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

The role of healthcare practitioners in reversing homeostatic imbalances essentially makes them external agents of homeostatic control—they are replacing the usual assessment, controlling and effector aspects that operate intrinsically in health (homeostasis) but have failed in ill‐health (homeostatic imbalances). This article examines the homeostatic imbalance of hypothyroidism, using a case study to draw analogies between the components of homeostatic theory and those of the nursing process. After reading this article, nurses should be able to explain: how the components of homeostasis are associated with health, and how failure of one or more of these components of homeostasis is associated with illness; that illness arises from a cellular, and therefore chemical, homeostatic imbalance; that hypothyroidism is a cellular imbalance of low levels of thyroid hormone, which is identified by signs and symptoms (i.e. other homeostatic imbalances) related to these low levels; and understand how primary care nu...

Homeostasis 3: nurses as external agents of control in hypothyroidism

Neurophysiology of pain.

Homeostasis and nature-nurture interactions: A framework for integrating the life sciences

All disorders involve a disturbance of cellular and hence chemical function in the body. Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that usually attacks synovial joints and surrounding ligaments, muscles and their tendons and blood vessels. This article applies the concept of health professionals operating as external agents of homeostatic control (Clancy and McVicar, 20011a; 2011b) to RA and to the care of affected patients, using a case scenario to illustrate attempts to minimize homeostatic imbalances. After reading the article, nurses should be able to understand: how the principles of homeostatic theory apply to skeletomuscular function, in particular to synovial joint function; the skeletomuscular homeostatic role in movement; and that homeostatic failure of reduced mobility, as in RA, is a result of nature-nurture interaction; that illness arises from a cellular, hence chemical, homeostatic imbalance(s) (Clancy and McVicar, 2011a; 2011b; 2011c; 2011d; 2011e). RA is consi...

Homeostasis 6: nurses as external control agents in rheumatoid arthritis

The role of health practitioners in attempting to reverse homeostatic imbalances essentially makes them external agents of homeostatic control-they are replacing the assessment, controlling and effector mechanisms that operate during health (homeostasis), but have failed in ill-health (homeostatic imbalances). Myocardial infarction (MI) is the homeostatic imbalance examined in this article, which aims to apply the analogy between the components of homeostatic theory and the components of the nursing process (Clancy and McVicar, 2011b) to the condition. After reading the article, nurses should be able to understand that: the components of homeostasis are associated with health, and the failure of one or more of these components results in illness; illness arises from a cellular, hence chemical, homeostatic imbalance(s); MI results from a cellular imbalance leading to a restriction in blood flow to the myocardium, and is identified by signs and symptoms (i.e. other homeostatic imbalances) related to the ischaemia; when caring for people with MI, coronary care nurses are acting as external agents of homeostatic control.

John Clancy

Papers

Homeostasis 3: nurses as external agents of control in hypothyroidism

Neurophysiology of pain.

Homeostasis and nature-nurture interactions: A framework for integrating the life sciences

Homeostasis 6: nurses as external control agents in rheumatoid arthritis

Homeostasis 4: nurses as agents of control in myocardial infarction