The culture of midwifery in the National Health Service in England

The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In-depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. There was a lack of mutual support and of positive role models of support with considerable pressure to conform. Guilt and self-blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.     

Skills competency in nurse education: nurse managers' perceptions of diploma level preparation

This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the 'fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long-standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the 'core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.     

Three‐Dimensional Ultrasound Imaging of Mammary Ducts in Lactating Women

Objective. The main function of the breast is to produce milk for offspring. As such, the ductal system, which carries milk from the milk‐secreting glands (alveoli) to the nipple, is central to the natural function of the breast. The ductal system is also the region in which many malignancies originate and spread. In this study, we aimed to assess the feasibility of manual mapping of ductal systems from 3‐dimensional (3D) ultrasound data and to evaluate the structures found with respect to conventional understanding of breast anatomy and physiology. Methods. Three‐dimensional ultrasound data of the breast were acquired using a mechanical system, which captures data in a conical shape covering most of the breast without excessive compression. Manual mapping of the ductal system was performed using custom software for data from 4 lactating volunteers. Results. Observational results are presented for ultrasound data from the 4 lactating volunteers. For all volunteers, only a small number of ductal structures were engorged with milk, suggesting that the lactiferous activity of the breast may be localized. These enlarged ducts were predominantly found in the inferior lateral quadrant of each breast. The observation was also made that the enlarged, milk‐storing parts of the duct were spread throughout the ductal system and not directly below the nipple as conventional anatomy suggests. Conclusions. Ultrasound visualization of the 3D structure of milk‐laden ducts in an uncompressed breast has been shown. Using manual tracing, it was possible to track milk‐laden ducts of diameters less than 1 mm.     

护生执业资格考试成绩预测模型的研究

通过对156名通过护士执业资格考试学生的在校课程成绩进行因子分析,研究课程间的内部结构,找出课程与护士执业资格考试之间的联系,旨在提高教学效果和考试通过率。根据因子分析的结果建立课程与护士执业考试成绩的多元线性回归预测模型,经检验预测精度高,误差低。     

Health Care Provider Perceptions of Pain Treatment in Hispanic Patients

Despite increasing numbers of Hispanic patients in the United States, this group continues to face disparities in access and quality of pain treatment. Although previous surveys have examined treatment disparities experienced by minority patients, none have provided a provider‐centric perspective on issues and concerns surrounding pain relief among pain patients of Hispanic/Latino origin. The goal of this study was to assess the relationship between provider characteristics (ie, Spanish fluency, Hispanic caseload size, and experience with Hispanic pain patients) and their perceptions of pain treatment in these patients. One hundred eighty‐seven health professionals completed an online survey. The major findings indicated that: (1) less than 20% of health professionals treating Hispanic pain patients reported Spanish proficiency at an advanced level; (2) surveyed health professionals were involved treating a significant proportion of Hispanic patients in their caseloads, but reported a lack of cultural competence training; (3) Spanish fluency and experience with Hispanic pain patients exerts a strong effect on the use of established pain treatment practices; (4) providers with greater Spanish fluency report a significantly greater effect of patients' cultural beliefs and attitudes on treatment; and (5) providers did not regard cultural or language barriers as significantly impacting opioid prescribing or patient compliance.     

Involving fathers in research

Column Editor: Lauren Clark Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.