Supportive counselling programme for nursing students experiencing academic failure: randomized controlled trial

Title.  Supportive counselling programme for nursing students experiencing academic failure: randomized controlled trial.
Aim.  This paper is a report of a study examining the effects of a supportive counselling programme on the academic performance of Iranian nursing students experiencing academic failure.
Background.  In order to using limited educational resources effectively, nursing students experiencing academic failure should be immediately identified in order that appropriate intervention can take place.
Method.  Data were collected over a 12-month period in 2006–2007, with 42 Bachelor of Science nursing students who displayed poor academic performance. They were randomly allocated to receive either supportive or ordinary counselling. The mean grades in basic theoretical courses, special courses, and also the combination of both basic and special courses was compared between the two groups.
Findings.  Over the study period, there were improvements in the mean grades of special courses and also in both basic and special courses of male students in the experimental group, compared with those of male students in the control group (0·27 against −1·43, P  = 0·014; and 1·87 against −0·40, P  = 0·009; respectively).
Conclusion.  A supportive counselling programme can improve the academic performance of male nursing students. Replication of the current study with larger samples and longer duration is recommended.     

Taiwanese nursing students' knowledge, application and confidence with standard and additional precautions in infection control

Aim. This study reports on nursing students’ current capacity to handle standard and additional infection‐control precautions in terms of their knowledge, application skills and confidence. Background. These precautions are recommended as the guidelines for preventing infections and ensuring occupational safety. As nursing students undertake patient care during clinical practice, their knowledge of and ability to apply these precautions with confidence should be examined before they enter the clinical field. Method. A specific tool, the Infection Control Evaluation, was developed and distributed. Design. A cross‐sectional survey involving a sample of preservice nursing students was conducted in southern Taiwan. Results. The results were based on an 88% response rate and indicated that the level of knowledge concerning standard and additional precautions was low among Taiwanese nursing students. Their ability in applying these precautions in clinical practice also appeared to be inadequate. Conclusions. Such findings indicate that Taiwanese preservice nursing students require a comprehensive foundation course in infection‐control precautions before they enter the clinical environment. This will help to ensure their protection and that of their patients. Relevance to clinical practice. As the findings highlight the importance of providing such education for students before they undertake any clinical work, the information provided here can help nursing educators and academics to develop a specific program.     

An evaluation of the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people

Objectives.  This paper reports the results of a study that aimed to evaluate the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people.
Background.  With repeated exposure to very sick older people in hospitals or nursing homes, nursing students are at risk of adopting stereotypical views about this section of the population as frail and dependent.
Design.  A pre- and post-test design was used to conduct the study.
Methods.  Using Kogan's Attitudes Towards Old People Scale, the attitudes of nursing students were tested at the beginning of a degree programme in Adult Nursing ( n  = 130) and one year later ( n  = 94) following a series of visits to a well-older person in the community.
Results.  Nursing students reported positive attitudes towards older people and these were retained throughout the first year of their nurse training. No statistically significant differences were found associated with any of the five independent variables in either pre- or postintervention students.
Conclusions.  The attitudes of nursing students towards older people remained positive. While it is possible that the experiential and educational interventions utilized in this study may have contributed to the retention of positive attitudes, further research is required to test this hypothesis.
Relevance to clinical practice.  Nurses have a major role to play in responding to the health and social care needs of older people and their families. The cultivation of positive attitudes is a key factor in enabling practising nurses to respond to this challenge.     

Modification of nursing students' performance in blood pressure measurement: an educational retraining programme

Aim:  To assess the procedure for measuring blood pressure (BP) among nursing students after the basic educational programme and after further supplementary training.
Methods:  One hundred and fifty nursing students participated in the study, which was divided into two phases. During the first phase, students attended the routine educational programme in respect of the technique of measuring BP in the course of the lesson 'Basic Nursing'. During the next semester (second phase), the same students attended the lesson of 'Internal Medicine Nursing'. In the course of this lesson, a supplementary educational intervention for BP measurement was introduced for the purpose of this study. In order to perform our study, the university's written approval was given. At the end of the second phase, the 150 participants (volunteers) gave their oral consent for the anonymous publication of the results.
Results:  The results showed an inadequate performance after the basic educational programme, but a significant improvement in the technique of measuring BP after supplementary educational intervention was achieved. This improvement was significant for all the parameters examined.
Conclusion:  Supplementary education of students may be required, as this could significantly improve their technique for the accurate measurement of BP.     

