Nurse managers as consultants

As a new nurse manager of a pediatric intensive care unit (PICU) 3 years ago, this author was faced with a nursing vacancy rate of 50%, with half of the unit's beds closed. In the time elapsed, all nursing positions were filled, allowing full use of all beds. This nurse manager was asked to serve as a consultant to a PICU in another hospital facing a similar crisis.     

Scofield as Socrates

Well, as Socrates exclaimed, "By the dog, Gorgias, there will be a great deal of discussion before we get to the truth of all this." In the course of that discussion, we will find that Mr. Scofield does ask many very pertinent questions about the nature and teaching of ethics. Each question is worth examining in itself. But somewhere along the line, he has wandered into exaggerations, rhetoricities, and illogicisms that make it difficult to "get to the truth of all this." If we were being truly Socratic, I would test each assertion and allow him to respond in turn, and he could question me. In so doing, we might elucidate the ideas behind ethics consultation and evaluate its worth. We might then learn, as Socrates would have us learn, how much we do not know. We might also learn, as Socrates desired, how to pursue the elusive answers. Unfortunately, in this essay, Scofield fails as Socrates.     

Tobacco use as a public health issue

Almost one-quarter of all adults are current smokers, along with more than a third of all high school students. Although a small drop in underage smoking from 1997 to 1998 has interrupted the otherwise steady increases in youth smoking since the early 1990s, smoking among kids is still at historically high levels. Over the past 10 years the number of kids under 18 who become daily smokers each year has increased by more than 70 percent.     

Intuition as implicite knowledge

The article relates the terms intuition, tacit knowledge and experience and describes their meaning for nursing. An empirical study with 16 experienced nurses is presented whereby the nurses had to deal with a simulated critical nursing situation. Basing on their actions a method for explication of action-guiding tacit knowledge was developed so that a closer scrutinizing of this type of knowledge became possible. Results underline the assumption of many practitioners that intuition as a resource in nursing activities is not to underestimate. At the same time a warning is given: Intuition and tacit knowledge is not always and at all times to evaluate positively. Finally, this differentiated point of view is discussed regarding consequences for nursing practice.     

Storytelling as cultural assessment

This article describes how story was used to teach cultural assessment to baccalaureate nursing students enrolled in clinicals in long-term care facilities. Class sessions focused on learning to elicit and listen to patients' stories and use story as an assessment tool in clinical practice. With their peers, students learned to listen in a nonjudgmental, contextual way to the values and beliefs of the storyteller. They learned that all people, even those from the dominant mainstream culture, have stories to tell, and that stories build bridges between nurses and clients.     

Parathyroid hyperplasia as a cause of recurrent hyperparathyroidism

Parathyroid hyperplasia is second only to adenoma as the most common cause of hyperparathyroidism. Symptoms are most likely to result from elevated serum calcium levels. Symptoms include nephrocalcinosis and nephrolithiasis. Studies that may help confirm a suspected diagnosis include ultrasonography, computed tomography, radionuclide scanning with thallium and/or technetium, and magnetic resonance imaging. Surgical treatment consists of excision of all but part of one parathyroid gland if all of the glands are enlarged.     

Leader as expert

A rapidly changing and uncertain health care delivery system requires well-educated nurse leaders who can work to achieve organizational missions that are appropriate for the needs of all who seek health care. Educators in both undergraduate and graduate programs can use the four ways of knowing as outlined by Carper (1978) to design curricula that will prepare nursing leaders as experts.     

Exercise as a treatment for depression in elders

PURPOSE: To describe the use of exercise when treating depression in elders and to discuss the data supporting the relationship between increased physical activity and decreased depression. DATA SOURCES: Extensive review of recent scientific literature, both medical and gerontological in content. CONCLUSIONS: Increasing physical activity markedly reduces depressive symptoms and is a safe adjunct or alternative to medication therapy. IMPLICATIONS FOR PRACTICE: Exercise has numerous physical and psychological benefits to patients. Physical activity should be recommended to all patients of all ages.     

