bluuebunny/crossref_metadata_2025_split huggingface dataset:
The art of clinical supervision
Authors: TITCHEN ANGIE , BINNIE ALISON 
Published: November 2007

Summary

Helping nurses to become effective and confident as primary nurses involves developing their interpersonal skills, sharpening their decision‐making and nurturing their creativity. In our action research study, we found that traditional methods of ward teaching did not help to promote this kind of professional growth. We therefore developed, tested and refined three distinct strategies for clinical supervision which specifically aimed to foster more thoughtful and more sensitive nursing practice. Very importantly, we found that these approaches to supervision were feasible and practical to use in a busy hospital ward.
In this paper, we describe the three supervision strategies, using a clinical story to illustrate what each demands from the supervisor and what it offers the nurse under supervision. We also suggest ways in which expert nurses can be helped to become effective clinical supervisors.
Complementary therapies in practice: the ethical issues
Authors: NORTON LAVINIA 
Published: November 2007

Summary

This article explores some of the ethical issues associated with the use of complementary therapies in practice.
The adopted terminology and related concepts are clarified. The term ‘complementary therapy’ is compared and contrasted with ‘alternative medicine’ and ‘non‐conventional therapy’.
The increasing emphasis on holistic nursing care is also discussed.
Ethical issues of patient choice, informed consent and the principle of beneficence are examined in relation to complementary therapies.
The article highlights the obligation of the nurse, midwife or health visitor to provide or facilitate holistic care including complementary therapies, such as massage or aromatherapy, for those clients who request such care, and where it can be demonstrated that there will be benefits for the patient.
It is concluded that nurses should consider the possibility of incorporating or facilitating certain complementary therapies in their practice in order to benefit their patients. There is a corresponding need for an appropriate knowledge base, founded on nursing research, into the effectiveness and outcomes of complementary therapies. In addition, relevant educational courses should be developed.
Stress among student nurses: is it practical or academic?
Authors: RHEAD M. M. 
Published: November 2007

Summary

Previous research into stress among student nurses has only concentrated on the practical aspects of nursing and has ignored stress caused by the academic side of training. In comparing Registered General Nurse (RGN) and Diploma of Higher Education in Nursing (Dip. HE Nursing) students using a modified nurses stress scale, the intensity of stress was investigated.
It was hypothesized that there would be a difference in the total stress scores between the two pre‐registration education courses as well as within the practical and academic elements.
Dip. HE Nursing students were significantly more stressed than RGN students, but equally for practical and academic elements. RGN students were significantly more stressed on the practical elements. Factors analysis clearly identified two factors: (i) the practical elements, and (ii) the academic elements of nursing. A third factor was also identified and this was related to stress induced by issues concerning death and suffering in the patient.
These results have implications for the development of the nurse education course (Dip. HE Nursing) which is still in its infancy.
The nutritional management of acute renal failure
Authors: GARRETT BERNARD MARK 
Published: November 2007

Summary

Acute renal failure (ARF) is a syndrome in which the kidneys are unable to excrete the products of metabolism. The failure of renal function is rapid in its onset but potentially reversible. It occurs rapidly, within 8 weeks of renal injury resulting in a rapid increase in serum urea and creatinine concentrations in patients with previously normal renal function.
It is a condition traditionally associated with a high mortality rate, often due to the complications of sepsis, delayed wound healing and disrupted haemocoagulation. Survivability has been demonstrated to be improved by early appropriate nutritional support (Bartlett et al., 1986) although in practice this is often difficult to achieve as nutritional support is complex. In the past high morbidity and mortality rates were related to infections and inadequate nutritional intake. This resulted from unnecessary protein restrictions in an attempt to control uraemic symptoms (Thomas, 1988).
To a large extent survivability of ARF has still not been greatly improved even with modern antibiotics and the careful dietary assessment of ARF patients. This reflects the complexity of managing patients with this condition. However, appropriate dietary management of ARF patients is essential to improve their long‐term prognosis. Although the precise form this takes remains a contentious issue amongst clinicians.
Assessing patient satisfaction. Part 1. The research process
Authors: PONTIN DAVID J. T. , WEBB CHRISTINE 
Published: November 2007

Summary

The research reported in this article formed part of a project evaluating nursing developments in four demonstration wards in one health authority, and the article focuses on evaluation of patient satisfaction.
The evaluation of patient satisfaction is a topic surrounded by much methodological debate and therefore it was necessary to clarify the issues involved at the planning stage of the study.
The ‘process’ aspects of evaluating patient satisfaction will be discussed here, while the content of patient interviews will be the subject of Part 2.
The training needs of health care support workers: results of a study of workers and their managers
Authors: Moseley Laurence G , Davies Moira , Evans Linda E 
Published: November 2007

