Achieving partnership: the contribution of nursing education to the production of a flexible workforce

Aim : This paper examines education's contribution to labour force reform in the nursing profession within the United Kingdom.
Background : In a globalized society there is increasing demand for more flexible forms of working. Nursing faces radical change in its employment characteristics if it is to continue to meet the health care needs of the population in the new century.
Origins of information and data analysis : Key sociological texts and contemporary analysis of nursing skill have been analysed and synthesized to identify the dynamic of change in nursing and nursing education's contribution to these changes.
Key issues : Patterns of upskilling and multiskilling are leading to the breakdown of professional role boundaries in the broader workforce. These patterns can also be seen in nursing. Upskilling is associated with increased stress and 'risk' for the individual, therefore achievement of flexibility is not without cost. Changes in the skill level in nursing lead many to conclude that the profession will become divided into a core and periphery distinction. This simplistic analysis does not account for the complexities of nursing and nursing skill although there is clearly a growing need for a 'knowledge and technical elite'.
Conclusions : The core–periphery distinction is too simplistic to analyse nursing skills and the dynamic of change in the workforce. A radical perspective of nursing characterized by workers with a range of skills and competencies is less likely to lead to rigid professional boundaries. There is a clear need for multiskilled and knowledgeable workers; the 'technical and knowledge elite'. These nurses may be recognized as advanced practice nurses. High quality education is required to prepare these practitioners. Adaptation of nursing to the postmodern world needs to be facilitated by changes in current educational policy and practice.     

Primary nursing: job satisfaction and staff retention

A survey to compare the levels of intrinsic job satisfaction of primary and non-primary nurses was conducted. Within the survey, the relationship between intrinsic job satisfaction and staff retention was addressed. Wards which met a criteria for primary nursing, designed by Davies (1989) were included in the study. Thirty-two primary nurses were identified. A comparative group of non-primary nurses was identified by 'pairing' nurses on certain variables. Data was gained by questionnaire using a Likert Scale. Open questions were also asked to gain qualitative data. Non-parametric statistical tests were used to analyse quantitative data. Content analysis was used to analyse qualitative data. No significant difference was demonstrated between primary and non-primary nurses levels of intrinsic job satisfaction or intentions to stay in nursing. Qualitative data yielded interesting results. Primary and non-primary nurses gained job satisfaction in different areas of work. Primary nurses gave intrinsic reasons, non-primary nurses gave extrinsic reasons for job satisfaction. Research concerning primary nursing and job satisfaction is often based on the assumption that all nurses as professionals find job satisfaction in intrinsic factors. This assumption must be questioned.     

Brief report: A randomized controlled trial of Synera™ versus lidocaine for epidural needle insertion in labouring parturients

PURPOSE: Skin infiltration with lidocaine, although brief, can be very stressful, painful, and may perpetuate anxiety. Synerat, a local anesthetic patch, which contains an oxygen-activated heating component to enhance the delivery of a eutectic mixture of lidocaine (70 mg) and tetracaine (70 mg), has provided analgesia for minor, dermatological procedures. We hypothesized that the analgesic effect of Synera, for pain in labouring parturients, would be superior to the traditional infiltration of lidocaine prior to epidural needle insertion. METHODS: With Institutional Review Board approval, we recruited women, who consented to epidural labour analgesia and who met the following criteria: older than 18 yr; body mass index less than 45 kg x m(-2); and with no history of hypersensitivity to any study medications. We randomized the labouring parturients into Synera (SS) or placebo (PL) groups. Group SS received the Synera patch and infiltration with saline prior to epidural needle insertion. Group PL received a placebo patch and infiltration with 2% lidocaine. RESULTS: The groups were similar with respect to age, estimated gestational age, gravidity, parity, and body mass index. The subjects' pain, with epidural placement, was significantly greater in the SS group (P < 0.001). More SS subjects required additional, deep, local anesthetic infiltration compared to PL (P = 0.02). CONCLUSION: The Synera patch provided inferior analgesia, for performing epidural labour analgesia in labouring parturients, compared to traditional infiltration with 2% lidocaine.     

Protectionism or competition in managing British nursing research? Current debate among nurse and midwifery teachers

Aim   The intention is to highlight key issues related to research by nurse and midwifery teachers.
Background   The debate centres on the 'culture change' facing teachers from traditional colleges moving to universities where a more formal research requirement prevails.
Origins of information   Data were drawn from selected official reports and other literature informing the introductory discussion. Emerging themes were discussed by 25 nurse and midwife teachers at Forresterhill College, Aberdeen in March 1996 and their views were recorded and analysed.
Data analysis   Selected documents and discussion records were reviewed, using a thematic approach.
Key issues   Main themes concerned nursing as art and science, balance between multidisciplinary and unidisciplinary research and ring-fencing nursing research funds.
Conclusions   Anxieties among teachers centred on the increased research requirement in universities with possible neglect of teaching excellence.     

A concept analysis of consent

This paper considers the meaning of consent for nursing. Consent had traditionally been looked at in relation to the medical profession. The paper argues for patient advocacy and discusses issues of competency and advocacy and implications for practice. The paper then goes on to critique the process of concept analysis and suggests ways of proceeding with this vital development for nursing.     

Conceptualization of differing levels of educational attainment: what are the characteristics of nurses and midwives who have undertaken diploma and degree educational programmes?

This paper looks at the differences in the characteristics of registered nurses and midwives who have achieved differing levels of educational attainment. A review of the pertinent literature demonstrates that there is little published material on this topic and therefore, proposals are put forward with regard to a conceptual model to frame outcome characteristics. The model is seen as being appropriate when trying to identify the different characteristics of nurses and midwives educated to diploma, degree, postgraduate diploma, masters and doctoral level. The model is subsequently applied to identifying core outcomes and composite statements of nurses and midwives who have undertaken diploma or degree programmes. Initial work examining the validity and reliability of the core outcomes and composite statements with regard to degree preparation is described. Areas for further research are also identified.     

Effects of Ventilation with Large Tidal Volumes or Positive End-Expiratory Pressure on Cardiorespiratory Function in Anesthetized Obese Patients

The cardiorespiratory effects of ventilation with large tidal volumes (LTV) or positive end-expiratory pressure (PEEP) were investigated in 10 extremely obese patients during anesthesia for a jejuno-ileal by-pass operation.
Elevation of the tidal volume by 35% and insertion of a dead space (LTV-group: five patients) or applying a PEEP of 1.0 kPa (PEEP-group: five patients) resulted in significant rises in arterial oxygen tensions (Pa_o2) of 87.4% and 72.4%, respectively. The alveolar-arterial oxygen tension differences (P(a-a)_o2) decreased by 29.2% in the LTV-group and 25.6% in the PEEP-group when compared to control values. No significant differences were found between the groups in Pa_o2 or P(A-a)o₂.
PEEP-ventilation caused a maximal increase in compliance of 42.6%, but there was an increase of only 20.8% in the LTV-group.
Stroke index (the impedance cardiography method) decreased by 19.7% in the PEEP-group, whereas no changes occurred in the LTV-group. The decrease in stroke index was probably due to a reduction in venous return, as reflected in the systolic time intervals. In the PEEP-group a prolongation of the pre-ejection period (PEP) was observed, causing an increase in the PEP/LVET-ratio of 41.2%. A 13.8% increase in PEP/LVET-ratio was found in the LTV-group.
In spite of the increased arterial oxygen contents, no improvements in arterial oxygen delivery were found in either of the groups.