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991.
Aim The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers Public health nurses are well placed to shape and influence health service culture through effective clinical leadership. 相似文献
Background Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers Public health nurses are well placed to shape and influence health service culture through effective clinical leadership. 相似文献
992.
Ingrid EJM Schiks Lisette Schoonhoven Wim RM Aengevaeren Coby Nogarede‐Hoekstra Theo Van Achterberg Freek WA Verheugt 《Journal of clinical nursing》2009,18(13):1862-1870
Aim and objectives. To investigate if ambulation four hours after sheath removal can replace ambulation 10 hours or more after sheath removal with regard to puncture site complications after percutaneous coronary interventions and to examine patient comfort in both groups. Background. Early ambulation after percutaneous coronary intervention may facilitate earlier hospital discharge. Whether this approach is safe, is unknown. Design. A non‐randomised comparative study. Methods. Percutaneous coronary intervention was performed by femoral approach. Registered nurses of the ward removed the sheath and haemostasis was achieved by manual compression. After bed rest with a compression bandage for four hours, the patients in the early ambulation group were ambulated. The patients in the control group stayed in bed till the next morning. Primary study endpoint was the composition of puncture site complications: haematoma, bleeding, false aneurysm and arteriovenous fistula. Secondary endpoints were occurrence of vasovagal collapse after mobilisation, back pain and problems with voiding. Results. In the early ambulation group (n = 329) the total number of complications was nine (2·7%), vs. six (3·0%) in the control group (n = 202). The complication rate in the early ambulation group is not increased compared to the control group (test for non‐inferiority p = 0·002). Hence non‐inferiority is accepted and practical equivalence shown. There were no statistically significant differences concerning patient comfort between the groups. Conclusions. Early ambulation four hours after femoral sheath removal is feasible and safe. The incidence of puncture site complications in the early ambulation group is not increased in comparison with the group with prolonged bed rest. Relevance to clinical practice. Patients could possibly be discharged earlier after percutaneous coronary intervention, allowing percutaneous coronary intervention in an ambulant setting. Further research should confirm these findings and extend the research to the effect of various closure devices in early ambulation and on patients’ well‐being. 相似文献
993.
994.
995.
Background: Several papers have called for a trial of planned cesarean section versus planned vaginal birth for low‐risk women—a recommendation that is fiercely debated. Although proponents of a trial have voiced their support, evidence suggests that in the United Kingdom few midwives and obstetricians believe such a trial to be feasible, and no studies reporting women's views on the prospect of such a trial have been published. The purpose of this study is to explore women's views of participation in a trial of planned cesarean birth versus planned vaginal birth. Methods: A qualitative study was conducted using in‐depth interviews in a large maternity hospital in the United Kingdom. Sixty‐four women were interviewed 12 months after giving birth. Women were asked “How do you think you would have felt if you had been approached to take part in such a trial during your first pregnancy?” Data were analyzed thematically. Results: Only 3 of the 64 women stated that they would have participated in a trial of planned vaginal birth versus planned cesarean section, had they been asked. However, five other women said that they would have consented to participate if they had been asked during pregnancy, but with hindsight, would have regretted that decision. The remainder of women would not have participated, unless a preference arm was offered. Three main themes were identified: “feeling cheated,”“let nature take its course, ” and “just another trauma that you don't need.” Conclusions: Few women supported a trial and most suggested that it was intuitively wrong. Given the strong views voiced by women, it is unlikely that a trial of planned vaginal delivery versus planned cesarean delivery would be feasible. 相似文献
996.