Aims and objectives.  This study was designed to assess the training needs of health care support workers. In the past, opinions on the topic have been varied, but were rarely based on empirical evidence.Design and methods.  The study was designed as a self‐report questionnaire survey of health care support workers and their managers in six units in health and social care, using as its basis 32 descriptors from the NHS Knowledge and Skills Framework, levels 1 and 2. The achieved sample was 117, giving a 77% response rate.Results.  Thirty‐five per cent of respondents thought that health care support workers were ‘unable’ to perform six or more of the 32 descriptors used, whilst on the criterion of being ‘less than able’, the figure was 64%. Support workers and their managers agreed closely (rho = 0·8) on where the difficulties lay in achieving Knowledge and Skills Framework competencies. Those difficulties lay particularly in two areas: (1) biomedical/physiological knowledge and (2) data‐handling.Conclusions.  We concluded that the numbers in need of training were substantial and the areas of need were the two identified above.Relevance to clinical practice.  The main implications for clinical practice are that (a) for those who supervise or mentor health care support workers, there should be a greater concentration on the more scientific areas of expertise and (b) a similar emphasis is needed for those who train mentors or supervisors. These implications will become more important over time as scientific knowledge about medicine and health care increases.
The rhetoric of caring and the recruitment of overseas nurses: the social production of a care gap
Authors: Allan Helen 
Published: November 2007

Aims and objectives.  I will argue that overseas nurse recruitment is the consequence of a care gap, which arose from several policy shifts in the 1990s and in part from the rhetoric of a normative moral discourse in the UK which claims that caring is the moral essence of nursing. I will suggest that this discourse has masked the uncoupling of caring from nursing practice and that this uncoupling places the overseas nurses in a contradictory position.Background.  In an increasingly competitive global labour market, the UK is faced with a nursing shortage and has been recruiting trained nurses from abroad (NMC 1993–2002).Design and methods.  This paper is based on two related, qualitative studies using semi‐structured focus groups and individual interviews. The first explored the experiences of overseas nurses in the UK and the second investigated the equal opportunities and career progression of overseas nurses in the UK.Results.  The data from these studies challenge the normative UK value that caring is at the heart of nursing. These data are the lens through which we see this contradiction explicitly played out. Overseas nurses observe that caring (as undertaken by health care assistants in care homes) is not nursing yet caring is being passed down the line as a process that marginalizes the overseas nurses and at the same time devalues their skills. I do not argue that overseas nurses care at a higher standard (although this may be the case) just that they care differently, that they expected UK nurses to deliver basic care and, instead, experience UK nursing practice as less autonomous and of a lower standard than they expected.Conclusions.  I argue that the overseas nurses’ views help us understand the processes by which the uncoupling of caring from nursing has come about.Relevance to clinical practice.  This paper discusses a workforce issue which is directly relevant to clinical practice because it focuses on the meaning of care; what is caring, what are caring activities and how are these represented in the discourse on caring in the literature? This paper also reveals significant worries among nursing managers about how to staff the nursing workforce and what nurses should be doing in the clinical areas.
Academics’ perceptions of the professional or clinical doctorate: findings of a national survey
Authors: Ellis Lorraine 
Published: November 2007

Aims and objectives.  The aim of this study was to report the perceptions of senior academics’ working in institutions of higher education towards professional doctorates for the health and social care professions.Background.  The professional doctorate is a product of its time introduced for the purpose of developing and improving clinical practice. The extent to which this has been realised, however, has yet to be determined, there being little empirical or theoretical work in this field. This research is an attempt to begin to produce an evidence base in this area by reporting the views of those stakeholders responsible for delivering the curriculum and its intended aim of improving clinical practice.Design.  A modified version of illuminative evaluation was designed to map the range of perceptions and intended outcomes of the professional doctorate.Methods.  Fifty‐five academics from 41 institutions of higher education were telephone interviewed and their perceptions of the professional doctorate elicited, together with a content analysis of the curriculum documents.Results.  Academics’ views fell into one of three broad categories: enthusiastic, ambivalent and sceptical.Conclusions and relevance to practice.  Academics’ perceptions of the professional doctorate may have a bearing on whether the stated aim of the curriculum and improvements in clinical practice is realised. Academics are responsible for the recruitment of students and the quality of the educational experience. Respondents’ perceptions raise questions about their commitment to professional doctorates relative to PhD, factors that will be considered during stages two and three of this research where the views of students and sponsors will be reported.
Field validation of experimental challenge models for IPN vaccines
Authors: Ramstad A , Romstad A B , Knappskog D H , Midtlyng P J 
Published: November 2007

