Showing papers in "International Journal of Nursing Practice in 2005"

Validation of the Australian/English version of the Diabetes Management Self-Efficacy Scale

Abstract: Australians' use of the English language is influenced by a British educational curriculum, exposure to international television programmes and cultural backgrounds. Hence, adapting research instruments for use with Australian populations can be challenging. This study adapted the United Kingdom's version of the 20-item Diabetes Management Self-Efficacy Scale and tested it psychometrically with Australians. Face validity of the adapted instrument was established through consultation with diabetes educators and people with type 2 diabetes. Data from a convenience sample of 88 people with type 2 diabetes were analysed to determine the psychometric properties of the adapted instrument. The results indicate that the Australian/English version of the instrument is internally consistent, stable over time and it measures self-efficacy. However, there was evidence to show that there might be some redundant items in the scale. Further psychometric testing is warranted with a larger sample to determine whether the scale requires refinement.

Familial contribution to adolescent subjective well-being.

Abstract: The purpose of this study was to obtain a more complete understanding of which familial factors contribute to adolescent satisfaction and ill-being, the latter term originally developed by Alexander Grob. Semistructured interviews were conducted with 19 non-clinical adolescents from the 7th and 9th grades. The data were analysed using qualitative content analysis. Six themes concerning satisfaction arose from the analysis. Teenagers described familial contribution to their satisfaction in terms of experiences of a comfortable home, emotionally warm atmosphere, open communication, familial involvement, possibilities for external relations and a sense of personal significance in the family. Three themes related to ill-being emerged: familial hostility, ill-being or death of a family member, as well as excessive dependency. The findings expand our understanding of the diversity of familial contribution to adolescent life and subjective well-being. They challenge nurses to focus on the adolescent's self-perception of familial effects on well-being and on promotion of familial factors in adolescent health issues.

Potential errors and their prevention in operating room teamwork as experienced by Finnish, British and American nurses

Abstract: This study describes how the potential sources of errors and error prevention in operating room (OR) teams are experienced by Finnish, American and British nurses. The data were collected by interviews and analysed using a qualitative content analysis. Results consisted of categories demanding teamwork practice, shared responsibility in teams and organized teamwork. The demanding practice category included fear of errors, turnover in teams, overtime work and emotional distress as potential factors leading to errors in OR teamwork. Shared responsibility emphasized how the familiar teams, safety control and formal documentation of errors prevented errors. At the organizational level, the prevention of errors required scheduling of work, good management, competency and a reasonable physical environment. In order to improve safety in OR teams, recognition should be given to the balance of error-making and learning from them. More effective ways in reporting incidents should be adopted and overall reporting systems should be developed in Finnish OR teams.

Physical and chemical restraints in acute care: their potential impact on the rehabilitation of older people.

Abstract: Agitation is a major problem for older people and is present in over half of the hospitalizations for people > 65 years of age. In a previous study by the authors, results indicated that nursing actions often did not meet best-practice standards in the care of older, agitated patients. This paper builds on these results by reviewing the literature pertaining to the use of restraints and contributes to the body of knowledge surrounding the impact of the acute-care experience on rehabilitation outcomes. Successful rehabilitation relies on the improvement of functional health outcomes and, for this to happen, physical and emotional well-being are important. The sequelae of restraint use in acute care have the potential to alter peoples' ability to participate fully in a rehabilitation programme, thereby placing their future placement at risk. This paper explores the outcomes of restraint use in the acute-care setting and presents the argument that their effects are likely to be detrimental to rehabilitation outcomes.

An exploratory study of nurses suffering from severe acute respiratory syndrome (SARS)

Abstract: In 2003, severe acute respiratory syndrome (SARS) came to be recognized as a newly emergent form of disease that is highly contagious. The aim of this study was to describe the perceptions of nurses with SARS in Hong Kong, as the perceptions of nurses who have suffered from SARS have not been studied. Ten nurses who had suffered from SARS were interviewed, either face-to-face or by telephone, about their subjective experiences. These interviews provided in-depth, descriptive data, which were analysed using content analysis. Nine broad categories were identified: uncertainty, information control, feelings of anger and guilt, lack of preparation and fear of death, feelings of isolation and loneliness, physical effects, support, change of perspective of life, and change of perspective of nursing. Although the dreaded disease affected the nurses tremendously, both physically and psychologically, it has also had its positive side. As a result of experiencing the illness, the participants came to treasure relationships, health and everyday life more. In caring for patients, they came to see the world more from the perspective of the patients. They found that they need to take the time to reassure patients and families and to seriously listen to all of their concerns.

