Growth in a context of cultural marginality: North American nurse educators in Japan

BACKGROUND: Concepts of marginality and partnership emerged from a questionnaire completed by 12 North American nurse educators working long term in Japan. METHODS: To study individual perceptions regarding current professional and personal experiences, including language competency, roles and responsibilities in a different culture, contributions made, and management of daily living. Respondents also made recommendations to others who accepted similar assignments. RESULTS: The data revealed growth accomplished and challenges encountered as a result of marginal status in the Japanese context with varying levels of socio-cultural adaptation.     

Making use of unsolicited research data

Two hundred and fifty-one unsolicited comments, relating in general terms to the research subject, were recorded during the collection of data for the writers current research concerning the role of the psychiatric nurse. The paper demonstrates how such'unofficial'comments may be used to further our understanding of the research process generally and of the research subject in particular. The comments are analysed and used to highlight a number of areas which are of concern to nurses, for example the difficulty which some respondents had with thinking about nursing activity in specific terms, and relating it to individual patients. The role of trade unions in the decision making process preceding, and following, entry to data collection sites is discussed That lines of communication between the researcher, nurse administrators and trade unions be clarified is one of the recommendations made in this paper. Other recommendations include the proposal that, where possible, research respondents be given an opportunity to make general and specific comment relating to the research in which they are being asked to participate.     

Mental health service user involvement in nurse education: exploring the issues

This paper reports on findings and issues arising from a study designed to promote mental health service users' involvement in a preregistration nursing curriculum. Users' views about the knowledge, skills and attributes required by mental health nurses were explored to inform the curriculum design. Strategies that would facilitate long term, active user involvement in the design and delivery of the curriculum were also explored. Findings are presented with concurrent discussion of issues arising from the research process in relation to user involvement in education. The issue of 'conflict' explores findings relating to users' views of a 'good' mental health nurse and inherent conflicts between user and professional views are highlighted. The representativeness of the research participants is explored and debated in relation to service user involvement in nurse education. Finally, the concepts of 'involvement' and 'tokenism' are discussed and recommendations made about how active user involvement in nurse education can be achieved.     

Experiences of nurse-researchers in gaining access to subjects for clinical nursing research.

This study investigated the experiences of nurse researchers in gaining access to potential research subjects within health care agencies. Responders were nurse researchers who were primary authors of clinical nursing research studies that had been published in nursing research journals between the years 1985 and 1989. A survey was mailed to 211 responders and returned by 99 (47 per cent). Eighty-six were employed primarily by educational institutions. Responses to the survey indicated that these nurse researchers experienced political and procedural obstacles in gaining access to potential research subjects within health care agencies.     

The nurse practitioner in primary care: alleviating problems of access?

Improving access to primary care services is an essential component of the NHS modernization plan and the advent of independent nurse practitioners in primary care has focused attention on the extent to which this group of nurses can effectively substitute for GPs. This study was designed to explore the role of a nurse practitioner in primary care, particularly whether the provision of a nurse practitioner facilitated access to care that met the needs of patients. Semistructured interviews were conducted with 14 patients who had consulted with the nurse practitioner, 10 staff within the practice who had knowledge of the role, and the nurse practitioner herself. With the permission of interviewees, interviews were audiotaped, the tapes transcribed verbatim, and the data were coded by theme. It was perceived by both groups of interviewees that access to care had been improved in that there were more appointments available, appointments were longer than they had been previously and were available at different times of the day. However, some areas in which access was 'restricted' were articulated by staff interviewees, such as limitations to the nurse practitioner's prescribing and problems with referring patients to secondary care. Additionally, while access to a member of the primary healthcare team was improved for many patients, access to a specific member of the team, such as a GP, was not always improved. Concerns were also expressed about how the role of the nurse practitioner needed to be developed in the practice. It can be concluded from this study that, potentially, the role of nurse practitioner has much to offer in terms of addressing problems of access in primary care for some patients. However, this is not a straightforward solution and in order for the role to be effective several issues highlighted in this study require addressing.     

Predictive data mining on monitoring data from the intensive care unit

The widespread implementation of computerized medical files in intensive care units (ICUs) over recent years has made available large databases of clinical data for the purpose of developing clinical prediction models. The typical intensive care unit has several information sources from which data is electronically collected as time series of varying time resolutions. We present an overview of research questions studied in the ICU setting that have been addressed through the automatic analysis of these large databases. We focus on automatic learning methods, specifically data mining approaches for predictive modeling based on these time series of clinical data. On the one hand we examine short and medium term predictions, which have as ultimate goal the development of early warning or decision support systems. On the other hand we examine long term outcome prediction models and evaluate their performance with respect to established scoring systems based on static admission and demographic data.     

Gaining Access to Native American Cultures by Non-Native American Nursing Researchers

The authors sought to identify the problems non-Native American nurse researchers might have in gaining access to Native American cultures. The authors' method was nursing ethnography; several different tribes were observed. Findings revealed five significant categories of barriers to health care: understanding of cultural differences, language barriers, differences in interpersonal communication, historical antipathy I fear of exploitation by Native Americans, and distrust of researcher motivation. The authors make several recommendations for researchers to prepare extensively if they plan to work with Native Americans.     

