The effects of education levels of developmental care in Australia: Perceptions and challenges

BackgroundDevelopmental care consists of a range of clinical, infant-focused, and family-focused interventions designed to modify the neonatal intensive care environment and caregiving practices to reduce stressors on the developing brain. Since the inception of developmental care in the early 1980s, it has been recommended and adopted globally as a component of routine practice for neonatal care. Despite its application for almost 40 y, little is known of the attitude of neonatal nurses in Australia towards the intervention.Aims and objectivesThe objective of this study was to establish Australian neonatal nurse perceptions of developmental care and explore associations between developmental care education levels of the nurses and personal beliefs in the application of developmental care.DesignThis involves a cross-sectional survey design.MethodsAn online questionnaire was completed by 171 neonatal nurses. Participants were members of the Australian College of Neonatal Nursing (n = 783). Covariate associations between key components of developmental care and respondents' geographical location, place of employment, professional qualifications, and developmental care education level were analysed. The reporting of this study is in accordance with the Enhancing the Quality and Transparency of Health Research Checklist for Reporting Results of Internet E-Surveys.ResultsDifferences were observed between groups for geographical location, place of employment, and professional qualification level. Rural nurses were less likely to support the provision of skin-to-skin care (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.2–1.8) than nurses in a metropolitsan unit. Nurses working in a neonatal intensive care unit and nurses with postgraduate qualifications were more likely to support parental involvement in care ([OR: 2.3, 95% CI: 0.9–6.2] and [OR: 2.1, 95% CI: 0.6–7.4], respectively). Rural respondents were more likely to have attended off-site education (OR: 3.6, 95% CI: 1.3–9.9) than metropolitan respondents.ConclusionThe application of developmental care in Australia may be influenced by inadequate resources and inequitable access to educational resources, and similar challenges have been reported in other countries. Overcoming the challenges requires a focused education strategy and support within and beyond the neonatal intensive care unit.     

Context Matters: Examining Perceived Health and Fitness Outcomes of Physical Activity Participation Among South Korean Adults and Youth

Purpose

To examine associations between physical activity contexts and health and fitness perceptions among Korean adults and youth.

Method

Data were from the Korean Survey on Citizens’ Sports Participation in 2015. Korean youth (N?=?832; M_age?=?14.7) and adults (N?=?6719; M_age?=?41.3) were included in the hierarchical logistic and linear regressions. Youth physical activity was examined in school-based (i.e., school-based and after-school/Saturday school sports) and out of school (i.e., organized sports) settings. Adults who met the World Health Organization (WHO) physical activity guidelines or not, and participated in structured (e.g., sport) and unstructured (e.g., walking) physical activity were compared. The outcome variables were self-reported health and fitness. Gender interactions between physical activity and all outcomes were examined for the adult sample only.

Results

No associations existed between physical activity and perceived health or fitness among youth. Adults who met the WHO guidelines, or participated in structured physical activity showed higher odds of reporting good health. Unstructured physical activity was associated with lower odds of reporting good health. Positive perceptions of fitness were more likely to be reported by males who met physical activity guidelines compared to females.

Conclusions

For youth, the potential benefit of physical activity, regardless of contexts, may be more apparent for psychological health than perceived physical health, and school should be used as a venue to promote physical activity. For adults, structured physical activity and achieving the WHO physical activity guidelines may be suggested for perceptions of overall health.

     

Loss of N‐WASP drives early progression in an Apc model of intestinal tumourigenesis

N‐WASP (WASL) is a widely expressed cytoskeletal signalling and scaffold protein also implicated in regulation of Wnt signalling and homeostatic maintenance of skin epithelial architecture. N‐WASP mediates invasion of cancer cells in vitro and its depletion reduces invasion and metastatic dissemination of breast cancer. Given this role in cancer invasion and universal expression in the gastrointestinal tract, we explored a role for N‐WASP in the initiation and progression of colorectal cancer. While deletion of N‐wasp is not detectably harmful in the murine intestinal tract, numbers of Paneth cells increased, indicating potential changes in the stem cell niche, and migration up the crypt–villus axis was enhanced. Loss of N‐wasp promoted adenoma formation in an adenomatous polyposis coli (Apc) deletion model of intestinal tumourigenesis. Thus, we establish a tumour suppressive role of N‐WASP in early intestinal carcinogenesis despite its later pro‐invasive role in other cancers. Our study highlights that while the actin cytoskeletal machinery promotes invasion of cancer cells, it also maintains normal epithelial tissue function and thus may have tumour suppressive roles in pre‐neoplastic tissues. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.     

Effect of empowerment on professional practice environments, work satisfaction, and patient care quality: further testing the Nursing Worklife Model

The purpose of this study was to test Leiter and Laschinger's Nursing Worklife Model linking structural empowerment to Lake's 5-factor professional practice work environment model and work quality outcomes. A predictive, nonexperimental design was used to test the model in a random sample of 234 staff nurses. The analysis revealed that professional practice environment characteristics mediated the relationship between structurally empowering work conditions and both job satisfaction and nurse-assessed patient care quality.     

The best interest principle as a standard for decision making in the care of neonates

In neonatal care, decisions are made on behalf of newborn infants by their parents or, in some instances, health professionals. This paper examines how the best interest standard is the most appropriate focus for decision-making concerning neonates. The components of surrogate decision-making are discussed from the perspective of the neonate's interests and the contribution of the various persons involved in caring for neonates. An argument is presented for the use of best interests when making decisions and the interpretation of best interests is explored. By examining the ethical approaches using best interests, an argument is put forward for caring as an expression of best interests. How some nurses use the best interest standard in their practice is described. The unique perspective nurses may have because of their philosophy, circumstances, experience and concern for neonates is discussed. Examples are used from the literature to support the argument for nurses being in roles and relationships where the neonate's interests are the basis of practice. How nurses classify infants on the basis of their future outcome is used to illustrate how nurses can apply the best interest standard. Ethical approaches of care and cure are used to show the best interest standard as applied to neonates. Caring as an expression of best interests is recommended for nursing decisions and actions using infant outcomes as a focus for caring and best interests.     

Workplace empowerment and magnet hospital characteristics: making the link

OBJECTIVE: To test a theoretical model linking nurses' perceptions of workplace empowerment, magnet hospital characteristics, and job satisfaction in 3 independent studies of nurses in different work settings. BACKGROUND: Strategies proposed in Kanter's structural empowerment theory have the potential to result in work environments that are described in terms of magnet hospital characteristics. Identifying factors that contribute to work conditions that attract and retain highly qualified committed nurses, such as those found in magnet hospitals, that can be put in place by nursing administrators is extremely important for work redesign to promote professional nursing practice. METHODS: Secondary analyses of data from 3 studies were conducted--2 of staff nurses and 1 with acute care nurse practitioners working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire-II, the NWI-R, and measures of job satisfaction were used to measure the major study variables.RESULTS The results of all 3 studies support the hypothesized relationships between structural empowerment and the magnet hospital characteristics of autonomy, control over practice environment, and positive nurse-physician relationships. The combination of access to empowering work conditions and magnet hospital characteristics was significantly predictive of nurses' satisfaction with their jobs. CONCLUSIONS/IMPLICATIONS: These findings suggest that nursing leaders' efforts to create empowering work environments can influence nurses' ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes.