Pilot study of an exercise intervention suitable for older heart failure patients with left ventricular systolic dysfunction

Background

Most studies of exercise training for heart failure have been conducted on relatively young patients with little comorbidity. Such programmes are unsuitable for the majority of older frail heart failure patients.

Aims

To test the acceptability and tolerability of an outpatient exercise programme in older heart failure patients with comorbid disease.

Methods

17 patients aged 70 years and over with left ventricular systolic dysfunction attended twice weekly group exercise classes for 12 weeks, focussing on endurance exercise and everyday functional tasks. Outcome measures were proportion of sessions attended; adverse events and reasons for non-attendance; six-minute walk, accelerometry, hospital depression and anxiety score, Guyatt quality of life scale, carer strain and satisfaction scores.

Results

83% of sessions were attended; 80% of subjects attended at least 80% of allocated sessions. One adverse incident occurred in 324 person-sessions. Encouraging improvements were seen in six minute walk test (+ 19 m, p = 0.14) and in Functional Limitation Profile score (− 82 points, p = 0.02). 50% of informal carers attended at least one session. No increase in carer strain was noted.

Conclusions

Twice-weekly group exercise focussing on aerobic endurance and everyday functional tasks was acceptable and well-tolerated in this patient group.     

Interactive effects of nurse-experienced time pressure and burnout on patient safety: A cross-sectional survey

Background

Global nursing shortages have exacerbated time pressure and burnout among nurses. Despite the well-established correlation between burnout and patient safety, no studies have addressed how time pressure among nurses and patient safety are related and whether burnout moderates such a relation.

Objectives

This study investigated how time pressure and the interaction of time pressure and nursing burnout affect patient safety.

Design-setting participants

This cross-sectional study surveyed 458 nurses in 90 units of two medical centres in northern Taiwan.

Methods

Nursing burnout was measured by the Maslach Burnout Inventory-Human Service Scale. Patient safety was inversely measured by six items on frequency of adverse events. Time pressure was measured by five items. Regressions were used for the analysis.

Results

While the results of regression analyses suggest that time pressure did not significantly affect patient safety (β = −.01, p > .05), time pressure and burnout had an interactive effect on patient safety (β = −.08, p < .05). Specifically, for nurses with high burnout (n = 223), time pressure was negatively related to patient safety (β = −.10, p < .05).

Conclusion

Time pressure adversely affected patient safety for nurses with a high level of burnout, but not for nurses with a low level of burnout.     

Effects of monthly practice on nursing students' CPR psychomotor skill performance

Aims

The study examined the effects of brief monthly practice on nursing students’ CPR psychomotor skill performance at 3, 6, 9, and 12 months compared to a control group with no practice, and of repeating the initial BLS course at 12 months.

Methods

Nursing students (n = 606) completed either HeartCode™ BLS or an instructor-led course and were then randomly assigned to an intervention group practice schedule, consisting of experimental (6 min of monthly practice on a voice advisory manikin) or control (no practice) and test out month. Every 3 months, a subset of students was randomly selected from both groups for reassessment of their CPR psychomotor skills. Outcome measures were compression rate and depth, percent of compressions performed with adequate depth, percent performed with correct hand placement, ventilation rate and volume, and percent of ventilations with adequate volume.

Results

At 3 months, there were no differences between the groups in mean ventilation volume (p = 0.71), but with practice by 6 months students were able to ventilate with an adequate volume; this skill continued to improve with monthly practice. In the control group, the mean ventilation volumes were less than the recommended minimum throughout the 12 months. The control group had a significant loss of ability to compress with adequate depth between 9 and 12 months (p = 0.004). By practicing only 6 min a month, students maintained or improved their CPR skills over the 12-month period.

Conclusion

The findings confirmed the importance of practicing CPR psychomotor skills to retain them and also revealed that short monthly practices could improve skills over baseline.     

The association between nursing diagnoses, resource utilisation and patient and caregiver outcomes in a nurse-led home care service: longitudinal study

Background

The information generated by nurses through standardised nursing languages is insufficiently evaluated and exploited, mainly in home care services, as is its potential impact on outcomes.