Working in long-term care settings for older people with dementia: nurses' aides

Aim. This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long‐term care settings in Taiwan. Background. High nurse aide turnover has been a major problem for many managers of long‐tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long‐term care settings in Taiwan. Methods. A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi‐structured interview guide and content analysis was used to identify the major themes in the data. Results. Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence). Conclusion. Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides’ needs to increase job retention and to improve the quality of resident care in long‐term care settings. Relevance to clinical practice. Careful appraisal of prospective nurse aides’ attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance‐based pay rises and subsidized training are practical retention strategies for these nurse aides.     

Issues and considerations when researching sensitive issues with men: examples from a study of men and sexual health

This article highlights some ethical considerations and practicalities that arose when conducting research with men in relation to decision making and seeking help for a sexually transmitted infection (STI). The aim of the study was to explore, using a grounded theory approach, the processes involved in making the decision to seek help. The main issues that arose were in relation to seeking permission and gaining approval, obtaining informed consent and susceptibility to harm. The interview itself and the concept of the researcher as a tool of data collection also gave rise to ethical issues. These issues have implications for the conduct of sensitive research with men and highlight the need for more overt reporting of the ethical issues and practical considerations that arise when planning and conducting research.     

The state Children's Health Insurance Program (CHIP)

PURPOSE: To provide an overview of the Children's Health Insurance Program (CHIP), along with implications for practice as it applies to nurse practitioners. DATA SOURCES: Extensive review of the on-line and published literature on CHIP. CONCLUSIONS: Congress established CHIP in an effort to reduce the high number of uninsured children in America. Each state administers its own program and children who are under age 19, 200% below federal poverty levels, and ineligible for Medicaid may qualify. Even though CHIP has made health care possible for over 3 million children, there are still many obstacles that need to be overcome to ensure that access to healthcare is a reality for America's children. IMPLICATIONS FOR PRACTICE: Although CHIP has made healthcare accessible for many low income children, there are still hundreds of children left without health insurance. Many children who could qualify for CHIP remain without access to healthcare. Nurse practitioners have the opportunity to make healthcare a reality for children by becoming knowledgeable about this plan in order to refer patients to the program who are eligible and by advocating for future legislation that will ensure its long term success.     

Conducting nursing research with men who have sex with men: challenges and strategies for nurse researchers.

The group most affected by the HIV epidemic is men who have sex with men (MSM). Since the beginning of the epidemic in 1981, this group was one the four identified high-risk groups, and MSM continue to comprise nearly 50% of all cases of HIV/AIDS. In the context of HIV infection and safer sex behaviors, this population has been the focus of numerous research studies. Despite the wealth of research that has been conducted on this population, very little information is available on research methods and strategies that nurse researchers can use to study this population. This report details one nurse researcher's experiences in gaining access to this population, unique recruitment issues, and challenges in data collection. In addition, strategies and interventions that were used by this researcher to overcome these challenges in the research process are discussed.     

国外护士执业准入管理的现状及其启示

本文旨在通过介绍国外护士执业准入管理现状,以及国内护士执业准入管理的基本情况,分析得出我国护士执业准入管理中存在的问题：护士执业资格考试内容与院校护理教学改革方向相脱离,缺乏护士执业准入标准等,并提出制定我国护士执业准入标准、建立新的护士执业资格考试模式等解决办法。     

Effects of nurses' sex-role orientation on positive and negative assertion

The present paper examines how the sex-role orientation of the nurse can affect both positive and negative assertion. The Bem Sex-Role Inventory (BRSI) and the Assertion Inventory (AI) were used to collect self-reported data from a convenience sample of 94 subjects. Behavioral data were obtained by directly sampling 50 nurses' responses within role-play situations. Contrary to earlier studies, the findings of the investigation indicated that there was no significant relationship between assertion measurements and sex-role orientation. Following a discussion of the findings, recommendations relating to future research are made and the limitations of the study are identified.     

Child-Focused Single Home Visiting

Abstract Home visiting is a central, long-standing, and yet theoretically underdeveloped public health nursing process. The general aim of this study was to expand and refine a preliminary model of home visiting A stylized field research investigation was conducted in the area of maternal-child health with one nurse in a visiting nurse association in New England. A specific type of home visiting, identified as child focused, emerged, with phases labeled as surveying and designating; selling and scheduling; approaching the home and the visit; entering the home; gaining permission to ask questions and access the infant—starting with the mother's expressed concerns; making the caregiving judgment—asking questions and weighing and examining the infant; and ending the visit. "Haunting and telling" was an additional phase for certain visits. The nurse conducted child-focused home visiting in three patterns. The single pattern is described in this article. Potential maternal, child, interactive, and environmental consequences were identified, as were factors influencing the process of maternal-child home visiting. Social exchange theory emerged as useful in describing how the nurse initiated, maintained, and ended the home visiting process, and in describing attendant client consequences.     

