bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review: nurses can improve patient nutrition in intensive care
Authors: Ros Caroline , McNeill Liz , Bennett Paul 
Published: June 2009

Aims and objectives.  To review the literature and identify opportunities for nutritional practice improvement in the critically ill and opportunities to improve nurses’ knowledge relating to enteral feeding.Background.  The literature reports varying nutritional practices in intensive care.Design.  Systematic review.Methods.  A systematic search, selection, analysis and review of nursing, medical and dietetic primary research articles was undertaken. Fifteen studies met the selection criteria.Results.  Delivery of nutrition to the critically ill varied widely. Patients were frequently underfed and less frequently, overfed. Both under‐ and overfeeding have been linked with unacceptable consequences including infections, extended weaning from mechanical ventilation, increased length of stay and increased mortality. Underfeeding was related to slow initiation and advancement of nutrition support and avoidable feed interruptions. The most common reasons for interrupting feeds were gastrointestinal intolerance and fasting for procedures. Certain nursing practices contributed to underfeeding such as the management of gastric residual volumes.Conclusions.  Consistent and reliable nutrition support in intensive care units is hampered by a lack of evidence leading to varying nutrition practices. Factors impeding delivery of enteral nutrition were considered avoidable. A new concept of a therapeutic range of energy delivery in the critically ill has emerged implying the need for re‐evaluation of energy recommendations and improved delivery of enteral nutrition.Relevance to clinical practice.  This review supports the multi‐disciplinary development and implementation of an evidence‐based enteral feeding protocol in intensive care units as a strategy to improve adequacy of nutritional intake. Critical care nurses are well placed to improve this process.
Thinking ‘taller’: sharing responsibility in the everyday lives of children with asthma
Authors: Meah Angela , Callery Peter , Milnes Linda , Rogers Sam 
Published: June 2009

Aims.  To explore negotiation of responsibilities for asthma self‐care between a group of preadolescent children aged 7–12 and their parents/carers and to explore the meaning of responsibility to these children and their adult carers.Background.  Living with asthma requires the distribution of a range of responsibilities between children and their adult carers, highlighting tensions between protection and promotion of autonomy. Previous studies have identified diverse factors associated with transfer of responsibility but a better understanding is required of the meaning of responsibility in children’s lives and how parents and children negotiate responsibilities.Design.  The design was qualitative.Methods.  Eighteen child participants aged 7–12 years and their parents/carers participated in open‐ended, conversational‐style interviews. The framework approach was used to analyse the data and interpretation of data drew upon both feminist epistemology and sociological understandings of children, health and the body which relocate subjective experience at the heart of scientific enquiry.Results.  Children demonstrated responsibility by avoiding asthma exacerbators and limiting the effect of asthma on themselves and their parents but there were limitations on children’s opportunities to exercise some responsibilities.Conclusions.  It is possible to consider responsibility as the exercise of agency by children rather than simply as compliance with adults’ instructions and prescriptions.Relevance to clinical practice.  Some parents would like more assistance from health professionals in managing the process of increasing independent self‐care by children. It is important to maintenance of the health of children with long‐term conditions that the distribution of responsibilities between adults and children both ensures children’s safety and provides appropriate preparation for independence in adult life. Understanding the process by which parents and children negotiate distribution of responsibilities for long‐term conditions could provide a basis for development of interventions to respond to parents’ requests for more professional support for managing this process.
Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach
Authors: Rolley John X , Davidson Patricia M , Salamonson Yenna , Fernandez Ritin , Dennison Cheryl R 
Published: June 2009

Aim.  To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention.Background.  Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management.Design.  Systematic review.Method.  The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage).Results.  Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri‐percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase.Conclusions.  Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design.Relevance to clinical practice.  To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high‐level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family.
The challenge of caring for patients in pain: from the nurse’s perspective
Authors: Blondal Katrin , Halldorsdottir Sigridur 
Published: June 2009

