Issues of reliability and validity in the measurement of challenging behaviour (behavioural difficulties) in learning disability: a discussion of implications for nursing research and practice

• ? The purpose of this paper is to contribute to the debate on issues related to the reliability and validity of measurement of challenging behaviour (behavioural difficulties) in learning disability. A number of practical, theoretical and methodological issues are discussed that have significance for the nurse both as practitioner and/or researcher in learning disability. These issues are equally important to both provider and purchaser of health care in order that resources can be most effectively targeted.
• ? The term ‘challenging behaviour’ would appear to be used both in literature and research synonymously with behavioural difficulties, this has implications for nurses in both their clinical practice and/or research. The author concludes by identifying a need to replace the term challenging behaviour, with ‘behavioural difficulties’. It is argued that such a term is much more explicit in meaning and amenable to operational definition, thus enabling empirical study. Such a proposal will not be accepted by all as justifiable; this is because some might argue that adopting the term behavioural difficulties may be a retrograde step that perpetuates negative imagery and inappropriate labelling of people with a learning disability.

     

An action research investigation into the feasibility of experienced registered sick children's nurses (RSCNs) becoming children's emergency nurse practitioners (ENPs)

• ? Emergency nurse practitioners (ENPs) formally developed in accident and emergency (A & E) departments as a direct response to waiting times for the walking wounded, the need to reduce junior doctors hours and changes in nursing practice.
• ? ENPs existed informally for many years in minor injuries units and specialist ophthalmic departments.
• ? This study aimed to examine whether or not the role of ENP could be applied to the specialist service of a paediatric casualty department.
• ? The results showed that 3% of patients could be seen and treated to conclusion by a children's ENP, and some patients could have their care accelerated by a children's ENP.
• ? The introduction of children's ENPs would have an impact on waiting times, junior doctors work-load and the quality of patient care.

     

Cervical cancer screening in Tamilnadu, India: a feasibility study of training the village health nurse

Uterine cervical cancer is the most common malignancy among females in developing countries, including India. The success of cervical cancer screening programs in North America and Western Europe has been the result of centralized cervical-cytology screening. This is not possible in the villages (n=17,000) of Tamilnadu where 58 percent of females in rural areas are illiterate, health infrastructure is mediocre, and cervical cytology is unknow. The present study was undertaken to examine if the village health nurse (VHN) could be trained quickly to identify a cervical abnormality by visual inspection so that we could down stage the cancer to earlier stages, more amenable to treatment. VHNs also would be trained to take an adequate Pap smear. A total of 101 VHNs were trained in batches and returned to their villages. Within two years, 6,459 engible women in the study area were screened. The agreement between the gynecologists and the VHNs in identifying cancer among those with abnormal cervix was 95 percent, and 80 percent of the Pap smears taken by VHNs were adequate by WHO criteria, making the feasibility study highly successful.Authors are with The Cancer Institute (WIA), Adyar, Madras, Tamil Nadu,India. Address correspondence to Dr Gajalakshmi, Epidemiology Division and Cancer Registry, 18, Sardar Patel Road, Cancer Institute (WIA), Madras-600 036, Tamilnadu, India. This project was funded by the Indian Council of Medical Research, Government of India, New Delhi, India.520 Cancer Causes and Control. Vol 7. 1996     

Thymic nurse cells account for the thymus dependency of preleukemic cells in mice after inoculation of radiation leukemia virus

Inoculation of Radiation Leukemia Virus (RadLV) into C57BL/Ka mice induces thymic lymphomas after a 3-6 month latent period. The leukemogenic process requires a sequence of events from the productive infection of susceptible target cells and induction of preleukemic cells to irreversible neoplastic transformation. Preleukemic cells were detected in the thymus during the first week following virus injection. The thymus dependency of these cells was shown to depend transiently upon peculiar lymphoepithelial complexes called "Thymic Nurse Cells" (TNCs). Indeed, the first preleukemic cells appearing in the RadLV-inoculated thymuses were observed selectively within TNCs. They remained closely associated with these complexes during the first 2 or 4 weeks. Later on, TNCs disappeared almost completely whereas non-TNCs associated preleukemic cells were found. Lymphoepithelial interactions within TNCs were thus required for the initial events of RadLV-induced lymphomagenesis. The subsequent TNCs depletion expressed a disturbance of thymic lymphopoiesis in relation with the neoplastic process.     