Population pharmacokinetic analysis of vancomycin in patients with gram-positive infections and the influence of infectious disease type

Objective:  To describe the population pharmacokinetics of vancomycin in patients with gram-positive infections and to investigate the influence of type of infectious disease.
Methods:  A two-compartment open model was adopted as a pharmacokinetic model. The nonlinear mixed-effects model was used to analyze the population pharmacokinetic models.
Results:  We propose one general model and one infectious disease type-specific model. The general model showed that vancomycin clearance (CL) was linearly correlated with estimated creatinine clearance (CL_CR) when CL_CR was less than 85 mL/min, as expressed by CL(L/h) = 0·0322 × CL_CR + 0·32. The distribution volumes of the central and peripheral compartment were different in healthy volunteers and patients with gram-positive infections. The infectious disease type-specific model showed that these differences were more pronounced in patients with pneumonia.
Conclusion:  The population pharmacokinetic parameters of vancomycin obtained here can be used to individualize the dosage of vancomycin in institutions with similar patient population characteristics.     

Problems associated with prophylactic use of erythromycin in 1566 staff to prevent hospital infection during the outbreak of pertussis

Background and objective:  Pertussis developed in Kagawa University Medical School and University Hospital in May 2007. To control the outbreak and prevent the infection of hospital inpatients, the Infection Control Team (ICT) carried out the prophylactic administration of erythromycin (EM) to hospital staff (1566 staff) who might be exposed to Bordetella pertussis .
Methods:  An oral dose of 1000 mg/day EM was given for 10 days. To assess compliance and estimate the frequency of adverse effect, the ICT conducted a questionnaire survey.
Results and discussion:  Of 942 respondents (response rate: 60·2%), 264 (28·0%) experienced some form of EM adverse effects, of which the most commonly reported involved digestive organ symptoms, e.g. diarrhoea (15·6%), stomachache (7·5%), nausea (3·6%), epigastric distress (2·1%) and abdominal distention (1·8%). More importantly, 246 participants (26·1%) stopped taking the EM before completing 10 days because of perceived adverse effects.
Conclusion:  These results indicate that EM appears to cause adverse effects more frequently than reported in the package insert in Japan. The prophylactic use of EM for pertussis infection is recognized in the guideline of the Centers for Disease Control and Prevention. However, this study suggests that attention should be paid to EM non-compliance during a pertussis outbreak, which could extend the duration of the outbreak and increase the number of affected patients.     

Improving district nurses' confidence and knowledge in the principles and practice of palliative care

Title.  Improving district nurses' confidence and knowledge in the principles and practice of palliative care.
Aim.  This paper is a report of part of an evaluation of the impact of a national palliative care education and support programme on the knowledge and confidence of members of district nursing teams.
Background.  District nursing teams are the mainstay of 'hands on' provision of care at home. In recognition of their central role, the English Department of Health commissioned a national palliative care education programme as postregistration education had been limited.
Methods.  The evaluation, conducted between 2002 and 2004, had a mixed methods design. In the summative component, 1280 nurses were randomly selected from eight cancer networks to receive postal questionnaires 1 year apart, before and after the educational intervention. Changes in scores were calculated and a multiple regression analysis undertaken to identify predictors of improvement in confidence in competence and knowledge. The formative component involved qualitative interviews with a sub-sample of 39 district nurses participating in the programme.
Findings.  Nurses who responded in both years (374/32%) were included in the analysis. There was a small statistically significant increase in confidence in palliative care competency and knowledge after participation in the educational programmes. Nurses without district nursing qualifications and who had never worked in specialist palliative care had the largest improvements in scores. Qualitative data supported these findings.
Conclusion.  The findings suggest that the education programme led to improvements in self-reported district nursing confidence in palliative care competencies and knowledge; it is likely that the baseline level of palliative care confidence in competency and knowledge has as a result been raised nationally.     

An Educational Strategy for Teaching Standardized Nursing Languages

PURPOSE.  The aim of this paper is to describe an educational strategy for teaching standardized nursing languages (SNL) used in both the classroom and clinical components of a psychiatric–mental health nursing course at the associate degree level.
DATA SOURCES.  Data included a review of the relevant literature, teaching experiences, and faculty and student experiences.
DATA SYNTHESIS.  Enhancing associate degree student nurses' competency regarding diagnosis and interventions is essential to influence positive health outcomes. Use of diagnostic, outcome, and intervention classifications for learning nursing care promotes critical thinking, individualization of nursing care, and students' fluency with SNL. One possible teaching strategy to assist students to learn and use SNL was implemented through the use of a faculty-developed Student Nurse Documentation Packet.
CONCLUSIONS.  The educational strategy provided students opportunities to enhance their experience with the SNL to plan and document care of individuals experiencing psychiatric–mental health problems.
IMPLICATIONS FOR NURSING.  The educational strategy used in this program was judged to be successful. Research is needed to provide empirical evidence of the efficacy of this pedagogical strategy for increasing knowledge and enhancing students' competency.     