Bladder carcinoma presenting as exercise-induced hematuria

Exercise-induced hematuria is becoming a common diagnosis for postexercise hematuria. However, a number of genitourinary tract diseases also may cause gross or microscopic hematuria in some physically active patients. Four cases of postexercise hematuria in patients with transitional cell carcinoma of the bladder are presented. The authors recommend urologic evaluation with excretory urography and cystoscopy for all patients with postexercise hematuria.     

Atrial fibrillation: rate control is as good as rhythm control for some,but not all

Four recent trials compared the strategies of rate control vs rhythm control in patients with atrial fibrillation. All of them found a rate control strategy to be equivalent to a rhythm control strategy in terms of primary outcomes, but the findings may not apply equally to all patients.     

Considering nursing resource as 'caring time'

The present constrained economic climate faced by health care agencies underscores the need for nurse administrators to have an in-depth appreciation of how nursing services are being used The purpose of this investigation was to increase the understanding of nursing as a resource Using phenomenological research methodology, the investigator purposefully selected six patients and a chain sample of 14 professionals responsible for their care, including nurses, nurse managers and physicians Data collection methods included in-depth interviews, document reviews, and participant observation The inductive interpretation depicts the nature of nursing resource to be 'caring time' Caring was understood primarily in terms of time and was experienced by all participants as 'spending time' Caring time was spent through 'being with' and 'doing to/doing for' the patient Study participants experienced tension with regard to how best to spend precious 'caring time' Nursing resource was inextricably linked to both quantitative and qualitative expressions of nursing, and 'being with' patients was a highly valued, under-allocated, and unintentionally provided component of nursing resource The researcher concluded that nursing administrators, nurse managers and practitioners all have leadership roles to play in achieving recognition, allocation and promotion of caring time within their agencies     

Stomahesive as a tracheostomy dressing

Seven patients had occlusive stomahesive dressings placed on their tracheostomies. These patients were compared with four patients managed with standard tracheostomy care. Stomahesive was applied using a defined technique and all seven patients were followed until tracheostomy closure. The average duration of stomahesive care was 26 days and the dressings remained occlusive for an average of 4 days. Photographic evidence revealed that skin changes were less in patients treated with stomahesive dressings.     

Unlicensed Personnel as Medication Technicians in Long-Term Care

The Arizona State Board of Nursing is providing the leadership to conduct and oversee a pilot program allowing the delegation of medication administration to certified nursing assistants in LTC facilities. Consensus from most major stakeholders and inclusion of those who opposed the original legislation contributed to the successful launch of the project. The complexity of both initiating the project and medication administration in LTC facilities cannot be underestimated. I believe that administration of medications by qualified CNAs who complete a rigorous training program and pass a legally defensible exam is safe, provided that the facility adopts a culture of safe medication administration by all staff. Challenges include personnel shortages, curriculum rigors, and licensed nurses' initial resistance. Benefits include freeing nursing staff for other essential functions, satisfaction of all staff, and an increased ability to meet residents' care needs.     

Osteoporosis as a lifestyle-related disease

Osteoporosis is now counted among the so-called lifestyle-related diseases, as its pathogenesis is multi-factorial, and involves aging, decreased estrogen secretion, and a disruption of various lifestyle factors. However, it has also come to be referred to as a "life function-related disease" that impairs the functional health of affected patients. With progression of disease, these patients go on to develop a vertebral deformity or a postural abnormality, if short of becoming bedridden, as a sequela of vertebral fracture, and this often leads to decreases in cardiopulmonary function, QOL and ADL in these patients due to concomitant diseases such as reflux esophagitis, and all of these combine to place them at high mortality risk.     