Objectives

To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation with use of resources, mortality, institutionalisation and satisfaction.

Design

Observational, longitudinal follow-up study.

Settings

Home care services delivered by Primary Healthcare Districts in Málaga, Costa del Sol, Almería and Granada, in Spain.

Participants

Patients and caregivers who initiated the Home Care Programme.

Methods

The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made by nurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use of resources, mortality, institutionalisation and satisfaction.

Results

Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8 diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p = 0.033). Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregivers were, in 78% of cases, due to the recipient’s baseline functional status. No relation was detected for institutionalisation or for patient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk for mortality (RR: 2.08 CI 95%: 1.26-3.42) (p = 0.012).

Conclusions

These data confirm results from other studies which find nursing diagnoses to be sound predictors of resources use. Their synergy with other case-mix systems in home care should be investigated.     

Sleep-related predictors of quality of life in the elderly versus younger heart failure patients: A questionnaire survey

Background

Research has indicated that sleep disorders reduce the quality of life of heart failure patients.

Objectives

To investigate quality of sleep, and the impact of poor sleep on quality of life among elderly versus younger heart failure patients.

Design

A two-group, cross-sectional study.

Setting

A community teaching hospital in Taipei, Taiwan.

Participants

Voluntarily self-enrolled heart failure patients who did not have sleep apnea or restless leg syndrome.

Methods

There were126 elderly and 67 young participants filled out five questionnaires (1) demographic information and current health status; (2) the Chinese Pittsburgh Sleep Quality Index; (3) the Chinese Epworth Sleepiness Scale, and (4) the short form (SF)-36 Taiwanese version. The major statistical procedures applied in this study were t-test, analysis of variance, Pearson's correlation, and a stepwise multiple linear regression. A p-value of <0.05 was adopted as significant.

Results

The prevalence of insomnia was 44.4% for the elderly group and 31.4% for the younger group. The top three prevalence sleep-disturbing events were: nocturia, long sleep latency, and early wake-up. In the elderly group, nocturnal dyspnea and long sleep latency were significant determinants of the mental (R² = 0.23) and physical components (R² = 0.21) of quality of life. In the young group, nocturnal dyspnea was a significant determinant of the mental component of quality of life (R² = 0.15), and early wake-up was a significant determinant of the physical component of quality of life (R² = 0.15).

Conclusion

The sleep disorder of heart failure patients is disease-specific rather than a matter of age. The prevalence of insomnia of young heart failure patients was higher than that of the healthy elderly. The major determinants of poor night sleep quality in the elderly group were dyspnea and long sleep latency, and in the younger group, these were dyspnea and early wake-up. Those also were significant determinants of quality of life of the heart failure patients.

Implications for nursing practice

Since the sleep-related predictors of quality of life were different in the elderly versus younger heart failure patients, to identify the insomnia factors individually and to provide guidance of appropriate usage of sleep medications and other methods to promote sleep should be considered.     

Utility of the Oswestry Disability Index for studies of back pain related disability in nurses: Evaluation of psychometric and measurement properties

Background

Disability due to back pain in nurses results in reduced productivity, work absenteeism and attrition from the nursing workforce internationally. Consistent use of outcome measures is needed in intervention studies to enable meta-analyses that determine efficacy of back pain preventive programs.

Objective

This study investigated the psychometric and measurement properties of the Oswestry Disability Index (ODI) in nursing students to determine its suitability for assessing back pain related disability in intervention studies.

Methods

Bachelor of Nursing students were recruited. Test-retest reliability and the ability of the ODI to discriminate between individuals with serious and non-serious back pain were investigated. The measurement error of the ODI was examined with the minimal detectable change at the 90% confidence level (MDC₉₀).

Results

Student nurses (n = 214) had a low mean ODI score of 8.8 ± 7.4%. Participants with serious back pain recorded higher scores than the rest of the cohort (p < 0.05). Test-retest reliability examined in 33 individuals was ICC = 0.88 (95%CI 0.77-0.94). The MDC₉₀ = 6%, and 36% of nursing students scored below the MDC₉₀ indicating the tool had limited ability to detect longitudinal change in disability in this population.

