The practice nurse: roles and perceptions

In the winter of 1992, a postal survey was conducted on all practice nurses in Gateshead, England The aim of the research was to descnbe the work of practice nurses (nurses working with and employed by general practitioners), with particular reference to health promotion and communication, and to explore the practice nurses' perceptions of their roles The research found little conformity about what practice nurses do, apart from practical tasks This confirms the essentially practical nature of their work, with poor role definition with regard to screening, health promotion and prevention Training was found to vary, indicating a need for improvement Women's health and surveillance of the health of elderly people were used to illustrate these issues A wide consensus was found about what tasks are appropriate to practice nurses, indicating either that the list of tasks used in the survey accurately describes their potential role or that they are prepared to perform most tasks Practice nurses perceive themselves as the specialists in health promotion although it was not possible to gain an understanding of whether they had a conception of the wider issues involved, which illustrated a limitation of survey methods The information obtained will be relevant in the debate about the future of practice nurses, as well as the future of primary health care services in general     

Supportive clinical supervision: a cruicible for personal and professional change

The purpose of this paper is to explore theoretical and practical issues pertinent to the implementation and development of supportive clinical supervision. The paper highlights a facilitative model of supervision that emphasizes the importance of the supervisory relationship within a person-valuing ethos. The authors put a case for sensitive utilization of a supervision concept that leads, they conclude, to self development, self realization, professional enhancement and advancement, and high quality client care. Over time, the ultimate goals of such supervisory practice are twofold: (i) to improve the overall health of the nation and (ii) to promote the progression of the nursing profession. The authors found that a facilitative approach to clinical supervision is therapeutic and self-propelling for both supervisor and supervisee.     

Advances in imaging of new targets for pharmacological intervention in stroke: real-time tracking of T-cells in the ischaemic brain

Background and purpose:

T-cells may play a role in the evolution of ischaemic damage and repair, but the ability to image these cells in the living brain after a stroke has been limited. We aim to extend the technique of real-time in situ brain imaging of T-cells, previously shown in models of immunological diseases, to models of experimental stroke.

Experimental approach:

Male C57BL6 mice (6–8 weeks) (n= 3) received a total of 2–5 × 10⁶ carboxyfluorescein diacetate succinimidyl ester (CFSE)-labelled lymphocytes from donor C57BL6 mice via i.v. injection by adoptive transfer. Twenty-four hours later, recipient mice underwent permanent left distal middle cerebral artery occlusion (MCAO) by electrocoagulation or by sham surgery under isoflurane anaesthesia. Female hCD2-green fluorescent protein (GFP) transgenic mice that exhibit GFP-labelled T-cells underwent MCAO. At 24 or 48 h post-MCAO, a sagittal brain slice (1500 µm thick) containing cortical branches of the occluded middle cerebral artery (MCA) was dissected and used for multiphoton laser scanning microscopy (MPLSM).

Key results:

Our results provide direct observations for the first time of dynamic T-cell behaviour in living brain tissue in real time and herein proved the feasibility of MPLSM for ex vivo live imaging of immune response after experimental stroke.

Conclusions and Implications:

It is hoped that these advances in the imaging of immune cells will provide information that can be harnessed to a therapeutic advantage.This article is part of a themed section on Imaging in Pharmacology. To view the editorial for this themed section visit http://dx.doi.org/10.1111/j.1476-5381.2010.00685.x     

Autonomy and reason: treatment choice in breast cancer

The practice of offering choice to those women with breast cancer for whom either breast conserving surgery or mastectomy would be equally beneficial has come to be seen as an important aspect of medical care. As well as improving satisfaction with treatment, this is seen as satisfying the ethical principle of respect for autonomy. A number of studies, however, show that women are not always comfortable with such choice, preferring to leave treatment decisions to their surgeons. A question then arises as to the extent that these women can be seen as autonomous or as exercising autonomy. This paper argues, however, that the understanding of autonomy which is applied in current approaches to breast cancer care does not adequately support the exercise of autonomy, and that the clinical context of care means that women are not able to engage in the kind of reasoning that might promote the exercise of autonomy. Where respect for autonomy is limited to informed consent and choice, there is a danger that women's interests are overlooked in those aspects of their care where choice is not appropriate, with very real, long‐term consequences for some women. Promoting the exercise of autonomy, it is argued, needs to go beyond the conception of autonomy as rational individuals making their own decisions, and clinicians need to work with an understanding of autonomy as relational in order to better involve women in their care.     

The role of patients and their relatives in ‘speaking up’ about their own safety – a qualitative study of acute illness

Background

Poor recognition of and response to acute illness in hospitalized patients continues to cause significant harm despite the implementation of safety strategies such as early warning scores. Patients and their relatives may be able to contribute to their own safety by speaking up about changes in condition, but little is known about the factors that influence this. This study examined the experiences and views of patients and their relatives to determine the potential for involvement in promoting their own safety.

