Background Stress perception is highly subjective, and so the complexity of nursing practice may result in variation between nurses in their identification of sources of stress, especially when the workplace and roles of nurses are changing, as is currently occurring in the United Kingdom health service This could have implications for measures being introduced to address problems of stress in nursing

Aims  To identify nurses’ perceptions of workplace stress, consider the potential effectiveness of initiatives to reduce distress, and identify directions for future research

Method  A literature search from January 1985 to April 2003 was conducted using the key words nursing, stress, distress, stress management, job satisfaction, staff turnover and coping to identify research on sources of stress in adult and child care nursing Recent (post-1997) United Kingdom Department of Health documents and literature about the views of practitioners was also consulted

Findings  Workload, leadership/management style, professional conflict and emotional cost of caring have been the main sources of distress for nurses for many years, but there is disagreement as to the magnitude of their impact Lack of reward and shiftworking may also now be displacing some of the other issues in order of ranking Organizational interventions are targeted at most but not all of these sources, and their effectiveness is likely to be limited, at least in the short to medium term Individuals must be supported better, but this is hindered by lack of understanding of how sources of stress vary between different practice areas, lack of predictive power of assessment tools, and a lack of understanding of how personal and workplace factors interact

Conclusions  Stress intervention measures should focus on stress prevention for individuals as well as tackling organizational issues Achieving this will require further comparative studies, and new tools to evaluate the intensity of individual distress

Workplace stress in nursing: a literature review.

Ammonia emissions from non-agricultural sources in the UK

Aim. The aim of this paper is to present a study of how ward-based staff use vital signs and the Early Warning Score to package physiological deterioration effectively to ensure successful referral to doctors.

Background.  The literature tends to emphasize the identification of premonitory signs in predicting physiological deterioration. However, these signs lack sensitivity and specificity, and there is evidence that nurses rely on subjective and subtle indicators. The Early Warning Score was developed for the early detection of deterioration and has been widely implemented, with various modifications.

Method.  The data reported here form part of a larger study investigating the practical problems faced by general ward staff in detecting physiological deterioration. During 2002, interviews and observations were carried out using a grounded theory approach, and a total of 44 participants were interviewed (30 nurses, 7 doctors and 7 healthcare support workers).

Findings.  Participants reported that quantifiable evidence is the most effective means of referring patients to doctors, and the Early Warning Score achieves this by improving communication between professionals. Rather than reporting changes in individual vital signs, the Early Warning Score effectively packages them together, resulting in a much more convincing referral. It gives nurses a precise, concise and unambiguous means of communicating deterioration, and confidence in using medical language. Thus, nurses are empowered and doctors can focus quickly on identified problems.

Conclusion.  The Early Warning Score leads to successful referral of patients by providing an agreed framework for assessment, increasing confidence in the use of medical language and empowering nurses. It is essential that nurses and nursing students are supported in its use and in developing confidence in using medical language by continued emphasis on physiology and pathophysiology in the nursing curriculum.

Packaging: a grounded theory of how to report physiological deterioration effectively

The Effect of Health Care Working Conditions on Patient Safety: Summary

Asthma and COPD are two chronic inflammatory disorders of the airway characterized by airflow limitation. While many similarities exist between these two diseases, they are pathologically distinct due to the involvement of different inflammatory cells; predominantly neutrophils, CD8 lymphocytes in COPD and eosinophils and CD4 lymphocytes in asthma. Cigarette smoking is associated with accelerated decline of lung function, increased mortality, and worsening of symptoms in both asthma and COPD. Furthermore, exposure to cigarette smoke can alter the inflammatory mechanisms in asthma to become similar to that seen in COPD with increasing CD8 cells and neutrophils and may therefore alter the response to therapy. Cigarette smoke exposure has been associated with a poor response to inhaled corticosteroids which are recommended as first line anti-inflammatory medications in asthma and as an add-on therapy in patients with severe COPD with history of exacerbations. While the main proposed mechanism for this altered response is the reduction of the histone deacetylase 2 (HDAC2) enzyme system, other possible mechanisms include the overexpression of GR-β, activation of p38 MAPK pathway and increased production of inflammatory cytokines such as IL-2, 4, 8, TNF-α and NF-Kß. Few clinical trials suggest that leukotriene modifiers may be an alternative to corticosteroids in smokers with asthma but there are currently no drugs which effectively reduce the progression of inflammation in smokers with COPD. However, several HDAC2 enhancers including low dose theophylline and other potential anti-inflammatory therapies including PDE4 inhibitors and p38 MAPK inhibitors are being evaluated.