Conclusion

Data from this and previous studies demonstrate that the measurement properties of the ODI are inappropriate for studying back pain related disability in nurses. The ODI is not recommended for back pain intervention studies in the nursing population and an alternative tool that is sensitive to lower levels of disability must be determined.     

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison

Background

Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction.

Objectives

We studied the effectiveness of a hand hygiene education program on the incidence of nosocomial bloodstream infections.

Design

Observational study with two pretests and two posttest measurements and interrupted time series analysis.

Setting

A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands.

Participants

Healthcare professionals who had physical contact with very low birth weight (VLBW) infants.

Methods

The study was conducted during a period of 4 years. Medical and nursing staff followed a problem-based education program on hand hygiene. Hand hygiene practices before and after the education program were compared by guided observations. The incidence of nosocomial infections in VLBW infants was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth weight infants were analyzed by a segmented loglinear regression analysis.

Results

During 1201 observations hand hygiene compliance before patient contact increased from 65% to 88% (p < 0.001). Median (interquartile range) drying time increased from 4 s (4-10) to 10 s (7-14) (p < 0.001).The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene intervention decreased from 44.5% to 36.1% (18.9%, p = 0.03) and from 17.3% to 13.5% (22.0%, p = 0.03), respectively.At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07% (95% CI −1.41 to +1.60) per month and decreased with −1.25% (95% CI −4.67 to +2.44) after the intervention (p = 0.51). The level of instant change was −14.8% (p = 0.48).

Conclusions

The results are consistent with relevant improvement of hand hygiene practices among healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in nosocomial bloodstream infections.     

High C5a levels are associated with increased mortality in sepsis patients--no enhancing effect by actin-free Gc-globulin

Background

Immune paralysis of phagocytic cells due to excess of the complement activation product C5a has been proposed as a critical pathomechanism in sepsis. In vitro studies suggest an interaction of C5a with Group-specific globulin (Gc-globulin).

Study objectives

To examine the predictive value of serum concentrations of both, C5a and actin-free Gc-globulin, and their ratio for prognosis (mortality) of critically ill patients.

Patients

154 critically ill (septic and non-septic) adult patients admitted to a Medical ICU and 38 healthy controls.

Measurements

Actin-free Gc-globulin and C5a were measured on ICU admission, alongside extensive laboratory, clinical and prospective outcome measures.

Results

Actin-free Gc-globulin and C5a serum concentrations were significantly reduced in critically ill patients compared with healthy controls. C5a levels, but not actin-free Gc-globulin, were significantly lower in patients with sepsis (n = 112) than in critically ill patients without sepsis (n = 42). C5a serum level was a prognostic parameter in patients with sepsis: High C5a levels were associated with increased mortality (at ICU and during follow-up). Although C5a and actin-free Gc-globulin were positively correlated, increasing serum concentrations of actin-free Gc-globulin did not enhance the C5a dependent effects in terms of prognosis or mortality in septic patients.

Conclusions

Investigation for C5a and/or actin-free Gc-globulin serum levels upon admission to the ICU may be helpful diagnostic tools. In patients with sepsis, C5a levels are an independent predictor of prognosis. However, different to pre-existing in vitro data, a clinically relevant interaction between actin-free Gc-globulin and C5a in terms of prognosis in severe inflammatory conditions is not given.     

Rating medical emergency teamwork performance: Development of the Team Emergency Assessment Measure (TEAM)

Aim

To develop a valid, reliable and feasible teamwork assessment measure for emergency resuscitation team performance.

Background

Generic and profession specific team performance assessment measures are available (e.g. anaesthetics) but there are no specific measures for the assessment of emergency resuscitation team performance.

Methods

(1) An extensive review of the literature for teamwork instruments, and (2) development of a draft instrument with an expert clinical team. (3) Review by an international team of seven independent experts for face and content validity. (4) Instrument testing on 56 video-recorded hospital and simulated resuscitation events for construct, consistency, concurrent validity and reliability and (5) a final set of ratings for feasibility on fifteen simulated ‘real time’ events.

