicin applied to forearm skin revealed by 6 h discharge of mast cell chymase and induction of E‐selectin in adjacent microvascular endothelium, events consistent with release of substance P from axons and subsequent stimulation of cytokine‐mediated mast cell‐endothelial interaction. Identical application of capsaicin to human skin xenografted to immunodeficient mice, and thus experimentally lacking in unmyelinated axons, failed to show similar findings. These results provide additional support to the concept that an elaborate network of cutaneous axons may play a functional role in regulation of skin inflammation and immunity.
Topical tretinoin replenishes CD1a‐positive epidermal Langerhans cells in chronically photodamaged human skin
Authors: Murphy George F. , Katz Sara , Kligman Albert M.
Published: December 2006

Excessive exposure to sunlight results in drastic degradative changes in the constitutive cells of the epidermis. Among these is a profound abrogation of Langerhans cell number and function, leading to compromised immunologic competency. Retinoids have recently been shown to restore immunologic function in the setting of iatrogenic immunosuppresion. We asked whether topical tretinoin would reverse Langerhans cell depletion in chronically photodamaged skin.

We examined the skin of 8 volunteers immunohistochemically before and after 6 months of daily applications of tretinoin. At baseline, there was a profound depletion of CD1a‐positive Langerhans cells in the interfollicular epidermis, but not in the adjoining follicular epithelium. After tretinoin, all patients demonstrated replenishment of interfollicular epidermis by CD1a‐positive Langerhans cells. This was associated with induction of HLA‐DR expression on infundibular keratinocytes, as well as the appearance of CD1a dendritic cells in the papillary dermis. Thus, the enhancement of epidermal immunity in photodamaged skin may reflect restoration of antigen‐presenting Langerhans cells. The source of this renewed dendritic cell population is likely to be follicular infundibulum and the papillary dermis.
Immunohistologic differential diagnosis of basal cell carcinoma, squamous cell carcinoma, and trichoepithelioma in small cutaneous biopsy specimens
Authors: Swanson Paul E. , Fitzpatrick Maureen M. , Ritter Jon H. , Glusac Earl J. , Wick Mark R.
Published: December 2006

The distinction between squamoid basal cell carcinoma and basaloid squamous cell carcinoma (or between BCC and trichoepithelioma variants) is usually made readily on the basis of defined histological criteria. However, these differential diagnoses occasionally can pose difficult morphological problems. The stated distinctions are clinically important because the risk of progressive disease is significantly higher with squamous carcinoma of the skin than with basal cell carcinoma (BCC), and a trichoepithelioma misinterpreted as BCC burdens the patient with an inaccurate diagnosis that may result in inappropriate surgery. Recent reports have suggested that reactivity with the monoclonal antibody Ber‐EP4 is capable of separating histologically similar basal cell and squamous carcinomas, and that ihe expression of bcl‐2 or CD34 antigen is able to distingtush BCC from trichoepithelioma. However, corroborative studies of these contentions are few in number. In order to investigate the usefulness of the stated immunostains in the above‐cited differential diagnoses, the authors analyzed 45 basal cell carcinomas and 22 squamous carcinomas, as well as 36 trichoepitheliomas. The monoclonal antibodies Ber‐EP4, My10 (CD34), and anti‐bcl‐2 were applied to formalin‐fixed paraffin sections in all cases, using a standard avidin‐biotin‐peroxidase complex method. Most BCCs demonstrated strong, diffuse cytoplasmic labeling with Ber‐EP4 and anti‐bcl‐2. In contrast, the squamous carcinomas were uniformly negative for the former marker and only focally reactive for the latter in four examples. ‘Peripheral’bcl‐2 staining of trichoepitheliomas was noted in 24 of 33 of the immunoreactive tumors, but the remainder were marked diffusely and similarly to most BCCs. Among the latter, immature trichoepitheliomas were diffusely reactive for this marker in 6 of 8 cases. Labeling of epithelium for CD34 failed to discriminate between any of the tumor types under evaluation, whereas staining of peritumoral stroma was characteristic of the majority of trichoepitheliomas and more than one‐third of metatypical basal cell carcinomas. These data support the suggestion that Ber‐EP4 and bcl‐2 are useful in the separation of BCC from squamous carcinomas. Nevertheless, they also serve to caution against reliance upon bcl‐2 and CD34 immunostains in attempting to distinguish BCC from trichoepithelioma in histologically enigmatic cases. There is currently no certain method other han conventional microscopy that can be applied successfully to the latter problem.