Aim. To increase understanding of what it is like for nurses to care for patients in pain.Background. Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses’ relations with patients and doctors, it may be fruitful to study nurses’ experience of caring for patients in pain to increase understanding of the above problem.Design. A phenomenological study involved 20 dialogues with 10 experienced nurses.Results. The findings indicate that caring for a patient in pain is a ‘challenging journey’ for the nurse. The nurse seems to have a ‘strong motivation to ease the pain’ through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are ‘reading the patient’, ‘dealing with inner conflict of moral dilemmas’, ‘dealing with gatekeepers’ (physicians) and ‘organisational hindrances’. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse.Conclusions. Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses’ knowledge in this respect may hitherto have been too narrowly defined.Relevance to clinical practice. The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses’ clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge.
Factors contributing to nursing task incompletion as perceived by nurses working in Kuwait general hospitals
Authors: Al‐Kandari Fatimah , Thomas Deepa 
Published: June 2009

Background.  Unfinished care has a strong relationship with quality of nursing care. Most issues related to tasks incompletion arise from staffing and workload.Objectives.  This study was conducted to assess the workload of nurses, the nursing activities (tasks) nurses commonly performed on medical and surgical wards, elements of nursing care activities left incomplete by nurses during a shift, factors contributing to task incompletion and the relationship between staffing, demographic variables and task incompletion.Design.  Exploratory survey using a self‐administered questionnaire developed from IHOC survey, USA.Participants.  All full time registered nurses working on the general medical and surgical wards of five government general hospitals in Kuwait.Methods.  Research assistants distributed and collected back the questionnaires. Four working days were given to participants to complete and return the questionnaires. A total of 820 questionnaires were distributed and 95% were returned.Data analysis.  Descriptive and inferential analysis using SPSS‐11.Results.  The five most frequently performed nursing activities were: administration of medications, assessing patient condition, preparing/updating nursing care plans, close patient monitoring and client health teaching. The most common nursing activities nurses were unable to complete were: comfort talk with patient and family, adequate documentation of nursing care, oral hygiene, routine catheter care and starting or changing IV fluid on time. Tasks were more complete when the nurse‐patient load was less than 5. Nurses’ age and educational background influenced task completion while nurses’ gender had no influence on it.Conclusions.  Increased patient loads, resulting in increased frequency of nursing tasks and non‐nursing tasks, were positively correlated to incompletion of nursing activities during the shift.Relevance to clinical practice.  Emphasis should be given to maintaining the optimum nurse–patient load and decreasing the non‐nursing workload of nurses to enhance the quality of nursing care.
The meaning of autonomy in nursing practice
Authors: Skår Randi 
Published: June 2009

Aim.  To illuminate the meaning of nurses’ experiences of autonomy in work situations.Background.  Professional autonomy means having the authority to make decisions and the freedom to act in accordance with one’s professional knowledge base. An understanding of autonomy is needed to clarify and develop the nursing profession in rapidly changing health care environments and internationally there is a concern about how the core elements of nursing are taken care of when focusing on expansion and extension of specialist nursing roles.Design.  Qualitative study.Methods.  This paper reports part of a project aimed at exploring the education and work qualifications required by the nursing profession. Eleven Norwegian nurses, each with 2–3 years of work experience since graduation, participated in both in‐depth interviews and focus group interviews in 2006. A qualitative hermeneutic approach, inspired by Gadamer’s philosophy, guided the research process and the analysis and interpretation of the transcribed interview‐texts.Results.  The nurses’ descriptions of their experiences of autonomy in work situations emerged as four themes: ‘to have a holistic view’, ‘to know the patient’, ‘to know that you know’ and ‘to dare’. To be knowledgeable and confident was found to be the coherent meaning of autonomy in nursing practice.Conclusions.  Authority of total patient care, the power to make decisions in a relationship with the patient and next of kin and the freedom to make clinical judgements, choices and actions seem to be connected to the meaning of autonomy in nursing practice.Relevance to clinical practice.  To gain autonomous practice, nurses must be competent and have the courage to take charge in situations where they are responsible. This study shows the challenges in handling this autonomous practice.
Effective nursing care of adolescents diagnosed with anorexia nervosa: the patients’ perspective
Authors: Van Ommen Joyce , Meerwijk Esther L , Kars Marijke , Van Elburg Annemarie , Van Meijel Berno 
Published: June 2009