Results

Following expert review, selected items were found to have a high total content validity index of 0.96. A single ‘teamwork’ construct was identified with an internal consistency of 0.89. Correlation between the total item score and global rating (rho 0.95; p < 0.01) indicated concurrent validity. Inter-rater (k 0.55) and retest reliability (k 0.53) were ‘fair’, with positive feasibility ratings following ‘real time’ testing. The final 12 item (11 specific and 1 global rating) are rated using a five-point scale and cover three categories leadership, teamwork and task management.

Conclusion

In this primary study TEAM was found to be a valid and reliable instrument and should be a useful addition to clinicians’ tool set for the measurement of teamwork during medical emergencies. Further evaluation of the instrument is warranted to fully determine its psychometric properties.     

Biphasic DC shock cardioverting doses for paediatric atrial dysrhythmias

Objective

To determine cardioversion doses of biphasic DC shock for paediatric atrial dysrhythmias.

Design

Prospective recording of energy, pre-shock and post-shock rhythms.

Setting

Paediatric hospital.

Patients

Shockable atrial dysrhythmias.

Main results

Forty episodes of atrial dysrhythmias among 25 children (mean age 6.8 ± 7.1 years, mean weight 28.2 ± 28.5 kg) were treated with external shock. The first shock converted the dysrhythmia to sinus rhythm in 25 episodes. Cardioversion occurred in 2 of 8 (25%) episodes with a dose of <0.5 J/kg, 14 of 16 (88%) with a dose of 0.5-1.0 J/kg and 9 of 16 (56%) with a dose of >1.0 J/kg (p = 0.01, Fisher's exact test). Ten of 15 initially non-responsive episodes were cardioverted with additional shocks at 1.1 ± 0.6 J/kg (range 0.5-2.1 J/kg). Of the remaining 5 unresponsive episodes, 2 of ventricular fibrillation (induced by unsynchronized shock) were successfully defibrillated, and 3 were managed with cardiopulmonary bypass. Among 11 additional children (mean age 4.3 ± 6.8 years, mean weight 18.1 ± 22.0 kg), 18 episodes of atrial dysrhythmias were treated with internal shock which successfully cardioverted all episodes with one or more shocks at 0.4 ± 0.2 J/kg.

Conclusions

In rounded doses, recommended initial external cardioversion doses are 0.5-1.0 J/kg and subsequently up to 2 J/kg, internal cardioversion doses are 0.5 J/kg.     

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: A questionnaire survey

Background

Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL).

Objectives

To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS.

Design

This study was a cross-sectional, questionnaire survey.

Settings

Three medical centers and five regional hospitals in Taipei were selected randomly.

Participants

In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean = 31.02, SD = 6.32), had normal body mass index, and had never given birth. Most nurses’ bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate.

Methods

Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS.

Results

Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS.

Conclusions

Although most of the nurses in this study were young (≦35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses’ possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses’ physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.     

The effect of quantity of ice and size of contact area on ice pack/skin interface temperature

Objective

To determine the effect of quantity of ice and contact area on ice pack/skin interface temperature during a 20-minute cooling period.

Design

Repeated measures.

Setting

Laboratory setting in an educational institution.

Participants

Twenty healthy males aged between 18 and 22 years.

Interventions

An ice pack was applied to the right thigh with compression using an elastic bandage. The effects of three packs measuring 18 cm × 23 cm containing 0.3, 0.6 and 0.8 kg of ice, and one pack measuring 20 cm × 25 cm containing 0.6 kg of ice were compared.

Main outcome measure

The reduction in temperature at the ice pack/skin interface during 20-minute ice applications was monitored at 1-minute intervals.

Results

The application of 0.8-kg and 0.6-kg ice packs led to a significantly greater decrease in the interface temperature compared with the 0.3-kg ice pack [0.8 kg vs. 0.3 kg: −2.35 °C, 95% confidence interval (CI) of the difference −3.36 to −1.34 °C; 0.6 kg vs. 0.3 kg: −2.95 °C, 95% CI −4.07 to −1.83 °C]. No significant difference in temperature was found between the 0.6-kg and 0.8-kg ice packs (0.8 kg vs. 0.6 kg: 0.6 °C, 95% CI −0.12 to 1.32 °C, P > 0.05). The size of the contact area did not alter the degree of cooling significantly (difference between smaller and larger pack: 0.05 °C, 95% CI −0.93 to 1.03 °C, P > 0.05). The lowest temperature during ice application was reached after 8-9 minutes of cooling.

