Developing nursing research in the United Arab Emirates: a narrative review

Aim

This article identified, critically analysed and synthesized the literature on international nursing and midwifery research capacity building and standards.

Background

The United Arab Emirates is heavily dependent up on expatriate nurses. Only 4% of nurses working within the country are Emirati. The nation is therefore committed to developing nurses and nursing as a profession.

Introduction

The United Arab Emirates’ Nursing and Midwifery Council was formed in 2009 and initially focused on regulation, education and specialization. This review was undertaken to inform the work of the Council's newly established Scientific Research Sub‐Committee.

Methods

A rapid narrative review was conducted using the Cumulative Index of Nursing and Allied Health Literature database, key words, Boolean operators, parameters and a journal‐specific search. An inclusion/exclusion criterion was identified.

Results

The search provided 332 articles with 45 included in the final review. The literature on nursing research ‘standards’ and ‘capacity building’ is diverse and inconsistent across continents and in approaches.

Discussion

Nursing research has evolved to varying degrees across the globe. Nevertheless, irrespective of the locale, there are similar problems encountered in growing research, for example nursing faculty shortage, lack of collaborative research, funding. There are also specific challenges in the Middle East and North Africa region.

Limitations

The review was constrained by time and access.

Conclusion and implications for nursing policy

There are specific challenges for the United Arab Emirates. However, the country is well placed to learn from the experiences of colleagues elsewhere. Time and commitment is required to build the solid foundations necessary to ensure robust, sustained growth. Identifying research capacity as both a process and outcome at the outset may also assist. Further, it may be prudent to consider initiating a Gulf Coast Countries’ collaborative approach to building research capacity to harness scare resources and create a larger critical mass.     

Pharmacist supplementary prescribing training: a study of pharmacists' perceptions and planned participation

Objective The aim of this research was to investigate in a national sample of pharmacists, who have not yet applied for a supplementary prescribing (SP) course, their planned participation in training, and attitudes towards pharmacist SP. Setting Great Britain. Method A postal questionnaire was sent to 4300 pharmacists (approximately 10% of all Great Britain registered pharmacists). The questionnaire had five sections: awareness of SP training; perceptions of aspects of SP training; actions taken relating to SP training based on ‘stage of change’ model; attitudes towards implementing SP into practice; and demographics. Within demographics, respondents were asked to denote themselves as innovators, early adopters, early majority, late majority and laggards, based on receptivity to change. Non‐respondents were mailed up to two reminders. Key findings The response rate was 55.1% (2371/4300). Of the 1707 with patient contact but who had not commenced training, almost all (1668, 97.7%) were aware of pharmacist SP. A minority had taken any significant SP training action, with most being at the precontemplation/contemplation stage of change. However, most respondents either strongly agreed/agreed that practising SP would improve patient care, but strongly disagreed/disagreed that they had sufficient pharmacist/technical support. Two‐hundred and forty‐three (73.0%) of the ‘venturesome’ pharmacists (the innovators) and 291 (79.5%) of the ‘role models’ (the role models) had either never thought about training or had not yet explored training options further. Following logistic regression, predictors of prescribing training actions were: awareness of local networks for SP; receptivity to change; knowledge of colleagues who had undertaken or were currently undertaking SP training; postgraduate qualifications; intrinsic (professional) factors such as professional duty to become a prescriber; and extrinsic (infrastructure) factors such as sufficient IT support. Conclusion We have demonstrated that pharmacists are aware of SP courses and that certain factors are associated with actions relating to prescribing training. However, the practice setting(s) require(s) attention to ensure readiness to support such innovations in areas such as IT and administrative support. These issues have implications for education providers, the NHS and policy makers; and the extension into independent prescribing. Issues based on receptivity to change and models of change require further investigation.     

Evaluation of the use of computed tomography versus conventional orthogonal X-ray simulation in the treatment of rectal cancer

The aim of this study is to compare and contrast the treatment fields designed using CT versus conventional orthogonal X-ray simulation in the treatment of patients with rectal cancer given preoperative chemotherapy and radiotherapy. Nine patients participated in this study. The coverage of treatment fields, the volume of treatment fields, and the position of the anorectal junction in relation to the inferior border of the obturator foramen as the delineator of the pelvic floor were evaluated in each patient using CT and conventional orthogonal X-ray simulation. The results demonstrated undercoverage of the anterior border of the lateral fields of up to 2.5 cm in seven of nine patients when conventional orthogonal X-ray simulation was compared to CT simulation. In addition, the inferior border of the obturator foramen proved to be a poor delineator of the pelvic floor with the anorectal junction situated up to 2 cm superiorly in seven of nine patients. In conclusion, CT simulation is superior to conventional orthogonal X-ray simulation when designing treatment fields for patients with rectal cancer.     