Aims and objectives.  The purpose of this study is to develop – from the patients’ perspective ‐ a tentative theoretical model explaining the effectiveness of inpatient nursing care of adolescents diagnosed with anorexia nervosa.Background.  The continuous and direct involvement of nurses with patients is likely to play a significant role in the recovery process of patients with anorexia nervosa. However, only limited evidence is available on what patients with anorexia nervosa themselves consider important and effective in terms of nursing care.Design.  The design of this study was qualitative.Methods.  A grounded theory approach was applied where 13 adolescents with anorexia nervosa were interviewed to generate data for the model.Results.  Participants stated that nurses contributed significantly to their recovery from anorexia nervosa. Three recurring themes emerged from the data: (1) normalisation, (2) structure and (3) responsibility. The focus of nursing care with respect to these themes shifted during the phases of recovery.Conclusions.  Based on patients’ experiences a theoretical model is developed describing effective nursing care of adolescents diagnosed with anorexia nervosa. Patients identified the key components of this model as essential to their weight recovery.Relevance to clinical practice.  The model may be used to improve the quality of nursing care of adolescents diagnosed with anorexia nervosa through analysis of current practice with respect to the key components of our model. Interventions that are based on these components closely follow the patients’ needs.
Not feeding, not coming home: parental experiences of infant feeding difficulties and family relationships in a neonatal unit
Authors: Swift Michelle Carr , Scholten Ingrid 
Published: June 2009

Aim.  This study had two main objectives: (1) to describe the experiences of parents who had a child in the Flinders Medical Centre neonatal unit with a feeding difficulty at 36 weeks gestational age and (2) to develop a preliminary model from the data as an account of the parents’ experiences to identify considerations for future and current neonatal unit staff.Background.  Family centred care is an important part of nursing practice. Research looking individually at the neonatal unit experience and childhood feeding difficulties has found that they can be stressful situations for parents. However, very little research has been conducted into parental experiences of feeding infants in a neonatal unit and there is no known research which has specifically looked at the effect on parents of having a child with a feeding difficulty in a neonatal unit.Design.  A qualitative phenomenological research design was employed.Method.  Nine parents whose children had feeding difficulties while in the Flinders Medical Centre neonatal unit, South Australia, participated via retrospective in‐depth interviews.Results.  Responses were coded to describe parents’ experiences and a preliminary model was proposed to explain the data. The main theme linking parental experiences was the desire to take the baby home. The feeding difficulty prevented this from occurring, shifting the feeding interaction from one of relationship development to one of weight gain.Conclusion.  This research identifies trigger points that may be acted on to encourage positive parent‐child feeding interactions.Relevance to clinical practice.  Family centred care is encouraged in paediatric nursing practice. This research identifies trigger points which may inform clinical practice involving parents of infants with feeding difficulties.
Global patterns in plant height
Authors: Moles Angela T. , Warton David I. , Warman Laura , Swenson Nathan G. , Laffan Shawn W. , Zanne Amy E. , Pitman Andy , Hemmings Frank A. , Leishman Michelle R. 
Published: June 2009

Summary 1.  Plant height is a central part of plant ecological strategy. It is strongly correlated with life span, seed mass and time to maturity, and is a major determinant of a species’ ability to compete for light. Plant height is also related to critical ecosystem variables such as animal diversity and carbon storage capacity. However, remarkably little is known about global patterns in plant height. Here, we use maximum height data for 7084 plant Species × Site combinations to provide the first global, cross‐species quantification of the latitudinal gradient in plant height. 2.
The mean maximum height of species growing within 15° of the equator (7.8 m) was 29 times greater than the height of species between 60° and 75° N (27 cm), and 31 times greater than the height of species between 45° and 60° S (25 cm). There was no evidence that the latitudinal gradient in plant height was different in the northern hemisphere than in the southern hemisphere (P = 0.29). A 2.4‐fold drop in plant height at the edge of the tropics (P = 0.006) supports the idea that there might be a switch in plant strategy between temperate and tropical zones. 3.
We investigated 22 environmental variables to determine which factors underlie the latitudinal gradient in plant height. We found that species with a wide range of height strategies were present in cold, dry, low productivity systems, but there was a noticeable lack of very short species in wetter, warmer, more productive sites. Variables that capture information about growing conditions during the harsh times of the year were relatively poor predictors of height. The best model for global patterns in plant height included only one term: precipitation in the wettest month (R2 = 0.256). 4.
Synthesis. We found a remarkably steep relationship between latitude and height, indicating a major difference in plant strategy between high and low latitude systems. We also provide new, surprising information about the correlations between plant height and environmental variables.
Seedling establishment shapes the distribution of shade‐adapted forest herbs across a topographical moisture gradient
Authors: Albrecht Matthew A. , McCarthy Brian C. 
Published: June 2009

