Reflection: an educational strategy to develop emotionally‐competent nurse leaders

Aim This paper explores educational strategies for nurses that focus on reflectivity and promote the development of self‐awareness, relationship and communication skills and ability to lead with presence and compassion in the midst of change. Background Today nurses move rapidly from carefully‐controlled educational experiences to a fast‐ paced clinical world of increasing patient complexity amid calls for improved quality of care. Making the transition to clinical competence and leadership in practice requires a strong sense of self and emotional intelligence. Evaluation Pedagogies that integrate theoretical and data‐based textbook learning with experiential learning and reflection are a foundation for the development of emotionally‐ and intellectually‐competent leaders and requires new ways of assessing learner outcomes. Key issues Reflection is a key instructional strategy for preparing transformational nurse leaders for interdisciplinary settings where they lead patient care management. The remarkable global spread of reflection in nursing education, practice and research follows an emphasis on developing self‐awareness as a leadership strategy for improving individual and organizational performance. Conclusions Empirical, experiential and anecdotal evidence suggests that reflection has the potential to prepare emotionally‐capable nurse leaders. Implications for Nursing Management As educators create more reflective and nurturing learning environments, they will promote the development of emotionally‐competent nurse leaders who will, in turn, inspire individual and organizational growth and positive change in society.     

Dog bites in Tea Tree Gully

Dog bite injury is a common reason for presentation to emergency departments. However the nature of this problem in Australia has not been closely studied and a number of unresolved questions remain regarding management options. This prospective study of 101 cases was undertaken to collect demographic information about victims and assailants, to describe the spectrum of injury seen and to report outcome following a standard management protocol. In common with other studies, young males were bitten most frequently, usually by German Shepherds, Heelers and Terriers. Nearly half (48%) of the facial injuries occurred in children under 10 years old. The infection rate in this study, using wound cleansing and prophylactic penicillin in all cases, was only 4%. Wound swabs on presentation were unhelpful. Controversies still exist regarding wound closure and the use of prophylactic antibiotics.     

Anxiety and depression in children and adolescents with spinal cord injuries

Aim  To determine the levels of anxiety and depression in young people with spinal cord injuries (SCI) and their associated factors and outcomes.
Method  Children and adolescents aged 7 to 17 years at interview who had sustained SCI at least 1 year before the study were assessed using the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Pediatric Quality of Life Inventory, the Children's Assessment of Participation and Enjoyment, and a demographic questionnaire designed for the study.
Results  The 118 participants (61 males, 57 females) had a mean age of 12 years 4 months, SD 3y 1mo, range 7-17y. Mean age at injury was 5 years 11 months, SD 4y 11m, range 0-16y; 89 participants (75%) had paraplegia and 29 (25%) had tetraplegia. Fifty-seven (52%) had complete injuries and 52 (48%) had incomplete injuries according to the American Spinal Injury Association impairment scale. Thirteen participants (13%) reported significant symptoms of anxiety, and seven (6%) reported significant levels of depression, which were comparable to the normative population. Age, race, and sex were not associated with anxiety or depression, but participants with shorter duration of injury were more likely to be anxious, and those with less functional independence were more likely to be depressed. Only one dimension of participation was associated with anxiety and depression, but all aspects of quality of life were decreased among those with anxiety or depression.
Interpretation  The levels of anxiety and depression in young people with SCI are comparable to the normative range. When anxiety and depression occur they are associated with reduced levels of quality of life.     

Dental caries and dental care level (restorative index) in children with diabetes mellitus type 1

International Journal of Paediatric Dentistry 2011; 21: 13–22 Introduction. The aim of the study was to investigate caries experience and dental care index in diabetic children and to determine if correlation exists between caries experience and metabolic control, insulin treatment, and the duration of diabetes. Materials and methods. The study group consisted of 52 children and adolescents, 3–16 years of age with type 1 diabetes attending the outpatient diabetic clinic at Ghent University Hospital, Belgium. Fifty healthy subjects recruited from the paediatric dental clinic served as the control group. Caries lesions were assessed using DMF‐index both at cavity and non‐cavity levels. Participants and/or their guardians provided information about oral hygiene habits and dietary habits. Diabetes‐related data (type, duration, insulin regimen) were collected from medical records and completed with the lab data on HbAlc. Conclusion. It became clear that, although children with type 1 diabetes mellitus could be expected to run a potential high caries risk taking into account the diabetes‐associated biological and behavioural alterations, no significant differences were observed regarding caries experience and dental care between diabetic children and healthy controls. The level of untreated dental decay among the diabetic children is, however, considerably high, which was reflected by a significant lower dental attendance.     