Bilirubin as a signaling molecule

For long time bilirubin was only considered as a potentially dangerous sign of liver diseases, but it now appears clear that it is also a powerful signaling molecule. Together with potent antioxidant activities that were only reported in the last few decades, many other biological effects have now been clearly described. These include especially profound inhibitory effects on almost all effectors of the immune system, with their clinical consequences in the bilirubin-mediated protection against autoimmune and inflammatory diseases. Separate from these, bilirubin activates various nuclear and cytoplasmic receptors, resembling the endocrine activities of actual hormonal substances. This is true for the “classical” hepatic nuclear receptors, including the aryl hydrocarbon receptor, or the constitutive androstane receptor; and also for some lesser-explored receptors such as peroxisome proliferator-activated receptors α and γ; Mas-related G protein-coupled receptor; or other signaling molecules including fatty acid binding protein 1, apolipoprotein D, or reactive oxygen species. All of these targets have broad metabolic effects, which in turn may offer protection against obesity, diabetes mellitus, and other metabolic diseases. The (mostly experimental) data are also supported by clinical evidence. In fact, data from the last three decades have convincingly demonstrated the protective effects of mildly elevated serum bilirubin concentrations against various “diseases of civilization.” Additionally, even tiny, micromolar changes of serum bilirubin concentrations have been associated with substantial alteration in the risks of these diseases. It is highly likely that all of the biological activities of bilirubin have yet to be exhaustively explored, and thus we can expect further clinical discoveries about this evolutionarily old molecule into the future.     

Insulin-Glucose as Adjunctive Therapy for Severe Calcium Channel Antagonist Poisoning

Case Report: This case series documents the clinical courses of 4 patients after verapamil overdose and 1 patient after amlodipine-atenolol overdose. All subjects had hypodynamic circulatory shock (hypotension, bradycardia, and acidosis) that was not adequately responsive to conventional treatment. After initiation of insulin-dextrose infusion, the hemodynamic status of all 5 patients stabilized and all patients survived. Plasma drug concentrations are reported for all cases and verapamil levels were extremely high in 2 patients (3710 ng/mL and 3980 ng/mL). However, because patients were not treated according to a standard protocol, each patient received variable other supportive measures and inotropic agents, and the infusion rates of insulin were variable among patients. This report provides preliminary evidence toward a larger trial of insulin-dextrose to treat hypodynamic shock from calcium channel blocker overdose.     

Kangaroo Care as a Neonatal Therapy

A review of the effects of Kangaroo Care on preterm infants is presented according to how Kangaroo Care, skin-to-skin, chest-to-chest contact between the infant and a parent, addresses the six key elements of a developmentally appropriate therapy. Kangaroo Care has been found to satisfy all requirements and have both short- and long-term beneficial effects, with recent findings showing select sustained effects for 10 and 16 years. Kangaroo Care is now considered a fundamental component of developmentally appropriate therapy for hospitalized preterm infants.     

血尿酸和胆红素水平与冠状动脉粥样硬化的关系探讨

目的探讨血尿酸（uricacid,UA）和胆红素水平与冠状动脉粥样硬化（coronary atherosclerosis,CA）的相关性。方法选择2012年1月至2014年1月我院98例CA患者为病例组,根据冠状动脉病变程度分为单支病变组和多支病变组,同期选择64例健康体检者为健康对照组,检测受试者UA、总胆红素（total bilirubin,TBIL）、直接胆红素（direct bilirubin,DBIL）和间接胆红素（indirect bilirubin,IBIL）水平,对检测结果进行统计学分析。结果CA患者组的UA水平高于健康对照组,差异有统计学意义（P〈0．05）。CA患者组的TBIL、DBIL和IBIL水平均低于健康对照组,且差异均有统计学意义（P均〈O．05）;多支病变组患者的UA水平高于单支病变组,且差异有统计学意义（P〈0．05）,多支病变组患者的TBIL、IBIL水平均低于单支病变组,且差异均有统计学意义（P均〈0．05）,多支病变组患者的DBIL水平虽低于单支病变组,但两组间差异无统计学意义（P〉0．05）;UA、TBIL、DBIL和IBIL水平与冠状动脉狭窄程度的相关系数r分别为0．907、-0．884、-0．867和-0．859（P均〈0．05）。结论高UA和低血胆红素水平是CA的危险因素,可作为CA的辅助诊断指标。