A comparison of nurses' needs/concerns and hospital disaster plans following Florida's Hurricane Floyd.

INTRODUCTION: The idea for this study was inspired by the response to Hurricane Floyd. Nurses are relied upon and expected to fulfill responsible roles during disaster situations, but little is known about the needs or concerns that nurses experience when they meet expectations and function as disaster responders. METHODS: Official copies of disaster protocols from 4 area hospitals were reviewed, and 4 focus groups consisting of ED nurses from respective hospitals provided information about nurses' concerns or needs in response to Hurricane Floyd. RESULTS: Of primary importance to nurses was family safety, pet care, and personal safety while at work. Secondary concerns were basic needs such as food, water, sleep, shelter, and rest. Group commitment levels to providing care during disaster situations varied greatly. Participants requested that hospital policy revisions address work assignments, pay/financial compensation, flexibility for extenuating circumstances, pet care, family sheltering, and provision of basic needs. DISCUSSION: It is not sufficient for a few key officials and planners to know their roles and responsibilities during a disaster; the roles of everyone involved must be clearly understood. Many participants described their conflict as family commitment versus professional obligation. We identified several areas of concerns in our interviews, and those areas have been clearly defined in the revised protocols. Other areas have yet to be addressed.     

Anthropometry, glucose tolerance, and insulin concentrations in Indian children: relationships to maternal glucose and insulin concentrations during pregnancy

OBJECTIVE: The purpose of this study was to test the hypothesis that the environment experienced by fetuses of mothers with gestational diabetes mellitus (GDM) and mothers with higher glucose concentrations that are in the normal range causes increased adiposity and altered glucose/insulin metabolism in childhood. RESEARCH DESIGN AND METHODS: Children (n = 630) whose mothers were tested for glucose tolerance during pregnancy had detailed anthropometry performed at birth and annually thereafter. At 5 years, plasma glucose and insulin concentrations were measured in the children (2-h oral glucose tolerance test) and their fathers (fasting samples only). RESULTS: Newborns of diabetic mothers (n = 41) were larger in all body measurements than control newborns (babies with nondiabetic parents). At 1 year, these differences had diminished and were not statistically significant. At 5 years, female offspring of diabetic mothers had larger subscapular and triceps skinfold thicknesses (P = 0.01) and higher 30- and 120-min insulin concentrations (P < 0.05) than control children. Offspring of diabetic fathers (n = 41) were lighter at birth than control children (P < 0.001); they showed no differences in anthropometry at 5 years. In control children, skinfold thickness and 30-min insulin concentrations were positively related to maternal insulin area under the curve, and skinfold thicknesses were related to paternal fasting insulin concentrations independently of the parents' skinfold thickness and socioeconomic status. CONCLUSIONS: Maternal GDM is associated with adiposity and higher glucose and insulin concentrations in female offspring at 5 years. The absence of similar associations in offspring of diabetic fathers suggests a programming effect in the diabetic intrauterine environment. More research is needed to determine whether higher maternal glucose concentrations in the nondiabetic range have similar effects.     

Career choice in nursing students: gendered constructs as psychological barriers

BACKGROUND: Gendered views of nursing remain widespread. This study explores how such views may influence student nurses' career aspirations. METHOD: A group of preregistration student nurses completed a questionnaire distributed early in their first year of study of a 3 year Higher Diploma in Nursing. Data were gathered on career aspirations and the perceived gendered nature of a number of career options. Gender role orientation and occupational and academic self-efficacy were also measured using the Bem Sex Role Inventory and an adaptation of the Betz and Hackett Self-Efficacy Scale. RESULTS: The results document the relative popularity of each specialism within nursing and students' perceptions of the gendered nature of each of the various nurse careers. Differences in these perceptions as related to gender and gender role identity are also outlined. Gender and gender role orientation were found to be predictive of sex-typed career aspirations only. CONCLUSION: The psychological barriers that exist for both men and women as they pursue careers in nursing need to be addressed if the current shortage of nursing personnel across the United Kingdom (UK) is to be solved.     

