The superiority of rectal thermometry to oral thermometry with regard to accuracy

Electronic oral thermometry is performed routinely in most medical centres From the studies available on this subject it seems difficult to find any documentation for this practice We have conducted clinically controlled studies in which the accuracy of electronic oral thermometry (CRAFTEMP and TERUMO WCT) and that of electronic rectal thermometry (TERUMO WCT) were tested Rectal glass mercury thermometry was used as a reference method Two studies were designed In study 1,184 patients (72 women, 112 men), median age 70 (18–95) years were investigated In study 2, 91 patients (41 women, 50 men), median age 59 (18–96) years were investigated Electronic oral thermometry was found unacceptably inaccurate under daily routine conditions Electronic rectal thermometry was found to be accurate Calculations of mean temperature difference between reference measurements and test measurements (mean ± SD) were found to be routine oral CRAFTEMP at 0 70 ± 0 50°C, optimum oral TERUMO WCT at 0 75 ± 0 74°C, routine rectal TERUMO WCT at 0 08 ± 0 26°C and optimum rectal TERUMO WCT at 0 02 ± 0 17 In the screening procedure for fever oral thermometry showed low sensitivity (routine CTAFTEMP 0 47 and optimum TERUMO WCT 0 59) whereas rectal thermometry showed high sensitivity (routine TERUMO WCT 0 74 and optimum TERUMO WCT 0 91) It was concluded that rectal thermometry must be preferred to oral thermometry for daily routine measurements     

Approaches to the problem of respondent attrition in a longitudinal panel study of nurses' careers

Longitudinal panel studies have several distinct methodological and analytical advantages over cross-sectional studies for gaining an understanding of nurses' careers and developing strategies to facilitate retention Panel studies do, however, present the researcher with a number of substantial challenges if maximum potential is to be achieved from the investment of time and resources that such studies entail Respondent attrition at successive phases of data collection, for example, is a major problem, often with the consequence that respondents are not representative of the study group as a whole This paper discusses reasons for choosing a longitudinal panel design for a programme of research into careers of midwives and nurses The way in which the problem of respondent attrition has been approached in one of the projects in the programme, that focusing on the careers of registered general nurses, is then described     

Nursing and health promotion: conceptual concerns

The importance of health promotion to nursing is now well established However, different interpretations of health promotion exist It is argued that many allegations of nursing's inadequacy in this field are misplaced and to a large extent result from the confused and variable ways in which the term health promotion is used Concepts of health promotion in general are considered and compared with usage of the term in nursing literature The contribution of nursing to health promotion and health education is discussed and some curncular issues are raised     

Unerupted first permanent molar. Case report

A case of an unerupted first permanent molar in a nine-year-old child is described and the aetiology is discussed. Surgical intervention was selected as the treatment of choice and resulted in a satisfactory outcome.     

Patient controlled analgesia—assessment of machine feedback to patients

The effect of varying patient-controlled analgesia machine feedback was studied in two groups of patients following a standard surgical procedure using patient controlled analgesia with morphine to control postoperative pain. Analgesic demands, morphine consumption, pain scores and side effects were compared and comments from the patients were noted. There was no significant difference between those whose machines signalled only successful demands compared with those who had every demand acknowledged. The patients in the former group appreciated the extra input and the nursing staff found this machine configuration to be less disturbing to the ward. There was no evidence of a clinically useful placebo effect in the latter group.     

Integrating what is taught with what is practised in the nursing curriculum: a multi-dimensional model

The discrepancy between nursing as it is taught in the classroom (theory) and nursing as it is experienced by students in the clinical setting (practice) has long been a source of concern to teachers, practitioners and learners This paper provides an overview of the literature on the theory-practice gap, exploring some of the many reasons cited for its existence as well as suggested ways of bridging the gap Drawing upon the findings, a comprehensive and multidimensional model designed to integrate theory and practice of nursing is proposed for use by curriculum planners Fundamental to the model is the notion of collaboration between education and service staff at all stages of the curriculum process The model highlights eight key areas for the curriculum team to consider the curriculum model to be used, sequencing of taught content and clinical practice, the content of the course, teaching methods to be used, assessment criteria, the role of tutors in the learning process, the contribution of service staff, and the influence of the hidden curriculum It is argued that only through such a comprehensive model can integration of theory and practice within the curriculum be achieved Adoption of the model, however, will require considerable individual and organizational commitment     

A philosophical analysis of the concept of reassurance and its effect on coping

The phenomenon of'reassurance' is an attribute of caring that is commonly used in the delivery of nursing care If caring is considered central to the concept of nursing, a case is made that the therapeutic value of reassurance needs to be analysed This paper addresses this issue from a phenomenological viewpoint Definition of the concept of reassurance is first analysed, highlighting the complexity of its meaning as it is commonly used in nursing practice, and an attempt is made at examining its effects on coping     

Interpersonal learning in groups: an investigation

The dissatisfaction of patients with communication in health care has largely been addressed by providing more communication skills training Research into why skills training might be ineffective has identified various factors, which include organizational resistance, personal defences against anxiety and a need for personal reflection and support In one college of nurse education small group discussion and reflection had become established practice for students in their first and second clinical experience The groups met once weekly and were facilitated by a nurse teacher Discussion was unstructured and focused on the nurse's interpersonal relationship with his or her patients This project examined one such group and sought to examine the use of small group reflective discussion by nurses about ther patients as a means of improving interpersonal communication The research was conducted over a period of 6 months with nine student nurses meeting once weekly during their first two episodes of clinical experience Kelly's personal construct theory was used and two repertory grids were constructed by the group One grid examined processes and change in intrapersonal construing, and the other grid examined processes and change in construing about certain patients These grids were completed by the students at the beginning and at the termination of the groups Notes were taken after each group meeting, which recorded impressions and processes, these were discussed once weekly with supervision The notes were analysed using a grounded theory methodology The results show some changes in patterns of constructing in relation to self which indicate an increase in anxiety and reluctance to self-reflect The need for defensive structures in order to facilitate self-reflection is discussed in the light of the qualitative analysis Finally the value of this type of work is supported by evidence of the group working as a social microcosm The limitations and indications for further research are noted, but this project supports the contention that in order to be truly effective those who come in contact with the emotional needs of patients