Conclusion

Application of an ice pack containing at least 0.6 kg of ice leads to a greater magnitude of cooling compared with application of a 0.3-kg ice pack, regardless of the size of the contact area. Thus, clinicians should consider using ice packs weighing at least 0.6 kg for cold treatment.     

Use of cyst fluid CEA, CA19-9, and amylase for evaluation of pancreatic lesions

Objectives

The study goals were development of reference intervals and an interpretive algorithm for pancreatic cyst fluid tumor markers.

Design and methods

442 pancreatic cyst fluids were tested for CEA, CA19-9, and amylase.

Results

CEA > 30 ng/mL discriminates mucinous from non-mucinous cysts. After CEA analysis, amylase and CA19-9 segregate non-mucinous and mucinous subtypes, respectively.

Conclusions

Pancreatic cyst fluid tumor markers supplement other diagnostic measures. This study provides estimated reference intervals and an algorithm for interpretation.     

Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback

Context

Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation.

Objective

To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting.

Design

Randomised cross-over trial.

Setting

Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007.

Participants

European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties.

Interventions

CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control.

Main outcome measures

Quality of chest compression during resuscitation.

Results

Feedback resulted in less deviation from ideal compression rate 100 min⁻¹ (9 ± 9 min⁻¹, p < 0.0001) with this effect becoming steadily larger over time. Applied work was less in the feedback group compared to controls (373 ± 448 cm × compression; p < 0.001). Feedback did not influence ideal compression depth significantly. There was some indication of a learning effect of the feedback device.

Conclusions

Real time automated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate.     

Comparison of three established measures of fear of falling in community-dwelling older adults: Psychometric testing

Background

Several approaches have emerged for measuring self-reported fear of falling. A comparison of measurement scales’ psychometric properties is needed for researchers to choose the proper scale for their study.

Objectives

To compare the psychometric properties of the Falling Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC) and the Geriatric Fear of Falling Measurement (GFFM).

Design

Secondary analysis using baseline and 8-week data from a randomized, controlled trial on fall and fear of falling prevention.

Settings

Rural area northeast of Taiwan with assessments conducted in participants’ homes.

Participants

Population-based sample of 168 community-dwelling older adults aged 60 and older.

Methods

During a home visit, a nurse administered the Tinetti Mobility Scale, and asked about the FES, ABC, GFFM, WHOQOL, falls, chronic illnesses and medicines taken.

Results

Baseline internal consistency measured using Cronbach's alpha was 0.98 for the FES, 0.96 for the ABC and 0.88 for the GFFM. Baseline concurrent validity between the FES, ABC and GFFM measured using a correlation coefficient was 0.88 (FES vs. ABC), −0.55 (FES vs. GFFM), and −0.57 (ABC vs. GFFM), respectively, p < .001. All three instruments scores were significantly correlated at baseline with physical performance tests and WHOQOL. The GFFM demonstrated responsiveness to change at 8 weeks.

Conclusions

The FES, ABC and GFFM demonstrated strong internal consistency reliability. The GFFM had stronger associations with physical and psychosocial functioning and may be more appropriate for studies focused on improving all aspects of fear of falling. Both FES and ABC instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively non-frail older community-dwelling adults. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population.     

The mediating role of psychological empowerment on job satisfaction and organizational commitment for school health nurses: A cross-sectional questionnaire survey

Background

The importance of the professional role of school health nurses in promoting children's health in their school environment is widely recognized. However, studies of their working experience have revealed feelings of disempowerment that appear to be related to insufficient support from school managers. In these unsupportive working environments, it seems possible that psychological empowerment may play a mediating role to strengthen employees’ satisfaction and commitment to their employing organization.

