The change process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing

Despite being constantly cited as a critical intervening variable in the recovery from alcohol problems, there is a paucity of literature on client motivation. This paper reviews the current literature which impacts on motivation and its importance in treatment and develops in a stepwise manner the revised expectancy/motivation hypothesis, tentatively explaining both motivation and denial as a natural process in behavioural change. Because of the revised expectancy/motivation hypothesis' distinctly defined stages which closely relate to the process of nursing and the qualitative and quantitative measurement it entails which the nursing process demands, it offers a particularly appropriate model for treatment within nurse practice.     

In situ saphenous vein bypass grafts: angiographic evaluation and interventional repair of complications

In situ saphenous vein grafts are being used with increasing frequency for bypass procedures involving the femoral and popliteal arteries. Complications of these procedures include anastomotic stenoses and persistent arteriovenous fistulae that may result in failure of the graft. Balloon angioplasty and embolotherapy with detachable balloons were employed successfully in three or four recent cases of patients with complications from in situ grafts. Tailored angiography is essential for evaluating in situ grafts, and interventional techniques are extremely useful for managing complications.     

Current Controversies in Pregnancy and Epilepsy: A Unique Challenge to Nursing

Approximately 11,550 women with epilepsy give birth annually, yet maternity nurses receive little information on how to care for these patients. Children of epileptic mothers are born with an increased incidence of birth defects, and have a higher perinatal mortality rate. Complications such as bleeding during pregnancy, and interventions such as cesarean births and labor inductions are more common among epileptic women, and seizures tend to increase during pregnancy in more than one-third of epileptic women. Informed nursing care is essential to ensure the best possible outcome of these pregnancies.     

Cyclophosphamide affects the dynamics of granuloma formation in experimental visceral leishmaniasis

We observed histopathological and ultrastructural hepatic changes following the intracardiac inoculation ofLeishmania donovani amastigotes into inbred LHC hamsters (group I). Since granuloma formation is known to be T-cell-dependent, we also examined infected hamsters under cyclophosphamide immunosuppressive treatment (group ICy) and evaluated the production of interleukin-2 (IL-2) by their cells. Group I showed more intense hepatocyte and endothelial cell clasmatosis as well as hepatocyte degeneration and necrosis, deposits of connective tissue fibers, granulomas with multinucleated giant cells (MGCs) of foreign-body and Langhans' types and reduced production of IL-2 by spleen cells. In contrast, group ICy hamsters exhibited larger eosinophil and lymphocyte populations within sinusoids and peri-sinusoidal areas but showed no MGCs in granulomas. A striking decline in IL-2 production was noted. These results suggest that cyclophosphamide induces a delay in the natural evolution ofL. donovani-induced granulomatous hepatic inflammation.     

Evaluation of awakening and recovery characteristics following anaesthesia with nitrous oxide and halothane fentanyl or both for brief outpatient procedures in infants

This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N₂O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty-six full term ASA PS I infants ages 1–12 months were studied. All received inhalation induction with N₂O, O₂ and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. For anaesthesia maintenance, patients were randomized into one of three groups. Group I received 70% N₂O, 30% O₂ and halothane. Group II received 70% N₂O, 30% O₂, halothane and 2 μg·kg^?1 fentanyl. Group III received 70% N₂O, 30% O₂ and 10 μg·kg^?1 fentanyl. Awakening times were similar in all three groups, however, Group I patients had significantly shorter recovery and discharge times than those of Group II and III. None of the patients experienced postoperative apnoea or periodic breathing. One patient in Group III experienced two brief episodes of bradycardia not associated with apnoea or arterial desaturation (Spo ₂ >90% for greater than 30 s). Decreased Spo ₂ occurred less frequently in Group I (5.9%) compared to Group II (22.7%) and Group III (19.0%) patients, however, the group differences were not significant. Transcutaneous CO₂ (TcCO₂) values were not statistically different among the three groups. Pain scores were initially lower in Groups II and III, but at 120 min the differences were not significant. Postoperative apnoea was not observed in this study. Spo ₂ <90% and TcCO₂ >9 kPa (70 mmHg) was more common in infants receiving 2 and 10 μg·kg^?1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants <3 months old did not have a higher incidence of Spo ₂ <90% or significantly higher TcCO₂ values when compared to infants >3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants.     

Incomplete holism in pre-registration nurse education: the position of the biological sciences

There is an ongoing debate in nurse education concerning the role and delivery of the biological sciences in the nursing curriculum. One of the fundamental questions raised by this debate asks how best can teachers impart biological knowledge in a manner that can be readily applied by students and qualified nurses to inform their clinical practice. This paper will include a discussion of some of the features of pre-registration education that may have influenced the manner in which biological sciences are perceived, taught and used by nurses. It will be argued that nursing may have developed a form of incomplete holism and that this may be in part responsible for the challenges that remain to be met within this area of the nursing curriculum. As a response to incomplete holism an innovative approach within pre-registration education will be introduced. This development involves the use of linked teaching sessions which aim to develop the analytical skills necessary to apply physiological knowledge to nursing practice.