Iconographies supplémentaires de l'article : The effects of cigarette smoke on airway inflammation in asthma and COPD: Therapeutic implications

Concerns have been expressed that bioscience education is not meeting the needs of nursing students in the UK. This paper explores the situation further by comparing student perceptions with those of experienced practitioners (Part One of the study) and also evaluates the confidence of staff nurses in explaining the rationale for care applied to a common but specific disorder (influenza; Part Two). Questionnaires were used. Responses were elicited from DipHE Nursing (Project 2000) adult/child branch students (n=153) from two universities and from adult/child care staff from their local clinical placements (n=171 in Part One of study; n=266 in Part Two). The questions asked followed two themes: (1) confidence in understanding biological science and (2) issues of teaching and learning. Most questions utilized a rating scale from 1 to 10; this scale provides no central value and a vertical line was drawn to encourage respondents to identify which half of the scale their responses came under (basically, a negative or positive viewpoint). The significance of the data distribution either side of the midline was analysed statistically (simple sign test), as were any differences in distribution between the groups (chi-square test). Median values were also determined. The data do not provide support for views that the biosciences are being significantly diminished by modern curricula, but also show no evidence for a great improvement in the bioscience knowledge base in recent years. What was surprising was the lack of confidence expressed by staff nurses: one illuminating finding was the lack of confidence in articulating their knowledge to patients and, even less so, to other health professionals. The paper reiterates a need for a national teaching and learning strategy for pre- and postregistration education in the biosciences. In particular, a means to raise the level of understanding of staff nurses must be identified urgently so that the mentoring of students in these subjects is improved.

Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice.

An exploratory study of the application of biosciences in practice, and implications for pre-qualifying education

"Physiology and Anatomy: A Homeostatic Approach" provides a modern approach to understanding how the human body functions in health and disease. Based on systems, the text uses homeostatic principles as a unique guiding concept throughout all the chapters. The format and content of this second edition facilitate the learning of human physiology by providing a framework for learning that takes the reader through 'basic' structure and function to more complex issues of clinical disorder and health care practice.

Physiology and anatomy : a homeostatic approach

The learning of biosciences by preregistration students has been recognized as being problematic, and the need for better resourcing of education has been identified. The Project 2000 initiative (UKCC, 1988) expanded the breadth and depth of the curriculum content in order to support the delivery of holistic care, and so the resources for bioscience education seemed likely to remain limited. However, the UKCC has concluded that there has been a shortfall in the acquisition of practice skills by preregistration students (UKCC, 2001). To address this, new directives indicate that curricula should move to competency-based outcomes, and use student-focused learning. However, there is a lack of clarity as to what the basic expectation is for bioscience learning at registration, and how this might be continued in postregistration programmes. The authors argue that if resources for bioscience teaching in preregistration curricula cannot be improved then it is time to review the situation to ensure that expectati...

The biosciences and fitness for practice: a time for review?

The aim of this article is to explore the sociopsychophysiological subjective nature of pain, using Melzack and Wall's gate control theory of pain In addition, the basis of pain control will be examined

John Clancy

Papers

Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice.

An exploratory study of the application of biosciences in practice, and implications for pre-qualifying education

Physiology and anatomy : a homeostatic approach

The biosciences and fitness for practice: a time for review?

Subjectivity of pain