Labour pain experience and intensity: a Jordanian perspective.

Abstract: In this descriptive study, 100 low-risk participants who delivered vaginally were recruited from the postpartum unit of a major hospital in the city of Amman. Three instruments, the Numeric Pain Intensity Scale (NPIS), a pain assessment questionnaire and a demographic questionnaire were used to assess labour experiences and labour pain intensity levels. The majority of Jordanian parturients did not receive pain relief. Eighty-one women reported pain intensity levels of > or = 8 on the NPIS (ranging from 0-10). The mean pain intensity level during the second stage of labour was 8.83. A significant difference in age was found between primiparas and multiparas. Jordanian parturients reported painful labour experiences; therefore, re-evaluation of current maternity nursing and midwifery practices and roles regarding labour pain management are warranted. The roles of supporter and educator among maternity nurses and midwives in Jordan also need to improve considerably.

Are patients with or at risk of pressure ulcers allocated appropriate prevention measures

Abstract: The aims of the study were to investigate the risk for and prevalence of pressure ulcers in different medical care groups, to discover if patients at risk for or with pressure ulcers are allocated appropriate pressure ulcer preventions and to investigate which variables are associated with appropriate pressure ulcer preventions. A cross-sectional survey design was used and followed the methodology developed by the European Pressure Ulcer Advisory Panel. A total of 612 patients participated in the study. The prevalence of pressure ulcers was greatest in geriatric care, followed by intensive care, acute care and neurological care. The majority of patients at risk for or with pressure ulcers did not receive appropriate preventative measures, either while they were in bed or in a chair. Significant variables associated with appropriate preventions in bed were intensive care, geriatric care, a low Braden score, a low score in the subscale activity and a long hospital stay.

Improved healing rates for chronic venous leg ulcers: pilot study results from a randomized controlled trial of a community nursing intervention

Abstract: Venous leg ulcers are a frequent source of chronic ill-health and a considerable cost to health-care systems. This paper reports pilot study results from a randomized controlled trial to determine the effectiveness of a community-based ‘Leg Club’ environment on improving healing rates of venous leg ulcers. Leg Clubs offer a setting where people with similar problems can socialize in a supportive, information-sharing environment. A sample of 33 clients with a below-knee venous leg ulcer were randomized to treatment, either in their own homes or in a community Leg Club. Treatment was provided to all participants, whether in the control group or intervention group, by a team of trained wound-care nurses following evidence-based assessment and treatment guidelines. Data were collected on admission to the study and at 12 weeks from admission. Results showed a significant improvement in healing in the intervention group compared to the control group, as measured by ulcer area size and Pressure Ulcer Scale for Healing scores. These results suggest that a community Leg Club environment provides benefits additional to wound care expertise and evidence-based care. Knowledge gained from this study provides evidence to guide service delivery and improve client outcomes.

Improving transfer from the intensive care unit: the development, implementation and evaluation of a brochure based on Knowles' Adult Learning Theory.

Abstract: This paper describes the development, implementation and evaluation of a transfer brochure for family members of patients in an intensive care unit (ICU) to improve patient transfer to a general ward. When family members fail to understand information, they respond in ways that affect patient recovery. The brochure was designed within Knowles' Adult Learning Theory framework and developed using a multidisciplinary team. A mixed design was used to collect data from families and nurses. Results indicate that the brochure helped nurses to address the individual family's issues during transfer from ICU. Furthermore, 95% of nurses (n = 33) recommended its introduction for all future transfers. Family members (n = 82) who received the brochure as part of their transfer were significantly more satisfied with all aspects of transfer than those who experienced ad hoc transfer methods (n = 80). These results provide strong support for Knowles' Adult Learning Theory as an educational foundation for adult learning.

‘They survive despite the organizational culture, not because of it’: A longitudinal study of new staff perceptions of what constitutes support during the transition to an acute tertiary facility

Abstract: Increasing difficulties of recruitment and retention of nursing staff strongly indicate that organizations should identify factors that contribute to successful transition of new staff to the workplace. Although many studies have identified problems facing new staff, fewer studies have articulated best practices. The purpose of this longitudinal study was to ascertain what new staff perceived as supportive elements implemented by the organization to assist their integration. Sixteen staff in Phase I and 12 staff in Phase II attended focus groups. The focus groups at 2-3 months provided specific information, with particular emphasis on negative interactions with other staff members and inadequate learning assistance and support. Different themes emerged within the focus groups at 6-9 months. Staff discussed being 'self-reliant' and 'getting to know the system'. Participants indicated that these skills might be beneficial to new staff in the development of organizational 'know how' and resourcefulness, rather than relying on preceptor support that, unfortunately, cannot be always guaranteed.