The De-Escalating Aggressive Behaviour Scale: development and psychometric testing

Title.  The De-Escalating Aggressive Behaviour Scale: development and psychometric testing.
Aim.  This paper is a report of a study to develop and test the psychometric properties of a scale measuring nursing students' performance in de-escalation of aggressive behaviour.
Background.  Successful training should lead not merely to more knowledge and amended attitudes but also to improved performance. However, the quality of de-escalation performance is difficult to assess.
Method.  Based on a qualitative investigation, seven topics pertaining to de-escalating behaviour were identified and the wording of items tested. The properties of the items and the scale were investigated quantitatively. A total of 1748 performance evaluations by students (rater group 1) from a skills laboratory were used to check distribution and conduct a factor analysis. Likewise, 456 completed evaluations by de-escalation experts (rater group 2) of videotaped performances at pre- and posttest were used to investigate internal consistency, interrater reliability, test–retest reliability, effect size and factor structure. Data were collected in 2007–2008 in German.
Findings.  Factor analysis showed a unidimensional 7-item scale with factor loadings ranging from 0·55 to 0·81 (rater group 1) and 0·48 to 0·88 (rater group 2). Cronbach's alphas of 0·87 and 0·88 indicated good internal consistency irrespective of rater group. A Pearson's r of 0·80 confirmed acceptable test–retest reliability, and interrater reliability Intraclass Correlation 3 ranging from 0·77 to 0·93 also showed acceptable results. The effect size r of 0·53 plus Cohen's d of 1·25 indicates the capacity of the scale to detect changes in performance.
Conclusion.  Further research is needed to test the English version of the scale and its validity.     

Nurse education: factors associated with attrition

Title.  Nurse education: factors associated with attrition.
Aim.  This paper is a report of a study to identify the factors having an impact on student completion rates in a preregistration programme.
Background.  Nursing student attrition is an international issue causing concern in many parts of the developed world including Australia, the United States and Europe. In the United Kingdom, nursing student attrition has become a major issue, despite having one of the lowest general university dropout rates in the developed world.
Method.  A retrospective cohort study was conducted in 2007 using routinely-collected demographic and completion data on four cohorts of nursing students (1259 in total) studying at a large English university.
Findings.  Students who were older on entry were more likely to complete the programme than younger students, and those who had only the minimum educational qualifications on entry were less likely to complete than those with higher-level qualifications. There was some evidence of increased risk of resigning from the course in students taking the child branch, and increased risk of discontinuation (involuntary removal) from the course in both male and black/minority ethnic students. There was also some evidence that the healthcare organization responsible for a student's placement could influence completion rates.
Conclusion.  To improve attrition rates on preregistration nursing programmes, higher education institutions should actively target recruitment at mature candidates; increase the level of qualification required to gain entry; examine course structures for flexibility and provide multi-level student support.     

The hormone sensitive lipase gene in familial combined hyperlipidemia and insulin resistance

Backround Insulin resistance in the most common familial dyslipidemia, familial combined hyperlipidemia (FCHL), could be due to variations in the hormone sensitive lipase (HSL) gene.
Materials and methods The coding region of the HSL gene was screened with the single strand conformation polymorphism analysis in probands of 27 FCHL families with 228 members. In addition, the C-60G promoter substitution of the HSL gene was determined by the restriction fragment length polymorphism analysis in these subjects.
Results No variants in the coding region of the HSL gene were found and the allele frequencies of the C-60G promoter substitution and the silent variant (G3138A) in the 3' untranslated region did not differ between 110 control subjects and 27 probands with FCHL. However, in control women the C-60G substitution was associated with high body mass index [30·6 ± 0·9 kg m⁻² (mean ± SD) in subjects with the C/G genotype and 24·8 ± 4·6 in subjects with the C/C genotype, P  = 0·012], and in control men with high rates of insulin-stimulated whole body glucose uptake (70·1 ± 14·7 vs. 56·7 ± 14·2 µmol kg⁻¹ min⁻¹, P  = 0·014). In 228 FCHL family members this substitution was associated with high low-density lipoprotein cholesterol levels in men (4·51 ± 1·12 vs. 5·17 ± 1·28 mmol L⁻¹, P  = 0·049), but not in women.
Conclusions The HSL gene is not a major gene for FCHL. However, the − 60G allele of this gene may affect body weight, insulin sensitivity and serum cholesterol levels.     

