Public nursing home staff's experience of participating in an intervention aimed at enhancing their self-esteem

Aim  The aim of the present study was to gain an understanding of how nursing staff experienced participating in a training programme aimed at strengthening their self-esteem and empowering them, to determine whether participation benefited them in any way, and to describe their opinions about possible benefits or disadvantages.
Background  Staff working in institutions such as nursing homes have a low status in society. A training programme was introduced to staff in a public nursing home. It focused on helping them understand factors in the work situation that influence them and on empowering them.
Method  The study was explorative and qualitative in design.
Findings  The participants in the programme were generally satisfied with it. Their opinions about the benefits they received from the programme can be described using three themes: 'improved communication skills', 'enhanced self-esteem' and 'sees work in a different light'.
Conclusions  The most important finding of the present study is that it was possible to strengthen and empower staff. Staff members were generally pleased and satisfied with the content/organization of the training programme. They felt the programme had been of value to them by improving their communication skills and increasing their self-esteem.
Implications for nursing management  The present result could be of value to managers and educators working in the area of nursing home care when planning education and development activities for staff. Learning to communicate better and understand the social structure at the workplace could improve staff members' self-esteem, thereby enhancing the work situation and atmosphere as well as empowering the individuals.     

General Practitioners' Comments on Video Recorded Consultations as an Aid to Understanding the Doctor-Patient Relationship

Arborelius E and Timpka T. General practitioners' comments onvideo recorded consultations as an aid to understanding thedoctor-patient relationship. Family Practice 1990; 7: 84–90. The aim of this study was to describe, understand and interpretphysicians' experiences of consultations. Forty-six consultationswere videotaped in four primary health care centres. Twelvegeneral practitioners and 46 patients participated. Afterwardsthe patients and the physicians (on different occasions) commentedon the recorded consultations. The comments were analysed froman inductive as well as a hypothetical-deductive model. Theanalyses agreed well with each other. The result demonstratedthat the physicians often had difficulties understanding thepatient, that they did not really know how to handle the conversationand felt that they did not really understand the context. Theperceived relation to the patient was mainly related to thepatient's ability to give adequate information. It is concludedthat a key factor in communication is the difficulty which thephysician has in understanding what the patient in fact wants-thefailure to be on the same wavelength so that the message fromthe patient can be received.     

Synaptic Plasma Mèmbrane Antigen D2 Measured in Human Cerebrospinal Fluid by Rocket-Line Immunoelectrophoresis. Determination in Psychiatric and Neurological Patients

The concentration of an antigen partially identical to the rat brain synaptic membrane antigen D2, was measured in human cerebrospinal fluid. The method used was rocket-line immunoelectrophoresis in agarose gel containing the detergent Triton X-100, and line-forming extract of rat brain membranes. No significant differences were found between the controls and patients with multiple sclerosis, inflammatory-degenerative neurological diseases, atrophic brain diseases, acute cerebro-vascular disease, schizophrenia, or affective psychosis.     

Walking function, pain, and fatigue in adults with cerebral palsy: a 7-year follow-up study

Aim  To compare walking function, pain, and fatigue in adults with cerebral palsy (CP) 7 years after an initial survey.
Method  A multidimensional questionnaire was mailed to 226 people with unilateral (hemiplegic) or bilateral (diplegic) spastic CP who had participated in a 1999 survey. People with additional diagnoses were excluded. Special emphasis was placed on participants with deterioration in walking. The questionnaire was the same as in 1999.
Results  One hundred and forty-nine participants (76 males, 73 females; mean age 40y 5mo, SD 10y 7mo, range 24–76y) with a diagnosis of unilateral ( n =81) or bilateral ( n =68) spastic CP responded. Fifty-two per cent of all participants reported deterioration in walking function since debut of walking, compared with 39% 7 years previously. In participants with bilateral CP, 71% reported deteriorated walking, compared with 37% of participants with unilateral CP. Participants with deteriorated walking function had greater pain frequency, pain intensity, impact of pain on daily activities, and physical fatigue and reduced balance. The number of people reporting overall mobility problems was almost double compared with 7 years previously.
Interpretation  The main finding was an increased prevalence of deteriorated walking, significantly associated with bilateral spastic CP, pain, fatigue, and reduced balance. Rehabilitation programmes addressing these areas are needed.     

Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF)

Background: The French‐Language Society of Paediatric Anaesthesiologists (ADARPEF) designed a 1‐year prospective, multicenter and anonymous study to update both epidemiology and morbidity of regional anesthesia in children. Methods: From November 2005 to October 2006, data from participating hospitals were recorded using an identification form, a data recording form, and a complication form. Information collected included the characteristics of the hospitals, the number and type of regional anesthetics (RA), the age of the involved children as well as the incidence, and type of complications. Results: Data collected in 47 institutions included 104 612 pure general anesthesias (GAs), 29 870 GAs associated with regional blocks, and 1262 pure regional blocks. Central blocks accounted for 34% of all RA. Peripheral blocks (66%) were upper or lower limb blocks (29% of peripheral blocks), trunk blocks, and face blocks (71%). In children aged ≤3 years, the percentage of central blocks was similar to the peripheral ones (45% vs 55), while in older children, peripheral blocks were more than four times used than central ones. Complications (41 involving 40 patients) were rare and usually minor. They did not result in any sequelae. The study revealed an overall rate of complication of 0.12%; CI 95% [0.09–0.17], significantly six times higher for central than for peripheral blocks. Conclusions: As a result of the low rate of complications, RA techniques have a good safety profile and can be used to provide postoperative analgesia. In addition, the results should encourage anesthesiologists to continue to use peripheral instead of central (including caudal) blocks as often as possible when appropriate.     