Operating theatre nurses: emotional labour and the hostess role.

Abstract: Emotional labour has been established as a significant factor in nursing work, although no studies have been done looking at emotional labour specifically in an operating theatre nursing context. Theatre staff (17 nurses and three Operating Department Practitioners (technicians) were observed in practice over a period of nine months by one of the authors. Each of the staff was subsequently interviewed. The transcriptions of the observation fieldwork notes and the semistructured interviews were analysed for themes and content. The (predominantly female) nurses perceived that one of their responsibilities was 'looking after the surgeons'. We have described this as the 'hostess' role. This role consisted of two major areas of activity: 'keeping the surgeons happy' and 'not upsetting the surgeons'. Examples are given of how this was accomplished through talk and actions. The (predominantly male) operating department practitioners did not see this as part of their work. This 'hostess' role is a kind of emotional labour, but performed with coworkers rather than patients. Like other forms of emotional labour, it is strongly gendered. The emotional labour performed by the theatre nurses was necessary to maintain what has been called elsewhere the 'sentimental order'.

The care encounter: Pondering caring, honest communication and control

Abstract: The proposition presented in this paper is that caring, underpinned by beneficence and non-maleficence, assumes that nurses will make determinations about another's best interests and act accordingly. With some emphasis on high-level (nursing home) aged care, it is the author's contention that nurses give priority to communication that controls the care encounter rather than acting in another's best interests. This view is supported in the literature, which suggests that nurses perceive honesty and information-sharing as less important in caring than do patients, and nurses' perception that telling another the truth is harmful and, therefore, contravenes the duties of beneficence and non-maleficence.

Exploring the relationship between nursing protocols and nursing practice in an Irish intensive care unit.

Abstract: Nursing practice no longer relies on tradition or ritual; instead, it is based on research and empirical evidence. The emphasis on evidence-based nursing, as well as standardization of nursing practice, has resulted in the production of policies, protocols and guidelines aimed at directing numerous aspects of nursing care. The aim of this study was to explore the relationship between these documents and actual nursing practice. To this end, this descriptive study employed a case study approach to examine the experiences of nurses in an Irish intensive care unit with a protocol on endotracheal tube suctioning. Focus group interviews of 17 nurses in six focus groups provided a significant insight into the experiences of these nurses in relation to policies, protocols and guidelines. Analysis of the data afforded some highly relevant findings, including the fact that nurses adapt clinical protocols as they see fit, thus demonstrating the importance that they place on their own professional judgement and autonomy.

Parasuicide, self-harm and suicide in Aboriginal people in rural Australia: a review of the literature with implications for mental health nursing practice.

Abstract: With reports of increased rates of suicide and parasuicide among Aboriginal people worldwide, the dual purpose of this background paper is to examine the literature on underlying mental health issues, as well as primary and secondary actions to try to minimize the risk related to this area among Aboriginal people nationally and internationally. The literature review contained in this paper has been developed upon the fundamental belief that prevention of mental health problems, mental illness and suicide should incorporate understanding of the factors that heighten the risk of these occurring and the factors that are protective against them, while simultaneously developing, disseminating and implementing effective interventions that are culturally and linguistically appropriate. To this end, continuity and integration of mental health care for rural Aboriginal people is attendant upon a whole-of-community and a whole-of-government response that respects the metaphor of cultural and linguistic experiences, as well as the mental health scope of practice.

Qualitative evaluation of regular morning meetings aimed at improving interdisciplinary communication and patient outcomes.

Abstract: Effective interdisciplinary communication is at the heart of clinical decision-making in contemporary health-care environments. Efforts to enhance communication and work processes among nurses and doctors in an infants-and-toddler ward of a specialist paediatric hospital led to the establishment of Surgical Morning Meetings (SMMs). To evaluate the experiences of nursing and medical team members and their perceptions of the changes brought about by the SMM, qualitative evaluation of the SMM was undertaken through semistructured interviews. The analysis identified four major areas of impact: predictability: a nice way to start the day, which captured the ways in which the SMM led to better planning of the day's activities, knowledge and perspectives: learning from each other, which highlighted the way that ongoing discussions led to greater understanding and respect, relationships and support: getting to know you, which reflected the benefits derived from greater commitment, and desired outcomes: making a difference to staff, children and families. Overall, we believe that initiatives as simple as discussions among nurses and doctors can enhance personal and professional experience and lead to improved health outcomes for our patients.