Amanda Henderson PhD RN RM David Shum PhD † Wai-Tong Chien MN RN ‡ 《Health expectations》2006,9(1):13-24
AIM: This exploratory pilot study developed and tested the validity of picture cards as a strategy to ascertain patients' desired participation in decision making. These were then used to ascertain characteristics of Hong Kong Chinese patients' decision-making preferences for surgery. VALIDATION OF TOOL: Two sets of analyses tested the validity of picture cards in an Australian and Hong Kong Chinese population. First, the ratings of the two groups of participants using the picture cards for three scenarios (severe, moderate and mild medical conditions) were correlated with mean ratings of three decision-making subscales of a self-report questionnaire for the three scenarios. Second, a 3 (Scenario) x 2 (Ethnic Group) mixed anova examined whether the picture cards are sensitive to differences relating to severity of medical conditions and ethnicity. SETTING AND PARTICIPANTS: A convenience sample of initially 35 Hong Kong and 24 Australian patients was used to validate the picture card tool. A convenience sample of a further 186 Hong Kong Chinese surgical inpatients used the tool. DESIGN: Participants selected the picture card that best represented their decision-making preference. MAIN VARIABLES: Demographic factors, prior knowledge, nature of surgery and preference for participation in decision making. RESULTS: Significant correlations were made between the questionnaire and the picture card tool. Using the tool, a significant difference was found between males' and females' decision-making preference, yet, no significant difference was found with respect to type or previous surgical operation. 相似文献
997.
998.
Polycyclic aromatic hydrocarbon-DNA adducts in human placenta and modulation by CYP1A1 induction and genotype 总被引:6,自引:1,他引:5
Whyatt RM; Bell DA; Jedrychowski W; Santella RM; Garte SJ; Cosma G; Manchester DK; Young TL; Cooper TB; Ottman R; Perera FP 《Carcinogenesis》1998,19(8):1389-1392
This study investigated the relationship in human placenta between
polycyclic aromatic hydrocabon (PAH)-DNA adduct levels and two biomarkers
of cytochrome P4501A1 (CYP1A1): gene induction evidenced by CYP1A1 mRNA,
and a genetic polymorphism, the CYP1A1 MspI RFLP. CYP1A1 codes for an
inducible enzyme system that catalyzes the bioactivation of PAHs. Prior
research found a high correlation in human lung tissue between CYP1A1
activity and DNA damage from PAHs. The CYP1A1 Mspi RFLP has been linked in
some studies to risk of lung cancer. The relationships in human placenta
between DNA damage, CYP1A1 activity and genotype have not been well
characterized and may be relevant to risks from transplacental PAH
exposure. The study cohort consisted of 70 newborns from Krakow, Poland, a
city with elevated air pollution, and 90 newborns from nearby Limanowa, an
area with lower air pollution but greater indoor coal use. Contrary to
results seen previously in lung tissue, CYP1A1 mRNA was not significantly
correlated with PAH-DNA adduct levels in the placenta. Smoking
(self-reported maternal and infant plasma cotinine) was significantly
associated with CYP1A1 mRNA levels (P < 0.01), but not with PAH-DNA
adduct levels. Placental PAH- DNA adduct levels were significantly higher
in infants with the CYP1A1 MspI restriction site compared with infants
without the restriction site (P < 0.01), implicating a genetic factor in
inter-individual variation in DNA damage in human placenta. Further studies
are needed to determine the relevance of this finding to risk of
transplacental carcinogenesis.
相似文献
999.
1000.
Several lines of evidence indicated that P cell-stimulating factor (PSF), a T lymphocyte-derived lymphokine known to stimulate the growth of hemopoietic stem and progenitor cells, also acted on macrophages. PSF was absorbed from medium that had been mixed for two hours at 0 degrees C with either resident or thioglycollate-elicited peritoneal cells, suggesting the presence of receptors for PSF on cells in the population. The addition of pure PSF to populations highly enriched in either resident or elicited adherent peritoneal macrophages resulted in stimulation of macrophages with morphological changes, including increases in size, spreading, vacuolation, and the number of cytoplasmic processes, together with stimulation of proliferation and the phagocytosis of opsonized yeast. PSF also stimulated the incorporation of [3H]thymidine by bone marrow-derived adherent macrophages. Addition of pure PSF to cultures that contained only a single macrophage resulted in enhanced survival and proliferation of these isolated cells, demonstrating that the effect of PSF on macrophages was direct. These results indicate that PSF can stimulate well-differentiated functional macrophages and raise the possibility that the effects of PSF on macrophages may play a regulatory role in immune responses. 相似文献