Cold extremities and difficulties initiating sleep: evidence of co‐morbidity from a random sample of a Swiss urban population

Difficulties initiating sleep (DIS) can frequently occur in psychiatric disorders but also in the general population. The primary vasospastic syndrome is a functional disorder of vascular regulation in otherwise healthy subjects complaining of thermal discomfort from cold extremities (TDCE). Laboratory studies have shown a close relationship between long sleep onset latency and increased distal vasoconstriction in healthy young subjects. Considering these findings, the aims of the Basel Survey were to assess the prevalence rates for DIS and TDCE and to determine whether both symptoms can be associated in the general population. In a random population sample of Basel‐Stadt, 2800 subjects (age: 20–40 years) were requested to complete a questionnaire on sleep behavior and TDCE (response rate: 72.3% in women, n = 1001; 60.0% in men, n = 809). Values of DIS and TDCE were based on questionnaire‐derived scores. In addition, TDCE was externally validated in a separate group of subjects (n = 256) by finger skin temperature measurements—high TDCE values were significantly associated with low finger skin temperature. A total of 31.1% of women and 6.9% of men complain of TDCE. In contrast, prevalence rates of DIS were only slightly higher in women in comparison to men (9.3% versus 6.7%, P < 0.1). Irrespective of gender, each seventh subject complaining of TDCE had concomitant DIS and the relative risk in these subjects was approximately doubled. Therefore, a thermophysiological approach to DIS may be relevant for its differential diagnosis and its treatment.     

Evaluation of the clinical supervision and professional development of student nurses

severinsson e. & sand å. (2010) Journal of Nursing Management  18, 669–677
Evaluation of the clinical supervision and professional development of student nurses Aim The aim of the present study was to evaluate the clinical supervision and professional development of student nurses during their undergraduate education. Background Nursing education has undergone radical changes as a result of improvements in the academic-based clinical education required for the Bachelor’s degree. Methods The sample consisted of student nurses (n = 147) and data were collected by means of questionnaires. Results The results demonstrated that the frequency of sessions and the supervision model employed influence the student nurses’ professional development. Several significant correlations were found, most of which were related to the development of the student nurses’ professional relationships with their supervisors and reflection on the development of their skills. From the patients’ perspective, a high correlation was found between the factors ‘preserving integrity’ and ‘protecting participation by patients and family members’. Conclusions Clinical supervision strongly influences the student nurses’ development of a professional identity, enhancing decision-making ability and personal growth. However, development of documentation skills should include a greater level of user involvement. Implications for nursing management The findings highlight the need for management and staff nurses to engage in on-going professional development. Transformative leadership, which is value driven, can facilitate and enhance the supervision and development of student nurses.     

Midwives' group supervision and the influence of their continuity of care model – a pilot study

severinsson e., haruna m. & friberg f. (2010) Journal of Nursing Management 18, 400–408
Midwives' group supervision and the influence of their continuity of care model – a pilot study Background Midwives’ different leadership and supervisory styles influence women’s experiences of childbirth in various ways. Aim The aim of this study was to evaluate midwives’ experiences of group supervision and the influence of the continuity of care model, with particular focus on childbearing women’s need for emotional support. An additional aim was to evaluate the development of the midwives’ professional competence. Methods Qualitative thematic analysis was used to analyse the notes made during the supervision sessions and focus group discussion. Results The significance of the midwives’ continuity of care model was: assessment of the women’s individual needs, enabling strategies to create a deeper relationship and acknowledging the vulnerability in the relationship with the women. The outcome of the midwives’ group supervision was increased professional competence. Three themes emerged: Integrating science into midwifery practice, Awareness of one’s professional role and Sensitivity in one’s professional role. Conclusions These findings provide a clear indication that the women’s need for emotional support can be fulfilled by the midwives’ leadership. Implication for nursing management The development of the midwife’s role as a leader in maternity care is closely related to the opportunities for the provision of supervision aimed at increasing her professional competence.     

Late asthmatic reactions and bronchial variability after challenge with low doses of allergen

Late allergic inflammatory reactions are probably of major importance for the development of asthma. In order to study the occurrence of early and late asthmatic reactions after challenge with different doses of allergen, inhalation provocation tests were performed in 13 patients with mild or moderate symptoms of allergic asthma. The provocation series was started with a low allergen dose (0.1–10 BU), which was then increased in successive ten-fold increments at intervals of 1 week until a pronounced bronchial reaction developed. Three different reaction patterns were observed. Six patients showed an isolated late reaction to relatively low doses of allergen. In four patients an immediate reaction was followed by a late reaction—a so-called dual response, and in three patients only an immediate reaction occurred. In four of the six patients who showed only a late reaction a higher allergen dose was given and this resulted in dual reactions in all four. One patient was challenged with an even higher dose, to which she reacted with an immediate response alone. After a late reaction, bronchial variability with low PEF values was observed over a period of several days. It is thus possible for an isolated late asthmatic reaction to be provoked by a low dose of inhaled allergen. This can be of clinical importance, repeated small doses of allergen may be unnoticed but still give bronchial inflammation and asthmatic symptoms.