Bringing the professional challenges for nursing in Jordan to light

Abstract: The definition of a profession consists of contributing characteristics. Nursing must achieve these characteristics in order to confirm its professional status. These characteristics include: a standard of education; professional organizations; commitment; autonomy; continuing education; body of knowledge and competencies; social value; and a code of ethics. Nursing in Jordan faces a unique set of challenges to meet these criteria. The purpose of this discussion is to bring the professional challenges of nursing in Jordan to light, to motivate collaborative efforts to remediate them and to discuss the value of evidence-based practice in this process. The key to confirming Jordanian nurses' professional status is for nurses to seek every opportunity to prove themselves, earn respect, take control over their work, support their colleagues and to make informed decisions. In addition, a more active and effective role for the nursing organizations is necessary to change the public's view of nursing. Efforts to reform regulation also should be intensified.

The role of the neonatal intensive care nurse in decision‐making: Advocacy, involvement in ethical decisions and communication

Abstract: Neonatal intensive care unit (NICU) nurses are often faced with complex clinical and ethical problems. Little is known about the role of the NICU nurse in ethical decision-making, or processes that inform decision-making in this setting. The purpose of this study was to explore and describe nurses' perceptions of their role as patient advocate, clinical situations that cause them concern and the extent of their involvement in ethical decision-making. A combined quantitative and qualitative research design was used. A questionnaire was administered to nurses working in the NICU of the sole perinatal tertiary referral centre of Western Australia, Australia. Findings showed that NICU nurses saw their role in ethical decision-making primarily as advocating for the best interests of the infant and family, that they used clinical knowledge and experience to guide ethical decision-making, they were able to clearly articulate ethical problems and respond to them according to the clinical scenario and, while being primarily assertive in presenting their views, some nurses took a more passive approach. These findings support the need for development of a multidisciplinary model for ethical decision-making, where the view of all team members are considered.

Finding the balance: living with memory loss.

Abstract: Since the late 1980s, it has been increasingly recognized that the experiences of people with dementia have been omitted from research in the area of dementia and memory loss. More recently, it has been accepted that people with dementia have insight into their condition and, therefore, the ability to contribute to research. A qualitative research project was undertaken with nine participants to explore the experiences and coping strategies of people with dementia. Interviews were undertaken and the data analysed using thematic analysis. Three major themes emerged: coming to terms with memory loss, maintaining control and independence, and the impact of illness on relationships. Understanding the reality for people is essential given that representations of the catastrophic impact of dementia generate high levels of anxiety and depression. Implications for nurses' practice include the need for skilled, well-paced, sensitive and ongoing information about the condition, along with the need to recognize and support the active coping strategies of people with memory loss.

Nurses' moral agency in negotiating parental participation in care.

Abstract: The purpose of this study was to investigate the issues for nurses in facilitating parental participation in the care of the hospitalized child. A qualitative study informed by grounded theory was undertaken. Nine nurses were recruited from an acute, high-dependency, 23-bed paediatric cardiac/renal unit in Melbourne, Australia. Data collection involved individual semistructured interviews, hospital policies related to family-centred care and a focus group interview. Constant comparative analysis was undertaken to develop an understanding of the data collected in the context of the nurses' experiences and the environment in which they work. Moral agency was identified as the central phenomenon of the study. Causal conditions related to this included the child's best interests, disputes about care and nurses' expectations. These causal conditions were seen to potentially lead to moral distress for the nurses. The coping mechanisms and strategies that affected moral agency have been identified.

Mutual suffering: a nurse's story of caring for the living as they are dying.

Abstract: The aim of this study was to uncover the meaning of the lived experience of mutual suffering in relation to the care of a dying patient. The study took place within an acute medical ward in a district general hospital on the south coast of England as part of a reflective practice development programme. Parse's human becoming theory provided a framework for the study and Parse's research methodology was adopted. Understanding the nature of human relationships within nursing practice is central to nursing work, enabling patients and their health-professional carers to live and work healthily in the context of human becoming. Illuminating mutual suffering through reflection enables nursing and health-care professionals to acknowledge the paradoxes of practice and, thus, create new strategies for the provision of care and the improvement of practice, so that quality of life is maximized for the patient and for themselves.

Outcomes of a nurse-led telephone triage service in Australia.