Evaluation of a burn prevention program in Israeli schools

The study describes an educational burn injuries preventionprogram for schoolchildren, and its short and long term effectson knowledge, attitudes and the wish to learn more about preventivebehaviors. The data were collected by self-administered questionnairesin two sampled groups of 10–14 year olds: a study groupof children who were exposed to the program, and a similar controlgroup. All children filled out the questionnaire three times.prior to the introduction of the program, at the end of it,and 10 weeks later. The results show an increase in knowledgein both groups. Yet, a significantly higher level of knowledge was achievedin the study group. Six out of ten attitudes studied changedin the expected direction after the program in the study group,and none in the control group. The expressed willingness tolearn more about prevention of injuries increased significantlyonly in the study group. The results indicate that this programachieved its immediate goals, and suggest that burn preventioneducation programs can be successfully implemented among schoolchildren.     

Biopharmaceutics: Changes in Gastric Mucosal Permeability Induced by Haemorrhagic Shock in the Anaesthetized Rat: Modulation by Acid

Gastric mucosal damage induced by haemorrhagic shock in the anaesthetized rat has been evaluated by studying changes in capillary-to-lumen clearance of fluorescein isothiocyanate (FITC)-labelled dextran. Haemorrhagic shock (20 min ischaemia + 20 min reperfusion) induced a significant increase in blood-to-lumen permeability to FITC-dextran of different molecular weight (10 000, 40 000 and 70 000) without modifying the macroscopic integrity of the gastric mucosa. The increase in vascular permeability was dependent on the time of administration of the tracer and was correlated with an elevation of the protein content of the gastric lumen. Intravenous administration of the secretagogue pentagastrin (20 or 50 μg kg^?1 h^?1) did not significantly modify the vascular permeability to dextran in control animals or in animals subjected to haemorrhagic shock. When the intraluminal pH was reduced by intragastric administration of acidic saline solution, only pH 1, which itself induced the appearance of macroscopic mucosal lesions, significantly increased vascular permeability to dextran, both in control animals and in animals subjected to haemorrhagic shock. These findings suggest that stress induced by haemorrhagic shock increases vascular gastric permeability to dextran, by an acid-independent mechanism, without affecting the macroscopic integrity of the gastric mucosa.     

EFFECTS OF FLUVOXAMINE AND CITALOPRAM IN MAINTAINING ABSTINENCE IN A SAMPLE OF ITALIAN DETOXIFIED ALCOHOLICS

A 16-week, randomized study was performed to test the efficacyof two selective serotonin reuptake inhibitors (SSRIs) fluvoxamineand citalopram, in decreasing relapse and craving in alcoholics,and to investigate possible differences in their clinical profile.After detoxification, each of the 81 patients (55 males and26 females) was randomly assigned to one of three groups: 23subjects did not receive any pharmacological treatment, 25 weretreated with fluvoxamine, 150mg/day, and 33 with citalopram.20mg/day. All patients received standard cognitive-behaviouraltherapy. Craving was assessed twice a month using a 10-stepscale. Every intake of alcohol was considered a relapse andthe subject was taken out of the study. At the end of the study,both the fluvoxamine and citalopram groups showed a statisticallyhigher rate of continuous abstinence (63.6 and 60.7%, respectively)compared to the group without pharmacological treatment (30.4%).Relapse severity did not differ among the three groups. Onlycitalopram showed a significant effect on craving throughoutthe study period. This study confirmed the efficacy of SSRIsas an adjunct to psychotherapy to prevent relapse in alcoholics.The relationship between the effects of these SSRIs on abstinenceand craving, as well as the differences between their profiles,are discussed.