Summary1. In deciduous forests, herb distribution patterns can shift dramatically across topographical gradients, yet it remains unclear whether topographical associations reflect regeneration niche differences that arise during early life‐history stages.2. We examined: (i) whether seedling recruitment patterns were consistent with topographical distributions of established populations and (ii) how environmental heterogeneity at two spatial scales influences spatial patterns of seedling recruitment in four shade‐adapted forest herbs (Actaea racemosa,Hydrastis canadensis,Panax quinquefoliusandSanguinaria canadensis), which are harvested from the wild for their medicinal properties but differ in life histories and seed mass. Topographical distributions were quantified in transect surveys of forest stands, and then seed was experimentally transplanted into litter microenvironments (bare, shallow and deep) on opposing topographical positions (NE‐facing cove forest and SW‐facing oak forest).3. Forest herbs that were more frequent in moist NE‐facing cove forests (A. racemosa,H. canadensisandS. canadensis) suffered higher mortality when their seeds were dispersed into the drier SW‐facing oak forest, although the stages that limited recruitment differed among species.4. ForA. racemosaandS. canadensis, the selectivity of the slope topographical filter varied in strength among years that differed in soil moisture. Seedling distributions expanded across the topographical gradient during a ‘wet’ year but contracted during a ‘dry’ year.5. Litter effects were often context‐dependent. Litter‐removing disturbance increased seedling recruitment ofH. canadensis, but only in the NE‐facing cove forest. When soil moisture was limiting in either space or time, microenvironments where litter was present tended to enhance emergence and/or survival relative to litter‐free microenvironments.6. ForP. quinquefolius, which has been harvested from the wild for over 200 years, seed limitation is a fundamental constraint on its distribution along a topographical moisture gradient. Across all microenvironments, the net recruitment rate ofP. quinquefolius, the largest‐seeded and least abundant species, was an order of magnitude greater than that ofA. racemosa, the smallest‐seeded and most abundant species.7. Synthesis.Many shade‐adapted forest herbs are declining in abundance due to anthropogenic factors. Conservation efforts must consider dispersal limitation in the spatial context of environmental filters that can vary in strength and quality over time.
Comparison of histological features, and description of histopathological lesions in thyroid glands from three species of free‐ranging sharks from the northwestern Atlantic, the blue shark, Prionace glauca (L.), the shortfin mako, Isurus oxyrhinchus Rafinesque, and the thresher, Alopias vulpinus (Bonnaterre)
Authors: Borucinska J D , Tafur M 
Published: June 2009

AbstractHistomorphological features of piscine thyroids are widely accepted and frequently used as bioindicators of environmental pollution. This despite the fact that there is marked variation in thyroid morphology resulting from numerous pathological and physiological conditions. Our hypothesis was that there will be variations in histological features in thyroids collected from different shark species during the summer season in the northwestern Atlantic. To test our hypothesis, we examined histological features encountered in grossly normal thyroids from three species of sharks, the shortfin mako, Isurus oxyrhinchus, thresher, Alopias vulpinus and blue sharks, Prionace glauca. In addition, microscopic lesions from these thyroids were described. Ninety‐four sharks were collected in summer 2001, 2002 and 2004. Routine, haematoxylin and eosin‐stained paraffin‐embedded sections were studied by light microscopy. We found inter‐species but not intra‐species variation in histological patterns of thyroids, which were distinct enough to allow ‘blind’ assignment of a thyroid to the specific species. The most common lesions encountered were lymphofollicular hyperplasia and chronic thyroiditis. In addition, one case each of intravascular larval nematodes and a myxosporean infection was found. Our results provide the first data on species‐specific morphology of thyroids collected during summer months from sharks. The results indicate that familiarity with normal thyroid morphology is crucial before using shark thyroids in biomonitoring of environmental contamination or interpreting data from this gland in shark‐health studies.