Abstract: This paper reports on a study which comprised the first comprehensive evaluation of the Kids Kare Line telephone triage service in which experienced registered nurses respond to parents' requests for health-care advice for their child. This service is located in an acute care hospital in regional New South Wales, Australia. One hundred and one parents who telephoned the Kids Kare Line responded to a telephone-administered survey designed to determine the service's efficiency and effectiveness. Responses demonstrated that parents sought advice about a range of issues, of which the management of fever was the most frequent. All but five parents considered their call to have been answered promptly, all parents understood the advice provided to them and 96% of parents were satisfied with this advice. Fifty parents identified that they had not used another service or health practitioner for the same issue subsequent to their Kids Kare Line telephone call.

The effects of a cognitive behavioural therapy programme for self-care on haemodialysis patients.

Abstract: A nurse-delivered haemodialysis patient education programme incorporating cognitive behavioural therapy (CBT) was developed. The effects of the CBT programme were compared with those of a standard patient education (SPE) programme on patients' salt intake and weight gain using a quasi-experimental design. There were 22 participants (11 CBT, 11 SPE) undergoing outpatient haemodialysis therapy at one clinic. Daily weight gain rates decreased in the intervention period compared with the baseline period in both the CBT and SPE groups. This effect lasted for 12 weeks in the CBT group but for only eight weeks in the SPE group. In addition, daily salt intake decreased in the intervention period compared with the baseline period in both the CBT and SPE groups, persisting for 12 weeks. From these results, both programmes were shown to be effective, but CBT had a longer effect.

Less money, less care: how nurses in long-term care allocate hours of needed care in a context of chronic shortage.

Abstract: The average funding of long-term care in Quebec, Canada, currently covers < 70% of the care hours required, which means that 30% of needs are unmet. The aims of this study were to understand how nurses, when they are in a position to do so, assign care hours, which needs are unmet by care dimensions and whether dimensions with unmet needs vary with client profiles. One-hundred-and-four nurses working in long-term care facilities participated in the study. They filled out individual questionnaires containing three case studies in the form of vignettes. When obliged to cut 30% of the care hours, the nurses ensured that treatment and diagnostic methods were done as prescribed and that vital feeding and elimination functions were preserved. However, they made the choice to cut some mobility and personal-care activities and, especially, communication with patients, families and other professionals. In this, they partly follow the theoretical care prioritization approach of Lefebvre and Dupuis, who take into account the degree of discomfort caused by the situation, the problem's place in Maslow's hierarchy of needs and the availability of a solution. Thus, although the choices made by the nurses follow a logical pattern, they could result in medium-term deterioration in the functional autonomy of their older patients. The overall consequences of these decisions are discussed.

'They first killed his heart (then) he took his own life'. Part 1: a review of the context and literature on mental health issues for refugees and asylum seekers.

Abstract: This is the first in a two-part series of papers examining mental health issues for refugees and asylum seekers. Beginning with the suicide of an asylum seeker in Scotland, the paper emphasizes mental health issues for adult and child asylum seekers, stress and memory, suicide, self-harm, risk and protective factors, compulsory health treatments and the prevention of mental illness. It sets the scene for the second paper by drawing implications for nursing practice in the community. Although most literature on refugee and asylum seeker mental health exists outside of nursing scholarship, a majority of the issues reviewed in this paper are mutual challenges for all in the health and helping professions. Nurses interested in refugee and migration issues face two intertwined challenges: that of how to assist migrants with their diverse mental health needs and how, at the same time, to contribute to a society that can promote mental health for all by taking on both the difficulties and opportunities posed by cultural diversity.

The effects of health beliefs on health care-seeking decisions of Jordanian patients with myocardial infarction symptoms.

Abstract: The main purpose of this study was to examine the significance of health beliefs, perceived seriousness of harmful consequences and perceived barriers in explaining health care-seeking decisions of patients experiencing myocardial infarction symptoms. A structured interview guide developed by the researchers that included health beliefs, patient delay, sociodemographics and clinical characteristics of the patients was introduced to 79 myocardial infarction patients on the third day of hospitalization. Thirty-eight per cent of the patients delayed the health care-seeking decision > 1 h. Gender, age and perceived seriousness of the consequences significantly distinguished between delayers and non-delayers, correctly classifying 77% of the cases. Delayers were more likely to be female and young adults, and those who perceived increased negative consequences to myocardial infarction. Educational and counselling programmes for individuals at increased risk for myocardial infarction should consider the negative influence of perceived seriousness of consequences on the decision-making process of the patients. Also, interventions to change women's perception of their vulnerability to this illness are needed.