Methods

This data set is drawn from a wider ethnographic study of the management of the acutely ill patient in hospital. Thirteen patients and seven relatives from two medical settings in two UK NHS Trusts were interviewed. Thematic analysis identified factors likely to influence patients'' and their relatives'' ability to contribute to the management of deterioration.

Results

All patients interviewed had experienced their acute illness within the context of a long‐term health problem. Speaking up was influenced by the ability to recognize changes in clinical condition, self‐monitoring, confidence and trust, and culture and system of health care. When patients or relatives did raise concerns, health‐care staff had a mediating effect on their comfort with and the effectiveness of speaking up.

Implications

Safety strategies based on patient involvement must take account of the complexities of acute illness. Those that promote partnership may be more acceptable to patients, their families and staff than those that promote challenging behaviour and may ultimately prove to be most safe and effective.     

龙附颗粒对慢性前列腺炎模型大鼠前列腺组织细胞因子IL-10和TNF-α表达的影响

目的:通过观察龙附颗粒对慢性前列腺炎(chronic abacterial prostatitis,CAP)模型大鼠前列腺组织细胞因子白细胞介素-10(IL-10)及肿瘤坏死因子-α(TNF-α)表达的影响,探讨其可能的作用机制。方法:将48只wistar大鼠随机分为正常对照组、CAP模型组、舍尼通组(0.125 g·kg-1)、龙附颗粒低剂量组(0.37 g·kg-1)、龙附颗粒中剂量组(0.74 g·kg-1)、龙附颗粒高剂量组(1.48 g·kg-1),每组8只。通过HE染色法观察各组大鼠前列腺组织形态学的差异,运用Elisa法检测各组前列腺组织中IL-10及TNF-α的差异。结果:(1)CAP模型组前列腺组织中IL-10和TNF-α的表达高于正常对照组(P0.05),经药物治疗后,舍尼通组、龙附颗粒中高剂量组IL-10表达升高、TNF-α表达降低(P0.05),而龙附颗粒低剂量组与CAP模型组比较,无显著性差异。(2)舍尼通组、龙附颗粒中高剂量组与CAP模型组比较,腺泡内上皮细胞增生程度改善,腺泡内炎性细胞减少,间质内纤维组织增生程度改善,炎性细胞减少。龙附颗粒低剂量组:与CAP模型组的病理形态表现接近。结论:龙附颗粒能够调节慢性前列腺炎模型大鼠前列腺组织中细胞因子IL-10和TNF-α的表达,进一步影响前列腺病理形态学变化,其作用机制与调节机体免疫炎症反应有关。     

An extended literature review of health professionals' perceptions of illicit drugs and their clients who use them

The literature relating to health professionals and illicit drugs and clients who use them shows many common themes. It is evident that the majority of health professionals hold negative, stereotypical perceptions of illicit drug-users. Consequently, these negative attitudes become prejudicial, hence blocking the professional from carrying out effective and humane nursing care to this client group.
Evidence also shows that health professionals' perceptions on the legalization of currently illicit drugs is linked to their own use of these drugs rather than any social or health reasons. Professionals' views on the different illicit substances are also coloured by their use, not by the actual evidence relating to the effects of that drug, in particular, cannabis. The literature shows that health professionals project heavily on to the client all their own negative perceptions of illicit drug use, in the care setting. This has produced very unsatisfactory and unsafe care, resulting in both client and carer being dissatisfied with the whole aspect of care. In addition, specialist teams are being swamped by health professionals who are referring almost every illicit drug-user to these services. The future may be brighter with the generalist and specialist working closely together for the benefit of all, especially the client and, ultimately, the community.     

Developing indicators for measuring Research Capacity Development in primary care organizations: a consensus approach using a nominal group technique

Research Capacity Development (RCD) in the National Health Service supports the production of evidence for decision-making in policy and practice. This study aimed to establish a level of consensus on a range of indicators to measure research capacity in primary care organizations. Indicators were developed in a two-stage process using workshops and modified nominal group technique. In 2005, workshops were used to generate possible indicators from a wide range of research active and research-interested people. A theoretical framework of six principles of RCD was used to explore and identify indicators. Data were thematically coded, and a 129-item, 9-point Likert scale questionnaire was developed. A purposive sample of nine experts in developing research capacity in primary care agreed to take part in a nominal group in April 2006. The questionnaire was circulated prior to the meeting, and analysis of the responses formed the basis for structured discussion. Participants were then asked to rescore the questionnaire. Only seven participants were able to take part in the discussion and rescore stages. Data were analysed in two ways: level of relevance attributed to each indicator as a measure of organizational RCD, represented by median responses (medians of 7–9 defined strong support, 4–6 indicated moderate support and 1–3 indicated weak support), and level of consensus reached by the group. Consensus was reached if 85% of the group rated an indicator within the same band. Eighty-nine (68%) indicators were ranked as strongly relevant, and for seventy-three of these indicators, a consensus was reached. The study was successful in generating a set of agreed indicators considered relevant for measuring RCD in primary care organizations. These will form the basis of a pilot tool kit to assist primary care organizations to develop research capacity. Further work will explore the applicability of the indicators in practice.