Stress and the intensive care patient: perceptions of patients and nurses

This study was a replication of an earlier Cochran & Ganong study that investigated the perception of nurses and patients regarding the stressors faced by patients in the intensive care unit environment. As the original study was American in origin, one of the aims of the present study was to discover if the results would be replicated in a United Kingdom (UK) intensive care unit. Data collection was by the use of an environmental stress questionnaire that was an adaptation of the original data collection tool modified for use in a UK intensive care unit. The study was undertaken in two intensive care units producing a sample size of 71 patients and 71 nurses. There appears to be a wide variation in the perception of nurses and patients regarding the stress faced by patients in the intensive care unit. Similarities were noted between subject groups as to the nature of the stressors, although nurses tended to rate items over which they believed they had control as being more stressful than did the patients. Patients tended to rate items related to their illness and physical comfort as being most stressful. The results are in keeping with those from the Cochran & Ganong study.     

Conceptualizing advanced nursing practice: curriculum issues to consider in the educational preparation of advanced practice nurses in the UK

The findings from a Florence Nightingale Scholarship to the USA and Canada, investigating the educational preparation of advanced practice nurses, are reported. The author considers a number of issues facing curriculum designers who might wish to develop clinically based advanced practice nurse programmes in the UK. Utilizing the experiential nature of personal visits, along with the available literature, the strategy adopted by some American and Canadian universities is highlighted to exemplify curriculum issues likely to be encountered in the UK. A definition of advanced nursing practice is provided as a foundation for discussion on curricular construction. This is followed by a discussion on advanced role nomenclature and components and characteristics of the 'nurse practitioner', 'clinical nurse specialist', 'nurse consultant' and 'nurse clinician', in order to clarify terminology and disentangle different advanced practice roles. The issues examined include the academic level of advanced practice nurse programmes; the determination of curricular content based on both a 'generalist' and 'specialist' model of practice; factors considered when exploring advanced practice competencies; and the resource implications for delivering opposing curriculum models. The paper suggests that there is a unique opportunity for advanced practice nursing to establish a key collaborative relationship in the delivery of health care, based on a nursing model, graduate study and the integration of key nursing and related concepts into clinical practice.     

转移生长因子-β1、碱性成纤维细胞生长因子、骨形态发生蛋白-2在大鼠骨质疏松骨折愈合骨痂中的表达

目的 观察去卵巢大鼠骨折愈合早期骨痂组织学变化以及转移生长因子β1(transforming growth factor beta，TGF-β1)、碱性成纤维细胞生长因子(basic fibroblast growth factor，bFGF)、骨形态发生蛋白-2(bone morphogenetic proteins-2，BMP-2)的表达与分布，探讨骨质疏松对大鼠骨折早期修复的影响与TGF—β1、bFGF、BMP-2对其起的作用。方法 雌性SD大鼠去除双侧卵巢3个月后造成股骨干骨折，并与伤后不同阶段处死，分别进行组织学以及TGF-β1、bFGF、BMP-2免疫组化染色方法观察。结果 (1)骨折后4—6周，去卵巢组形成的骨痂中含有的软骨痂比例高于假手术组。(2)骨折后2周，去卵巢组与对照组中各因子的表达均达到高峰，4—6周时回落到极低水平。(3)骨折后2周，去卵巢组中表随达TGF-β1的成骨细胞数目少于对照组。结论 (1)骨质疏松大鼠骨折早期愈合形成的骨痂质量较差。(2)BMP-2、bFGF、TGF-β1在骨折愈合过程中存在的为期4周的“释放恒定时期”导致了骨质疏松骨折愈合的进一步延缓。(3)TGF-β1在成骨细胞中的表达减少是骨质疏松和骨折愈合质量下降的可能因素之一。     

连续性血液净化对重症急性胰腺炎患者胃黏膜酸度的影响

目的观察连续性血液净化(CBP)对重症急性胰腺炎(SAP)患者胃黏膜酸度的影响。方法选择SAP患者20例,随机分为CBP治疗组和非CBP治疗对照组各10例,两组均在治疗前、治疗第2天、4天和6天测定其胃黏膜pH值(pHi)及动脉血乳酸值。结果两组患者初始pHi均值均偏低,CBP组患者治疗后第4天和第6天pHi水平较治疗前明显升高,且差异有显著性(分别为P<0.05和P<0.01),对照组治疗前后pHi水平未见显著改变。两组间比较,治疗第4天和第6天,CBP组pHi水平显著高于对照组(分别为P<0.05和P<0.01)。CBP组在治疗第2天乳酸值即开始显著下降(P<0.05),治疗第6天乳酸值下降最为显著(P<0.01);对照组治疗前后乳酸值无显著改变(P>0.05);与对照组比较,治疗后第2天和第4天CBP组乳酸水平显著降低(P<0.05),第6天降低最为明显(P<0.01)。结论应用CBP治疗可提高SAP患者pHi,并降低患者乳酸代谢水平,改善患者胃肠道的微循环灌注及氧合。     

Recollections of Nursing and Health Care in the Soviet Union

I led a party of British nurses on an Interchange of London study tour of Moscow and Leningrad early in 1986. The limitations inherent in a short tour, in which the visits were strictly organized by our hosts, are appreciated, but the party was able to visit examples of the three main institutions of care in which Soviet nurses work and to spend two evenings in informal discussion with nursing personnel. The interpretation of findings is my own and does not necessarily assume complete objectivity. Nevertheless, I have attempted to discuss data dispassionately and feel that information obtained is relevant and interesting in its own right. I have no doubt that we were shown the very best of Soviet nursing and health care, and no claims are made as to how representative the particular polyclinic, ambulance center, and hospital visited are of those in the USSR as a whole.     

The changing academic role of the nurse teacher in the United Kingdom

This paper presents findings from a national study conducted over a 3-year period (1991–94) which examined the changing role of the nurse teacher The study used multiple methods to collect data from a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers) This paper presents the findings relating to the development of the nurse teacher's academic role following the introduction of Project 2000 The issues presented and discussed include specialization within the nurse teacher's role, the nature of this specialization and the development of academic credibility and scholarship The implications of these changes in terms of the development of nursing as an academic subject area and the opportunity to contribute to the establishment of research based practice are explored