AbstractAtlantic salmon S1/2 pre‐smolts from the VESO Vikan hatchery were assigned to study groups, i.p. immunized with commercially available, multivalent oil‐adjuvanted vaccines with (Norvax Compact 6 – NC‐6) or without (Norvax Compact 4 – NC‐4) recombinant infectious pancreatic necrosis virus (IPNV) antigen. A control group received saline solution. When ready for sea, the fish were transported to the VESO Vikan experimental laboratory, where two identical tanks were stocked with 75 fish per group before being transferred to 10 °C sea water and exposed by bath to first passage IPNV grown in CHSE‐214 cells. The third tank containing 40 fish from each group was challenged by the introduction of 116 fish that had received an i.p injection of IPNV‐challenge material. The remaining vaccinated fish were transported to the VESO Vikan marine field trial site and placed in two identical pens, each containing approximately 53 000 fish from the NC‐6 group and 9000 fish from the NC‐4 group. In the experimental bath challenge trial, the cumulative mortality was 75% and 78% in the control groups, and the relative percentage survival (RPS) of the NC‐6‐immunized fish vs. the reference vaccine groups was 60% and 82%, respectively. In the cohabitation challenge, the control mortality reached 74% and the IPNV‐specific vaccine RPS was 72%. In both models, the reference vaccine lacking IPNV antigen gave a moderate but statistically significant non‐specific protection. In the field, a natural outbreak of infectious pancreatic necrosis (IPN) occurred after 7 weeks lasting for approximately 3.5 months before problems due to winter ulcers became dominating. During this outbreak, mortality in the NC‐4 groups were 33.5% and 31.6%, respectively, whereas mortality in the NC‐6 groups were 6.9% and 5.3%, respectively, amounting to 81% IPNV‐specific protection. In conclusion, the IPN protection estimates obtained by experimental challenges were consistent between tanks, and were confirmed by the field results.
Microhabitat selection of Gyrodactylus salaris Malmberg on different salmonids
Authors: Heinecke R D , Martinussen T , Buchmann K 
Published: November 2007

AbstractThe microhabitat selection of the ectoparasite Gyrodactylus salaris (Lærdalselva strain, Norway) was investigated concurrently with studies on the parasite population growth on five strains of Atlantic salmon, Salmo salar L., and a strain of Danish rainbow trout, Oncorhynchus mykiss (Walbaum). The salmon used were hatchery‐reared parr of East Atlantic strains [River Conon (Scotland), River Storå (western Denmark) and River Ätran (western Sweden)] and Baltic strains [Lule and Ume (eastern Sweden)]. The location and numbers of parasites were recorded on anaesthetized fish once a week from week 0 to week 8. The mean abundance of G. salaris steadily increased to high levels on the River Conon, Storå and Ätran strains until the end of the experiment. The mean abundance of G. salaris on the two Baltic strains (River Lule älv and River Ume älv) initially increased but after 4–7 weeks the growth of the parasite infrapopulations decreased markedly. The Danish rainbow trout strain showed the lowest abundances of all the fish species and strains. Gyrodactylus salaris preferentially selected the fins and head region when colonising the hosts (all species and strains). Increasing percentages of G. salaris on the tail fins of the East Atlantic strains and rainbow trout were found during the course of infection, whereas the two Baltic salmon strains experienced a decreasing percentage of parasites in this microhabitat.
The aetiology of spinal deformity in Atlantic salmon, Salmo salar L.: influence of genetic factors on the frequency and severity in freshwater stages
Authors: Sullivan M , Guy D R , Roberts R J , Manchester N J 
Published: November 2007

AbstractA radiographic study was carried out on 2‐year groups of pre‐smolt parr to detect the comparative frequency of vertebral change in a range of defined pedigreed families of high growth rate of Atlantic salmon, Salmo salar L., reared under identical conditions. The observed frequency of deformity was related to the observed deformity level in the seawater parental generation, and to a potentially uncontrolled environmental determinant, i.e. stripping date. High and low parental deformity groups of families were found to produce offspring that had very similar levels of radiographically detectable spinal deformities in the pre‐smolt parr, suggesting no genetic link. With regard to stripping date, the overall incidence was nearly half that seen in the preceding year (8.7% cf 16.6%). However, a non‐significant trend to fewer radiographic spinal deformities was seen in the later stripping period.
The aetiology of spinal deformity in Atlantic salmon, Salmo salar L.: influence of different commercial diets on the incidence and severity of the preclinical condition in salmon parr under two contrasting husbandry regimes
Authors: Sullivan M , Reid S W J , Ternent H , Manchester N J , Roberts R J , Stone D A J , Hardy R W 
Published: November 2007