Seeking approval for research access: the gatekeeper''s role in facilitating a study of the care of the relinquishing mother

While undertaking a study of midwives' care of mothers relinquishing a baby for adoption, the search for permission for access provided valuable insights into the role and functioning of the 'gatekeepers', who included a range of nursing/midwifery personnel and others. The benefits and positive aspects of this process are discussed. The variability of the response to the request for permission for research access gives insight into the gatekeepers' decision-making process. The functioning of research ethics committees is shown to be unpredictable. The gatekeepers' comments are related to the comments made by mothers in an early stage of the study. The way in which the gatekeepers utilize their own individual experience is crucial to their decisions regarding permitting research access. This experience may take the form of personal experience, occupational experience or experience of research.     

Opioid abuse among nurse anesthetists and anesthesiologists

Abuse and dependency on potent opioids have long been recognized as problems among nurse anesthetists and anesthesiologists. Research has provided insight into the incidence of abuse, risk factors associated with this type of dependency, identification of an impaired provider, treatment for abuse and dependency, and prevention strategies. Although several factors influence the development of abuse and dependency, access to potent opioids likely has a large role. This access also makes returning to practice while in recovery extremely difficult because the temptation for relapse continually surrounds a recovering anesthesia provider. There is research supporting successful reentry of anesthesia providers into the practice of anesthesia; however, research also reveals high relapse rates among anesthesia providers who return to the practice of anesthesia. This article reviews the literature regarding opioid abuse and dependency among nurse anesthetists and anesthesiologists and offers implications for future research.     

Nurse and midwifery prescribing in Ireland: A scope‐of‐practice development for worldwide consideration

For 10 years, select Irish nurses and midwives who pass a rigorous 6 month theory and practical program can prescribe medications and other medicinal products. Given the need for timely, accessible, and affordable health‐care services in all countries, this nursing/midwifery education and practice development is worthy of examination. Irish nurse/midwife prescribing occurred following long‐term deliberative nursing profession advocacy, nursing education planning, nursing administration and practice planning, interdisciplinary health‐care team support and complementary efforts, and government action. A review of documents, research, and other articles was undertaken to examine this development process and report evaluative information for consideration by other countries seeking to improve their health‐care systems. Nurse/midwife prescribing was accomplished successfully in Ireland, with the steps taken there to initiate and establish nurse/midwife prescribing of value internationally.     

长期专职陪护人员心理状况现状的调查

目的 调查长期专职陪护人员的心理状况,探讨改善其心理状况的有效方法,提高护理质量.方法 采用一般资料调查、陪护相关护理知识测试、基本护理技能测试、焦虑自评量表、抑郁自评量表对40名陪护时间大于或等于6个月(长期陪护组)和40名陪护时间小于6个月(短期陪护组)的专职陪护人员进行测评.结果 长期陪护组陪护人员基本护理技能测试得分、抑郁自评得分高于短期陪护组、二者之间差异有统计学意义(P<0.05).结论 长期专职陪护工作的人员存在抑郁情绪但基本护理技能较好,护士除了充分发挥优秀长期专职陪护人员的优势,协同护士做好病人的基础护理外,还应该关注其心理健康,教会陪护简单的减轻压力的方法,尽快提高整体陪护技能,更好地服务于病人.     

Cancer of the cervix

OBJECTIVES: To review the advances in the diagnosis, evaluation, staging, and treatment of cervical cancer that have been made in the past 10 years, and identify the work that still needs to be done. DATA SOURCES: Journal and review articles, book chapters, and research studies. CONCLUSIONS: Although cervical cancer has a preinvasive component and should be easily preventable, it has not been eradicated. Issues that prevent access to health care need to be addressed. IMPLICATIONS FOR NURSING PRACTICE: Nurses now have a more extended role in screening patients and educating them regarding the importance of preventive care. As new treatments are developed, the nurse is the one who will monitor the patient for side effects and assist with minimizing them. When all treatments fail in advanced disease, the nurse will assist the patient to deal with end-of-life issues and symptom control.     

Nurse prescribing: the experiences of psychiatric nurses in the United States

AIM: This study sought to elicit the views of psychiatric nurses in the United States on various aspects of nurse prescribing, with the aim of informing UK nurses about future problems and possible solutions. METHOD: A survey design with an opportunistic sample of psychiatric nurse clinical specialists was used. The questionnaire consisted of 14 items seeking to elicit information on demographic data, current involvement in medication management, perceptions of the advantages and disadvantages of nurse prescribing, awareness of research about nurse prescribing, accountability and autonomy, and the prescribers' relationship with the pharmaceutical industry. Of the 80 questionnaires distributed, 51 (43 completed by female nurses and eight by male nurses) were returned--a response rate of 64 per cent. RESULTS: The results highlight the many advantages of nurse prescribing, which centre on improving the quality of care for patients; concerns relating to the relationship between nurse prescribers and non-prescribers; and the relationship between nurse prescribers and medical supervisors. CONCLUSION: Nurse prescribing has advantages for nurses and patients, including enhanced career development opportunities and better quality of patient care. However, though nurses may feel ready for this development, some members of the public may take longer to accept it.