Services for children with developmental co-ordination disorder: an evaluation against best practice principles

Purpose: The National Health Service in Scotland published a best practice framework to support occupational therapists and physiotherapists to deliver effective services for children with developmental co-ordination disorder (DCD); however, adherence is variable. To highlight areas for development, this study compared the care pathway within a paediatric DCD service against the NHS Scotland framework. Methods: A partnership of researchers and clinicians based in the United Kingdom conducted a qualitative study with 37 participants (N?=?13 interview participants, N?=?24 workshop participants). In-depth interviews and/or workshops were used to map the DCD service against the NHS framework. Identified gaps were aligned with four key stages of the care pathway. Qualitative analysis software was used to analyse the data. Results: Core principles to guide future development were identified for each phase of the pathway. These core principles related to the NHS framework and focused on issues such as involving the family, defining clear pathways and enhancing children’s participation. Participants identified potential strategies for service improvement such as developing community-based interventions and information provision. Conclusion: Challenges when providing services for children with DCD include confusing service pathways and poor partnership working. It is, therefore, important that clinicians utilise collaborative working strategies that support children’s participation.

• Implications for Rehabilitation

• There are numerous challenges related to the implementation of best practice principles into the provision of therapy services for children with developmental coordination disorder (DCD).

• It is important that AHPs seek ways of engaging parents and educational professionals at all stages of the care pathway in order to ensure optimum service provision for the child.

• Addressing participation is an important aspect and community-based strategies may be particularly beneficial, both as a preventative activity and as an intervention approach.

     

Compliance with perioperative prophylaxis guidelines and the use of novel outcome measures

Postoperative wound infections represent an important source of morbidity and mortality in children. Perioperative antibiotic prophylaxis has been shown to decrease the risk of developing infections and hospital guidelines surrounding antibiotic use exist to standardize patient care. Despite supporting evidence, rates of compliance with guidelines vary. Quality improvement initiatives have been introduced to improve compliance with intraoperative antibiotic guidelines. Thorough infection surveillance, including antibiotic provision in presurgical checklists, computerized voice antibiotic administration prompts, and national feedback systems are now increasingly common. Few studies have been conducted investigating the effectiveness of prophylactic antibiotics in children. Outcome measures such as morbidity and mortality and return to the operating room can be used to examine the relationship between antibiotic use and patient outcome but these measures are limited in that they occur infrequently or are subjective and difficult to measure. Metrics such as days alive out of hospital and length of hospital stay may be useful alternatives for ongoing monitoring of infections and identifying improvements in patient outcomes. Guidelines on antibiotic prophylaxis have facilitated an increase in the correct provision of perioperative antibiotics and a reduction in the incidence of postoperative infection. Measures of patient outcome such as days alive out of hospital and length of hospital stay are easy to collect and calculate but further work is needed to confirm the utility of these measures for monitoring infection rates.     

An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: rationale and design

BACKGROUND: Hypertension disproportionately affects African Americans compared to whites, and it is the single most common explanation for the disparity in mortality between African Americans and whites. Adherence with antihypertensive medications can help reduce risk of negative hypertension-related outcomes. Motivational interviewing is a promising patient-centered approach for improving adherence in patients with chronic diseases. In this paper we describe the rationale and design of an ongoing randomized controlled trial testing the effectiveness of motivational interviewing versus usual care in improving medication adherence among 190 African American uncontrolled hypertensive patients, who receive care in a primary care setting. METHODS: The usual care group receives standard medical care, while those in the intervention group receive standard care plus four sessions of motivational interviewing at 3-month intervals for a period of 1 year. This technique consists of brief, patient-driven counseling sessions to facilitate initiation and maintenance of behavior change. The primary outcome is adherence to prescribed antihypertensive medication, assessed with the electronic medication events monitoring system (MEMS) and the Morisky self-report adherence questionnaire. Secondary outcomes are within-patient changes in blood pressure, self-efficacy, and intrinsic motivation between baseline and 12 months. We report the baseline sociodemographic and clinical characteristics of the participants. CONCLUSIONS: Despite the potential utility of motivational interviewing, little is known about its effectiveness in improving medication adherence among hypertensive patients, especially African Americans. In addition to the baseline data this study has generated, this trial should provide data with which we can assess the effectiveness of this approach as a behavioral intervention.