Managing change in nurse education: the introduction of Project 2000 in the community

The United Kingdom Central Council's proposals for nurse education (Project 2000: A New Preparation for Practice) were implemented in 13 demonstration districts in England in 1989. In 1991, as part of an English National Board-funded research study, the author conducted 15 interviews with first line managers from three of these demonstration districts. The data were reinterpreted in 1995; the experience of implementing educational change in the community setting was discovered to be a complex and difficult process for the managers involved. They found themselves confronted with sometimes conflicting responsibilities; their perception of their role encompassed the meeting of a range of needs, which are presented in this paper within three categories. Firstly, the managers felt they had an obligation to meet the needs of students and of education in general in order both to provide an adequate experience for each individual student and to safeguard standards in community nursing in the long term. Secondly, they were confronted with the need to mitigate the pressures Project 2000 placed on'their'staff. The new educational programme meant that community nurses spent much more time with students than formerly, and the difficulties they encountered were exacerbated by uncertainty about their role with these students. Finally, and most importantly, managers were responsible for ensuring that clients'needs were met. In particular, they saw it as their role to ensure that the presence of large numbers of students in the community for long periods of time did not compromise standards in the delivery of community nursing services.     

Quality of life in long-stay institutions in England: nurse and resident perceptions

Quality of life (QOL) of older persons living in institutions is a critical consideration in international economic policies and health care decisions Yet, there is little relevant research to support decisions about culturally acceptable and effective nursing care for this population This qualitative study explored and compared perceptions of older residents and nurses in three long-stay institutions in south-west England It addressed issues viewed as important to a good QOL for residents and ways in which nurses promote QOL A convenience sample of 10 residents aged 65 and older (80% female) and nine nurses (n=five registered general nurses and four enrolled nurses) were interviewed using a semi-structured schedule Interview data were analysed using an analytic induction method of content analysis While theme frequency and examples differed, themes common to both residents and nurses were individuality, professionalism, connectedness, and physical functioning Resident responses tended to be personal, succinct, and sometimes negative Nurses' responses were more positive, detailed, and reflective of general professional responsibilities Implications for nursing education, research, and practice are discussed Improvement in QOL will be addressed differently based on social and cultural settings However, there may be commonalities that are applicable across cultures     

Attributes of nurses that determine the quality of care for mentally handicapped people in an institution

This is an ethnographic study that examines, from the relatives' perspective, the attributes of nurses that are considered important in the caring process of mentally handicapped people in an institutional setting in Hong Kong Twelve interviews were carried out with a family member who had a relative living in a special unit for severely mentally handicapped people Empirical studies, mainly from the west, have shown that decisions to place a mentally handicapped family member in residential care is a complex process Family characteristics, the relatives' characteristics as well as the availability of support, have been found to influence decisions about out-of-home placement Once this decision has been made, a new caring relationship between nurse, family and relative needs to be established The final categories that emerged from the data show that families have expectations about the nurses' competence and comittment to the job and about their relationships with the client and the family Consequently quality is judged, not only by the way in which nurses work with the clients, but also by the way in which they work with the family Implications for practice and education of nurses working with mentally handicapped people and for nursing administration in Hong Kong are discussed     

Teratogenic response to arsenite during neurulation: relative sensitivities of C57BL/6J and SWV/Fnn mice and impact of the splotch allele

Arsenic is an environmental contaminant that induces congenital malformations, primarily neural tube defects, in laboratory animals, and it may contribute to human birth defects. The acute doses of arsenicals required to elicit teratogenesis in outbred strains of mice, however, are orders of magnitude higher than those to which humans are exposed environmentally. In order to examine interactions between arsenite administration during neurulation and murine genotype, the present study compares two inbred mouse strains, establishes a teratogenic dose of arsenite, and evaluates the effect of the splotch mutation on arsenic-induced teratogenesis. SWV/Fnn or C57BL/6J females were injected intraperitoneally with sodium arsenite (10 mg/kg) on days 6.5, 7.0, 7.5, 8.0, 8.5, or 9.0 of gestation. A dose-response study was carried out in the C57BL/6J strain, and the effect of the splotch mutation, introduced via the male (C57BL/6J Sp/+), was assessed. Fetuses were examined for external, visceral, and skeletal malformations. Fetuses from crosses of C57BL/6J females with C57BL/6J Sp/+ males were genotyped by PCR. Ten-mg/kg sodium arsenite was teratogenic in nearly 50% of C57BL/6J fetuses, and the C57BL/6J strain was significantly more sensitive to arsenite-induced embryo-lethality and teratogenicity than the SWV/Fnn strain. The spectrum of malformations produced was dependent on the gestational time point of arsenite administration. Introduction of the splotch allele significantly increased neural tube defects and other specific malformations. This result demonstrates that a mutation in a single gene can increase sensitivity to arsenic-induced birth defects. This murine study examines the interaction between arsenite-induced teratogenicity and genotype.      

Brachial plexus: correlation of MR imaging with CT and pathologic findings

Thirty-two patients with symptoms referable to the brachial plexus were evaluated with magnetic resonance (MR) imaging. Sixteen patients had undergone concurrent computed tomography (CT). MR imaging demonstrated normal findings in 16, 12 neoplasms, three cases of trauma, and one case of possible neural edema. Of the 16 patients with normal findings on MR images, eight had CT scans that were also normal. In one patient, MR images showed that the "mass" seen on CT was actually a tortuous blood vessel. In six of the 12 cases of neoplasm in which CT scans were available, MR imaging revealed more extensive disease. In the other six cases of tumor, MR imaging provided sufficient clinical information to obviate the need for CT or any other imaging modality. MR imaging provided definitive diagnoses in the three cases of trauma without further imaging. In one patient with paresthesia, MR imaging showed high signal intensity of the nerves on T2-weighted images, which was compatible with neural edema. A concurrent CT scan was normal.     

Quantitative Ultrasound (QUS) of the Heel Predicts Wrist and Osteoporosis-Related Fractures in Women Age 45–75 Years

This study was designed to determine the ability of quantitative ultrasound (QUS) of the heel to predict fracture risk at different sites in postmenopausal women between the ages of 45 and 75 years. Heel QUS was measured at baseline using a Lunar Achilles scanner, and subsequent fractures were identified over 3 yr. The results were analyzed graphically after age adjustment and using Cox's proportional regression to estimate odds ratios for fracture risk; 3180 women were scanned (79% of sample). Sixty-three wrist, 12 hip, 4 vertebral, 7 proximal humerus, 3 pelvic, and 61 other fractures were identified over a mean followup of 31 mo. There was a fivefold difference in numbers of wrist and osteoporosis-related fractures (hip, vertebra, pelvis, and humerus combined) between the lowest and highest quartiles of QUS results adjusted for age. The odds ratios per 1 SD decline in QUS parameters adjusted for age were: wrist fractures BUA = 1.6, SOS = 1.5, stiffness = 1.8, osteoporosis-related fractures BUA = 1.9, speed of sound (SOS) = 1.6, stiffness = 2.2, and other fractures, BUA = 1.0, SOS = 1.1, stiffness = 1.1. When analyzed for each 10-yr age group, the odds ratios were generally higher in the 56-65 yr group than the other decades. In women between 45 and 75 yr, heel QUS can predict wrist and osteoporosis- related fractures at about the same level that dual-energy X-ray absorptiometry (DXA) of various sites can predict wrist fractures. This extends the current evidence that heel QUS can predict hip fracture risk in women over 75 yr to include other fracture sites in younger women. Heel QUS may be useful in the primary care assessment of osteoporotic fracture risk in women after the menopause.