Emotional stability of nurses: impact on patient safety

Title.  Emotional stability of nurses: impact on patient safety.
Aim.  This paper is a report of a study conducted to examine the influence of the emotional stability of nurses on patient safety.
Background.  Individuals with greater emotional stability are less likely to exhibit strong emotional reactions to stressful situations, and tend to be more proactive and successful in problem-solving. Effectively managing patient safety is a priority concern in countries where nurses face high pressure. A heavy work load leads to burnout (a syndrome associated with negative emotions), reduced job satisfaction and increased turnover. While emotional stability influences job performance in various contexts, its influence on patient safety has not been addressed.
Method.  A cross-sectional design was adopted. The sample comprised 263 nurses working in two Taiwanese medical centres. The data were collected in 2007–2008, with a response rate of 92·6%. All participants were nursing college graduates aged below 50 years. Participants provided information on both their emotional stability and patient safety. Staffing adequacy, hospital, and years of nursing experience served as control variables.
Findings.  Hierarchical regression analysis indicated that emotional stability predicted patient safety (β = 0·18, P  < 0·01). The addition of emotional stability as a predictor of patient safety increased the associated explained variance (Δ R ² = 0·03, P  < 0·01).
Conclusion.  It is important for to managers create an organisational climate that promotes the emotional stability of nurses. This could help to improve global patient safety by reducing the frequency of adverse events.     

Characterizing violence in health care in British Columbia

Title.  Characterizing violence in health care in British Columbia.
Background.  The high rate of violence in the healthcare sector supports the need for greater surveillance efforts.
Aim.  The purpose of this study was to use a province-wide workplace incident reporting system to calculate rates and identify risk factors for violence in the British Columbia healthcare industry by occupational groups, including nursing.
Methods.  Data were extracted for a 1-year period (2004–2005) from the Workplace Health Indicator Tracking and Evaluation database for all employee reports of violence incidents for four of the six British Columbia health authorities. Risk factors for violence were identified through comparisons of incident rates (number of incidents/100,000 worked hours) by work characteristics, including nursing occupations and work units, and by regression models adjusted for demographic factors.
Results.  Across health authorities, three groups at particularly high risk for violence were identified: very small healthcare facilities [rate ratios (RR) = 6·58, 95% CI =3·49, 12·41], the care aide occupation (RR = 10·05, 95% CI = 6·72, 15·05), and paediatric departments in acute care hospitals (RR = 2·22, 95% CI = 1·05, 4·67).
Conclusions.  The three high-risk groups warrant targeted prevention or intervention efforts be implemented. The identification of high-risk groups supports the importance of a province-wide surveillance system for public health planning.     

Experiences and needs of nursing students during pandemic outbreaks: A systematic overview of the literature

BackgroundRecent epidemics have placed overwhelming demands on health systems, leading at times to the deployment of nursing students during the crisis. Little is known about the impact this experience has on students. Although studies have explored nursing students' knowledge about infection control, there are no specific recommendations regarding how these issues should be addressed in nurse education.PurposeTo conduct a comprehensive systematic overview of the literature concerning nursing students in the context of emerging infectious disease epidemics or pandemics caused by zoonotic viruses.MethodsSystematic overview.ResultsForty-eight articles were included. Five themes were identified: education; knowledge, concern about risk and preventive behaviour; willingness to work during a pandemic outbreak; experiences and emotional impact; and ethical dilemmas.ConclusionsThere is a need to enhance nurse education to ensure that students have adequate education in infection prevention and control and the opportunity to develop the skills and attitudes required to provide care to infected patients during a pandemic. The outcomes of these education programmes would need to be evaluated using valid and reliable instruments so as to enable comparisons to be made to prepare future nurses to deal with new pandemics in an increasingly globalized world.     

Kinetics of absorption and elimination of ofloxacin in humans after oral and rectal administrations

Ofloxacin pharmacokinetics have been studied in four healthy subjects after a single oral or rectal dose, each of 200 mg. For the oral dose t _max was about 2 h, C _max 1·96±0·56 μ g/ml and AUC _1–15 15·22  μ g/ml.h. Two‐phase elimination pharmacol kinetics were observed for the oral dose, t_1/2 for the rapid elimination phase was 3·3 h and for the slow phase 10 h. With the rectal dose t _max was 6 h, C _max 0·71±0·44 μ g/ml and AUC _0–15 7·58  μ g/ml.h. The relative rectal bioavailability ( AUC rectal/ AUC oral) was 49·8%.%Elimination rate of the rectal dose was generally slow ( t_1/2=9 h), an observation attributable to the sustained‐release effect of the rectal suppository base, PEG 6000. The indication is that the rectal formulation cannot be substituted totally for the oral without first increasing the rectal dose; the 200 mg suppository can however be employed as a follow‐up therapy to the oral dose in certain situations.