Objectives

The aim of this study is to test an exploratory model of empowerment in a Taiwanese sample of school health nurses by examining the mediating role of psychological empowerment in the relationship between external factors and work-related attitudes, specifically job satisfaction and organizational commitment.

Design

A cross-sectional survey with self-reported questionnaires.

Participants and methods

Probability proportional sampling was used to generate a randomly selected sample of 500 school health nurses in elementary and junior high schools in Taiwan. A total of 330 valid questionnaires were returned, yielding a response rate of 66%.

Results

The exploratory model including all hypothesized variables provided an adequate fit (χ² = 29.24; df = 17; p = .052; adjusted goodness-of-fit index [AGFI] = .96; goodness-of-fit index [GFI] = .98; root-mean-square error of approximation [RMSEA] = .05) for the data and indicated that psychological empowerment did not fully mediate the relationship between organizational empowerment and job satisfaction because of the strong direct effects of organizational empowerment on job satisfaction. The influence of empowerment on organizational commitment was mediated through job satisfaction.

Conclusions

Psychological empowerment did not mediate the relationship between external factors and work attitudes, and job satisfaction emerged as an important factor. If school leaders can improve the job satisfaction of school health nurses, this will help them achieve greater commitment and loyalty of school health nurses to their employing schools.     

Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation

Background

Chronic obstructive pulmonary disease (COPD) is predominantly caused by cigarette smoking and is considered a worldwide preventable chronic illness. Smoking cessation is considered the primary intervention for disease management and nurses should play a major role in assisting patients to stop smoking. Currently there is a lack of professional consensus on how cessation interventions should be evaluated. The vast array of biochemical markers reported in the literature can be confusing and can make the comparisons of results difficult.

Objective

To validate self-report data on smoking with exhaled carbon monoxide in patients with chronic obstructive pulmonary disease over twelve months.

Design

We performed a secondary analysis of a previously published randomized controlled trial evaluating nursing interventions to assist respiratory patients to stop smoking.

Setting

Northern Ireland's Regional Respiratory Centre.

Participants

A total of 91 cigarette smokers attending secondary care for the treatment for COPD participated in the study.

Method

Self-reported smoking status and cigarettes smoked per day were compared to exhaled carbon monoxide readings at baseline, 2, 3, 6, 9 and 12 months. The cut-off value of ≤10 ppm was used to identify non-smokers. The p-values are based on Pearson's correlation coefficient and Kappa Coefficient as appropriate.

Results

Findings suggest self-reported smoking status and cigarette consumption amongst patients with chronic obstructive pulmonary disease was highly consistent with exhaled carbon monoxide results (p = 0.001-0.003).

Conclusion

The majority of patients with chronic obstructive pulmonary disease reliably report their cigarette consumption.     

The effect of a physiotherapy education compared with a non-healthcare education on the attitudes and beliefs of students towards functioning in individuals with back pain: An observational, cross-sectional study

Objectives

To investigate the difference in attitudes: (1) between first and fourth year physiotherapy students towards functioning in individuals with back pain; and (2) between physiotherapy students and non-healthcare students towards functioning in individuals with back pain.

Design

Observational, cross-sectional study.

Setting

Glasgow Caledonian University, Scotland, UK.

Participants

First year physiotherapy (n = 61) and non-healthcare students (n = 61), and fourth year physiotherapy (n = 62) and non-healthcare students (n = 62).

Main outcomes

All participants completed the Health Care Providers’ Pain and Impairment Relationship Scale (range 15 to 105). This questionnaire measures attitudes towards functioning in individuals with back pain.

Results

Fourth year physiotherapy students had more positive attitudes towards functioning in individuals with back pain than first year physiotherapy students [57.4 vs 66.6 (mean difference −9.2, 95% confidence interval −12.2 to −6.1, P < 0.01)]. Similarly, fourth year non-healthcare students had more positive attitudes towards functioning in individuals with back pain compared with first year non-healthcare students [69.2 vs 65.3 (mean difference −3.9, 95% confidence interval −7.2 to −0.5, P = 0.03)]. Physiotherapy students had more positive attitudes than non-healthcare students in the first year [66.6 vs 69.2 (mean difference −2.6, 95% confidence interval −5.5 to 0.4, P = 0.08)] and the fourth year [57.4 vs 65.3 (mean difference −7.9, 95% confidence interval −11.4 to −4.4, P < 0.01)] of study.