High tidal volume is associated with the development of acute lung injury after severe brain injury: an international observational study

OBJECTIVE: Although a significant number of patients with severe brain injury develop acute lung injury, only intracranial risk factors have previously been studied. We investigated the role of extracranial predisposing factors, including hemodynamic and ventilatory management, as independent predictors of acute lung injury in brain-injured patients. DESIGN: Prospective multicenter observational study. SETTING: Four European intensive care units in university-affiliated hospitals. PATIENTS: Eighty-six severely brain-injured patients enrolled in 13 months. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients with severe brain injury (Glasgow Coma Scale score <9) were studied for 8 days from admission. Ventilatory pattern, respiratory system compliance, blood gas analysis, and hemodynamic profile were recorded and entered in a stepwise regression model. Length of stay in the intensive care unit, ventilator-free days, and mortality were collected. Eighteen patients (22%) developed acute lung injury on day 2.8 +/- 1. They were initially ventilated with significantly higher tidal volume per predicted body weight (9.5 +/- 1 vs. 10.4 +/- 1.1), respiratory rate, and minute ventilation and more often required vasoactive drugs (p < .05). In addition to a lower Pao2/Fio2 (odds ratio 0.98, 95% confidence interval 0.98-0.99), the use of high tidal volume (odds ratio 5.4, 95% confidence interval 1.54-19.24) and relatively high respiratory rate (odds ratio 1.8, 95% confidence interval 1.13-2.86) were independent predictors of acute lung injury (p < .01). After the onset of acute lung injury, patients remained ventilated with similar tidal volumes to maintain mild hypocapnia and had a longer length of stay in the intensive care unit and fewer ventilator-free days (p < .05). CONCLUSIONS: In addition to a lower Pao2/Fio2, the use of high tidal volume and high respiratory rate are independent predictors of acute lung injury in patients with severe brain injury. In this patient population, alternative ventilator strategies should be considered to protect the lung and guarantee a tight CO2 control.     

Lymphocyte depletion during treatment with intensive chemotherapy for cancer

Recently we have observed an increased incidence of opportunistic infections in patients treated with intensive chemotherapy for cancer. Because T-cell depletion is associated with similar clinical events in human immunodeficiency virus infection and after bone marrow transplantation, we have analyzed peripheral blood lymphocyte populations in a series of patients during treatment with intensive chemotherapy for cancer. Although neutrophil, monocyte, and platelet numbers consistently recovered to greater than 50% of pretreatment values after each sequential cycle of therapy, lymphocyte numbers did not recover within the same time period. B cells decreased rapidly from a mean value of 149 +/- 46/mm3 before chemotherapy to 4 +/- 1/mm3 during chemotherapy (P = .01). CD4+ T cells decreased from a mean of 588 +/- 76/mm3 before chemotherapy to 105 +/- 28/mm3 during chemotherapy (P = .0002) and CD8+ T cells decreased from a mean of 382 +/- 41/mm3 before chemotherapy to 150 +/- 46/mm3 during chemotherapy (P = .0009). Natural killer cell numbers did not show significant declines (171 +/- 30/mm3 before, 114 +/- 24/mm3 during, P = .19). Based on the history of opportunistic complications in patients with other disorders who display similar degrees of CD4+ T-cell lymphopenia and preliminary observations in this population, immune incompetence could surface as a dose-limiting toxicity for highly dose-intensive chemotherapy regimens.     

Chromosomal findings in 150 couples referred for genetic counselling prior to intracytoplasmic sperm injection

A total of 150 infertile couples underwent chromosome analysis and genetic counselling before intracytoplasmic sperm injection (ICSI). Chromosomal abnormalities, including low-level sex chromosome mosaicism, were detected in 12% of the men and an unexpectedly high 6% of the women. Chromosomal abnormalities included gonosomal mosaicism in 13 cases, Robertsonian translocations in four males, autosomal reciprocal translocations in five cases, reciprocal translocation involving a sex chromosome in one case, inversions in three cases and a marker chromosome in one male. Chromosomal variants found in 11 women and 13 men were not included in the above percentages. Couples with a chromosomal aberration in one partner received a second counselling. The different aspects of genetic counselling in these couples are discussed. In conclusion, we recommend genetic counselling and chromosomal analysis of men and women prior to ICSI therapy.      

Seasonality of sudden infant death syndrome (SIDS) by age at death

Seasonality of sudden infant death syndrome (SIDS) is a well-established epidemiological finding. The purpose of the study was to determine whether this feature varied significantly with age at death. In total, 13 990 cases of SIDS in Scotland, England and Wales during 1982–1992 were studied by age group at death. Seasonality was established by fitting a sinusoidal curve and for each set of monthly data the peak position in the year and its magnitude were determined. Weighted regression revealed significant differences in peak position and amplitude of seasonal variation between those dying at ≤ 4 months and those aged ≥ 5 months at death. Those infants in the younger age group were more likely to die earlier in the winter months and had a smaller variation in seasonality. The peak (acrophase) months were January for ≤ 4 months and February for ≥ 5 months at death. Weighted regressions of peak position and amplitude on age at death had p-values of < 0.001 and < 0.01, respectively. A log linear model relating SIDS incidence to month of birth, month of death and age was able to explain some of these findings. The findings support the hypothesis that in SIDS there may be more than one infant cohort, each of which passes through a vulnerable developmental window at different ages.