AbstractA large‐scale trial of the effect of different commercial diets on the incidence of preclinical spinal deformation, as assessed by radiography, and the influence of two contrasting rearing systems was carried out. Two sets of three populations of Atlantic salmon, each of 20 000 first feeding fry of identical hatchery origin, created from equal numbers of eggs from 15 different families, were reared under commercial conditions on two different farms. Three commercial (closed formula) extruded fish meal‐based diets were used in this study (diets A, B & C). Each diet was fed to one population of 20 000 fish at each site. Fish were fed a percentage of their body weight per day, with feeding rates set at commercial levels, based on water temperature, day length and fish biomass. Additional hand feeding was used to ensure satiation in all tanks. Fish in each tank were bulk‐weighed and counted at the beginning and at 2‐week intervals throughout the study. The fish were grown for 30 weeks. In addition, phosphorus (P) digestibility was evaluated by in‐feed absorption testing in rainbow trout. The morphology of the radiographic lesions conformed to those described previously. Statistical analysis using multivariate regression analysis showed that date of sampling, site and diet were all statistically significant (P < 0.001) on univariable analysis. Farm A had significantly more affected fish than farm B (P < 0.001), which may have been attributable to variation in dissolved oxygen levels. The available dietary P levels were low in each diet. The number of fish affected in the group of fish being fed diet B was significantly lower than in the groups being fed diets A or C (P < 0.001). It appears most likely that the occurrence of preclinical radiographically apparent defects in parr which are believed to lead to the condition known as ‘spinal deformity’ is predominantly caused by a deficiency of available dietary P in first‐feeding fry. The availability of dietary P may also vary considerably between diets formulated using different ingredients. Phytate‐P associated with plant ingredients may affect the availability of P as well as other essential dietary nutrients. Additionally, diets for the production of salmonids in fresh water are currently formulated to keep P effluent to a minimum compatible with healthy spinal development. These various factors combine to make it crucial that small Atlantic salmon, especially first‐feeding fry, are provided with carefully formulated diets fortified to an adequate level with a high quality source of available P.
Inhibitory motor control in apneic and insomniac patients: a stop task study
Authors: SAGASPE PATRICIA , PHILIP PIERRE , SCHWARTZ SOPHIE 
Published: November 2007

SummaryThe aim of this study was to assess with a stop task the inhibitory motor control efficiency – a major component of executive control functions – in patients suffering from sleep disorders. Twenty‐two patients with untreated obstructive sleep apnea syndrome (OSAS) (mean age 46 ± 9 years; mean apnea–hypopnea index, AHI = 30 ± 20) and 13 patients with psychophysiological insomnia (mean age 47 ± 12 years) were compared with individually matched healthy controls. Sleep disturbances in the patient populations were clinically and polysomnographically diagnosed. The stop task has a frequent visual ‘Go’ stimulus to set up a response tendency and a less frequent auditory ‘Stop’ signal to withhold the planned or prepotent response. The stop signal reaction time (SSRT) reflects the time to internally suppress the ongoing response. SSRT was slower for the apneic patients than for their respective controls (248 ± 107 versus 171 ± 115 ms, anova, P < 0.05) but not for the insomniac patients compared with their controls (235 ± 112 versus 194 ± 109 ms, NS). Moreover, in apneic patients, slower SSRT was associated with lower nocturnal oxygen saturation (r = −0.477, P < 0.05). By contrast, neither apneics nor insomniacs differed from their matched controls for reaction times on Go trials. To conclude, unlike insomniacs, OSAS patients present an impaired inhibitory motor control, an executive function which is required in many common everyday life situations. Inhibitory motor control relies on the integrity of the inferior prefrontal cortex, which could be affected by nocturnal oxyhemoglobin desaturation in apneic patients.
Diagnosis of sleep‐disordered breathing in patients with chronic heart failure: evaluation of a portable limited sleep study system
Authors: SMITH LINDSAY A. , CHONG DENNIS W. S. , VENNELLE MARJORIE , DENVIR MARTIN A. , NEWBY DAVID E. , DOUGLAS NEIL J. 
Published: November 2007

SummarySleep‐disordered breathing (SDB) is common in chronic heart failure (CHF), affects disease progression and presents a potential therapeutic target. This study was designed to test the hypothesis that there would be good agreement in diagnostic outcome between home limited sleep studies and in‐laboratory polysomnography (PSG) in the identification of SDB in patients with CHF. We performed synchronous in‐laboratory Embletta and PSG, and home Embletta studies, prospectively in 20 consecutive patients with stable symptomatic CHF (ejection fraction 33 ± 12%) on optimal medical therapy. Sleep efficiency was poor at 57 ± 21%. Unlike synchronous in‐laboratory Embletta (kappa coefficient 0.63, P < 0.01), home Embletta showed poor agreement with PSG (kappa coefficient 0.27, P = 0.06). Positive and negative predictive values for home Embletta in detecting SDB were 83% and 57% respectively. In this relatively small study, agreement in diagnostic outcome between home Embletta and PSG, and negative predictive value for the home Embletta, were poor. We explore possible explanations for this, both technical and situational, which should be taken into consideration when considering potential screening or diagnostic tools for SDB in patients with CHF.