Jordanian women: perceptions and practices of first-time pregnancy.

Abstract: A woman's child-bearing encounter is an experience that reflects the cultural beliefs and practices of the society. The purpose of this study was to describe the perceptions and practices of urban, low socioeconomic, Jordanian women (aged 18-30 years) in relation to their pregnancy career. An opportunistic sample consisting of 67 Muslim first-time pregnant women who followed up antenatal care at two maternity-care centres in East Amman was selected. A qualitative approach, including ethnographic semistructured interview, participant observation data from the households and clinics and oblique interviewing in random conversations initiated by the primigravidae, was conducted over 18 months. Women gave elaborative accounts of their pregnancy and childbirth expectations in narrative, phenomenological forms. Qualitative data analysis was performed concurrently with data collection, revealing the essential themes of immediacy of pregnancy; familial support and changing networks, especially for the after-birth period; fear of pain and medical interventions, all emphasizing the traditional and religious perceptions and practices in a familial context.

Reaching for the stars: career advancement and the registered nurse.

Abstract: Clinical nursing has long struggled to secure the place of primacy it deserves in the profession's hierarchy of importance and worth. It is ironic that, even at the beginning of the 21st century, a clinical nurse is generally not as well-recognized, rewarded or remunerated as a colleague working in nursing management, education or research. Until the profession recognizes and takes serious action to remedy this situation, the crisis of recruitment and retention in nursing currently ravaging the globe is likely to continue. In this paper, I present a discursive account of an exciting initiative by a leading private, acute-care hospital which addresses this very problem. A new ladder for clinical nurse specialists (CNSs) introduces a rigorous and systematic approach to the appointment of three classifications of CNS, each requiring evidence of successively higher levels of competency, and which are accompanied by fiscal reward and stronger peer recognition.

Relationships in nurse prescribing in district nursing practice in England: A preliminary investigation

Abstract: Nurse prescribing is a significant change in the working lives of district nurses in the United Kingdom. It has been achieved as the result of a 13-year sociopolitical struggle, eventually culminating in an Act of Parliament, which enabled selected nurses to prescribe from a limited formulary. This research attempts to discover the nature of its impact on the relationships between prescribers, nurses, doctors, pharmacists, patients and carers. Using a qualitative approach, guided interviews were carried out with nurses, doctors, pharmacists, patients and carers. Initial findings indicate that far from producing an independent prescribing workforce, some prescribers are reverting to their preprescribing behaviour. For these prescribers, there is a suggestion that old hierarchies are being reinforced, which might be detrimental to nurse prescribing.

The influence of HIV/AIDS on the practice of primary care nurses in Jordan: rhetoric and reality.

Abstract: The role of nurses in raising community awareness about HIV/AIDS is well-reported. However, little is known about the practice of Jordanian nurses and the role they play in the prevention and control of HIV/AIDS. This interpretive ethnographic study sought to illuminate the role of primary care nurses and examine the influence of HIV/AIDS on their practice. The study was undertaken in Jordan in three rural and three urban primary health-care centres. Data collection included participant observation, key informant interviews and document analysis. These data informed the development of descriptive ethnographic accounts that allowed for the subsequent identification of common and divergent themes reflective of factors recognized as influencing the practice of the nurse participants. The findings indicate that the rhetoric offered by all levels of administration and endorsed in policy is not reflective of the reality of practice. Poor resources and educational preparation, a limited nursing skill mix and access to professional development, lack of nursing leadership and role models, cultural beliefs and geographic isolation are factors that reduced the capacity of the primary care nurses to raise awareness and, therefore, influence the prevention and control of HIV/AIDS.

The relationship between patient blood pathology values and patient falls in an acute-care setting: A retrospective analysis

Abstract: Few studies have investigated the relationship between patient falls and patient blood pathology values, which can reveal objective information about the health and nutritional status of a patient. It could be that some abnormal values are associated with patients that fall. The objectives of the current study were to determine whether blood pathology values were different in patients who fell compared to patients who did not fall, and whether there was a difference in the type and number of currently documented risk factors for falls found for patients who fell compared to patients who did not fall. A retrospective audit of patient incident reports and medical records was conducted in an acute-care hospital for 220 patients who fell and who did not fall. Faller and non-faller patients were matched by casemix type and length of stay. Findings revealed a significant relationship between patients who fell and the variables of age, confusion status and alkaline phosphatase blood values.