Conclusion

These findings suggest that physiotherapy education brings about positive student attitudes towards functioning in individuals with back pain. This may be partly attributable to receiving a university degree education, but would appear to be further enhanced by specifically receiving a physiotherapy degree. This may facilitate students to become more evidence-based practitioners following qualification.     

The Hyperemesis Impact of Symptoms Questionnaire: Development and validation of a clinical tool

Background

The Hyperemesis Impact of Symptoms Questionnaire is a clinical tool designed to assess holistically the impact of the physical and psychosocial symptoms of hyperemesis gravidarum (HG) on individuals. Its purpose is to aid planning and implementation of tailored care for women with HG. To our knowledge no similar tool exists.

Objective

To assess the validity and reliability of the HIS questionnaire.

Design

As no similar tool exists, we compared the HIS with three tools that reflect its key areas: physical impact (Pregnancy Unique Quantification of Emesis - PUQE score and markers of severity of HG), psychological impact (Hospital Anxiety and Depression Score - HADS) and social impact (SF12 quality of life score).

Setting

A large regional referral, women and children's hospital in the North West of England.

Participants

The HIS was evaluated on 50 women admitted to hospital with HG and 50 women recruited from ante-natal clinic without severe nausea and vomiting of pregnancy and with an uncomplicated pregnancy.

Results

Good criterion validity was demonstrated by strong significant correlations with all three scores (PUQE, r = 0.75, p < 0.001, HADS, depression r = 0.76, p < 0.001, and SF12, mental component r = −0.65, p < 0.001). The HIS showed good internal consistency, Cronbach alpha 0.87, split half 0.80.

Conclusions

There is evidence for the validity and reliability of the HIS to assess the impact of the physical and psychosocial symptoms of HG. Further research is currently underway to establish the clinical utility of the HIS questionnaire in the care of women hospitalised with HG.     

Quality of faculty, students, curriculum and resources for nursing doctoral education in Korea: A focus group study

Background

The rapidly increasing number of nursing doctoral programs has caused concern about the quality of nursing doctoral education, including in Korea.

Objectives

To describe the perceived quality of Korean nursing doctoral education in faculty, student, curriculum and resources.

Design

Focus group.

Settings

Fourteen Korean nursing doctoral programs that are research focused and include coursework.

Participants

Four groups of deans, faculty, students and graduates; students completed three semesters of doctoral program; and graduates completed doctoral programs within the most recent 3 years.

Methods

Focus groups examined the strengths and weaknesses of faculty, students, curriculum, and resources.

Results

Faculty strengths were universities’ recognition of faculty research/scholarship and the ability of faculty to attract extramural funding. Faculty weaknesses were aging faculty; high faculty workload; insufficient number of faculty; and teaching without expertise in nursing theories. Student strengths were diverse student backgrounds; multidisciplinary dissertation committee members, and opportunities to socialize with peers and graduates/faculty. Students’ weaknesses were overproduction of PhDs with low academic quality; a lower number and quality of doctoral applicants; and lack of full-time students. Curriculum strengths were focusing on specific research areas; emphasis on research ethics; and multidisciplinary courses. Curriculum weaknesses were insufficient time for curriculum development; inadequate courses for core research competencies; and a lack of linkage between theory and practice. Resources strengths were inter-institutional courses with credit transfer. Weaknesses were diminished university financial support for graduate students and limited access to school facilities. Variations in participant groups (providers [deans and faculty] vs. receivers [students and graduates]) and geographical location (capital city vs. regional) were noted on all the four components.

Conclusions

The quality characteristics of faculty, students, curriculum, and resources identified in this first systematic evaluation of the quality of nursing doctoral education can inform nursing schools, universities, and policy-makers about areas for improvement in Korea and possibly in the world. Geographical variations found in these four components of doctoral education warrant attention by policy-makers in Korea.