One Practice Week at a Glance

This is the synopsis of the work week of an RN practicing in a level III neonatal intensive care unit. The married mother of three daughters works three shifts per week. Her husband recently started his own business and, despite the hectic hours, is supportive of her educational goals.     

Qualitative research in health care: II. A structured review and evaluation of studies

A hand search of the original papers in seven medical journals over 5 years was conducted in order to identify those reporting qualitative research. A total of 210 papers were initially identified, of which 70 used qualitative methods of both data collection and analysis. These papers were evaluated by the researchers using a checklist which specified the criteria of good practice. Overall, 2% of the original papers published in the journals reported qualitative studies. Papers were more frequently positively assessed in terms of having clear aims, reporting research for which a qualitative approach was appropriate and describing their methods of data collection. Papers were less frequently positively assessed in relation to issues of data analysis such as validity, reliability and providing representative supporting evidence. It is concluded that the full potential of qualitative research has yet to be realized in the field of health care.     

Clinical research priorities in oncology nursing: An Australian perspective

The aims of this research project were to identify areas for research in oncology nursing that have potential for improvement in patient care and to advise about nursing-research policy and priorities that have relevance to areas of patients'needs. Research participants included 10 Clinical Nurse Consultants (CNC) representing 10 area health authorities in New South Wales, Australia. The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and more than 31 high priorities were identified. Quality of life and symptom management emerged as the top two priority categories in the study. The findings of the study provide direction for clinical nursing research in oncology.     

The health belief model and use of accident and emergency services by the general public

There has been much debate about the use made by the general public of accident and emergency services A strong element of professional dissaproval has been present, as shown by phrases such as 'inappropriate attender' This paper examines the reasons why people attend accident and emergency and the factors that delay or accelerate attendance, utilizing a framework espoused in the medical sociology literature, i e the Health Belief Model This predicts that individuals carry out a treatment cost-benefit analysis when making decisions about seeking medical assistance A sample of 200 adult, ambulatory accident and emergency patients was interviewed whilst waiting to see the casualty officer for this study The data demonstrated that much of the medical, sociological literature concerning patient consultation with doctors is applicable to the accident and emergency situation, in particularthe Health Belief Model A range of factors was shown to make statistically significant differences to the delay times involved in deciding to attend accident and emergency and the time it took to then subsequently attend and register as a patient These factors also fit the cost-benefit analysis which the Health Benefit Model predicts takes place Accident and emergency attendance therefore needs to be seen as a logical decision-making process thatrequires hospitals to provide appropriate services, rather than merely labelling the patients as inappropriate     

Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study

Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study ¶ Over the past decade, pre- and post-registration education for nurses and midwives in the United Kingdom has undergone major change, creating an atmosphere where continuing professional development is a matter of priority for individual health care staff. Against this context of change, and as part of a larger study of continuing education and training in the National Health Service, a cohort of participants in a part-time health studies degree course were interviewed using a semi-structured schedule. Twenty-nine nurses, midwives and allied professional staff described their motives for participation in the course and its effects on their professional and personal lives. Data collected in interviews were analysed using qualitative methods and revealed that participation was encouraged by both professional and personal factors. For many staff participation was prompted by negative feelings about themselves and their professional status. Participation in the course was associated with (largely negative) changes in home and family life and most participants faced additional financial burdens. The findings of the study have implications for policy relating to the funding of continual professional education for nurses and other health care staff. Health care staff are receiving mixed messages about continuing education from policy makers and employers. Dependence on willingness and ability to pay for post-registration degree-level studies is unlikely to be an efficient or equitable means of ensuring lifelong learning for healthcare staff.     

A Cross-Cultural Tool To Identify Continuing Education Needs

Cost-controlled health reforms have created the need for training nurses to provide evidence-based care in new contexts. Planning for nurses' continuing education must thus target the appropriate personnel and simultaneously consider local healthcare needs and training requirements. To plan such educational programmes, a training needs analysis instrument was developed in the UK and used to compare the training needs of nurses in Australia, the USA and the UK. Below, the findings of this survey.     

多发伤患者血清胆碱酯酶与急性期蛋白的相关性

目的 探讨多发伤患者血清胆碱酯酶(ChE)与急性期蛋白(APP)变化的相关性,比较它们在反映病情严重度和判断预后中的价值. 方法 为前瞻性观察研究.选择2005年10月至2007年10月在伤后24 h内收住浙江大学医学院附属第二医院急诊监护室的多发伤患者共81例.排除标准:(1)有慢性肝病、有机磷接触、活动性肺结核或肿瘤病史;(2)伤前有主要脏器感染;(3)存在肝脏损伤;(4)年龄<18周岁者.其中男57例,女24例;年龄(46±18)岁,损伤严重度评分(34.0±11.9).另选择76例本院健康体检者作为对照,其中男53例,女23例;年龄(44±16)岁.排除标准同患者组.2组性别、年龄构成均具可比性.患者组在伤后第1、3,7天抽取静脉血常规方法检测血清ChE活性、血清白蛋白(ALB)、前白蛋白(PAB)、转铁蛋白(TRF)、C反应蛋白(CRP),同时记录急性生理和慢性健康评分Ⅲ(APACHEⅢ).对照组以同样方法测定血清ChE、ALB、PAB、TRF、CRP,并采用t检验或秩和检验分别与患者组各时点相比较.采用单因素重复方差分析患者组血清ChE及各APP指标在伤后的动态变化情况,采用Pearson相关分析法分析血清ChE与各APP的相关性及它们与APACHEⅢ的相关性.根据患者转归分为存活和死亡2组,采用t检验或秩和检验比较组间各指标的差异,通过Logistic回归分析比较它们在预后判断中的价值. 结果 患者伤后各时点血清ChE、ALB、PAB、TRF均比各对照组显著降低,CRP则明显升高,其中血清ChE活性都比对照组下降超过25%(42.3%～50.2%),并与PAB、TRF一样呈下降趋势;血清ChE活性在各时点与ALB、PAB、TRF都显著正相关,与CRP第3、7天负相关.患者APACHEⅢ在各时点与血清ChE、TRF均显著负相关,与ALB仅第1天负相关,与PAB仅第1、7天负相关,与CRP仅第7天正相关;各时点死亡组血清ChE活性和TRF都显著低于存活组,而死亡组ALB仅在第7天、PAB仅在第1天和第7天显著低于存活组,CRP仅在第7天显著高于存活组,Logistic回归分析提示仅血清ChE和PAB是判断预后的独立因素. 结论 血清ChE可视为负急性期蛋白的一种,在反映多发伤病情严重度和预测患者转归中的综合价值要优于其他主要APP.