Medical Specialization,Profession, and Mediating Beliefs That Predict Stated Likelihood of Alcohol Screening and Brief Intervention: Targeting Educational Interventions

Practitioner-level educational approaches that promote screening and brief intervention (SBI) seldom consider providers' profession and medical specialization. Strategies that consider these variables may be better equipped to affect change in beliefs and behavior. The aim of this study was to identify beliefs that predict stated likelihood of practicing SBI by specialty and health profession in order to guide the direction of educational strategies. Physicians and nurse practitioners were studied that specialized in family, internal, obstetric gynecology (ObGyn), and pediatric medicine. The results indicated that independent of amount of previous postgraduate alcohol education and knowledge, self-rated competence mediated between specialty and likelihood of practicing SBI. For instance, low self-rated competence for ObGyn was a barrier that suppressed likelihood of practicing SBI. Other findings were that role legitimacy mediated the association between profession and likelihood of SBI, so that lack of role legitimacy was a barrier for physicians but not for nurse practitioners. We suggest that targeted educational strategies for ObGyn and pediatric clinicians may prove more effective than the prevalent one-size-fits all approaches aimed at general adult populations.     

锁骨下静脉置管化疗的应用及护理

目的 减少外周静脉化疗引起的静脉炎及药物外渗性损伤。方法 对46例锁骨下静脉置管化疗病人进行了护理观察。结果 接受锁骨下静脉置管的患者均完成了3周期化疗，导管保留时间最长为186天，无并发症发生。结论 应用中心静脉导管，一次置管可完成多程化疗，治疗方便，尤其适用于多程化疗及恶液质病人的支持治疗。     

Doctor or nurse? The patients' choice

This project's aim was to assess patients perceived need for a specialist nurse in inflammatory bowel disease. A letter was sent to 64 patients with a summary of the potential role of a specialist nurse. Patients were asked to complete a questionnaire of 10 scenarios on who would be their preferred provider on the range of issues. There were 35 (55%) replies. When comparing the results between the consultant and the specialist nurse patients preferred to see a specialist nurse significantly in four scenarios, and patients preferred to see the consultant significantly in two scenarios. The results indicate that patients feel specialist nurses would have more time to discuss issues and they do not want to bother the busy doctors with them. But they do want doctors to carry out the medical aspects of their care.     

护士人格特质与服务态度满意度的相关性研究

目的　研究护士人格特质与患者对护士服务态度满意度的相关情况。方法　使用 16 PF测查 376名护士的人格特质 ,使用自行编制的“住院病人对所住科室护士服务态度调查表”测查现住的 1334名住院病人对所住科室护士服务态度的满意度并量化 ,将两个量表的分值进行相关性分析。结果　 16 PF中 A、B、C、F、G、H、I、Q3等因子与患者满意度分值呈正相关 ,E、L、M等因子呈负相关 ,其它因子相关性不明显 ;其中 ,A、C、G、L、M等因子相关性达到显著性水平 (P<0 .0 5 )。结论　护士的人格特质影响着护患关系及患者对护士服务态度的满意度 ,护理管理人员对护士应加强心理知识技能的训练及心理综合品质的培养     

沙培林联合顺铂治疗恶性胸腔积液的观察与护理

目的:探讨沙培林联合顺铂治疗恶性胸腔积液的临床观察与护理方法,以达到减轻药物毒副反应和提高病人的生存质量的目的。方法:将96例恶性胸腔积液病人,随机分为两组。治疗组:在做好临床观察与护理的同时,胸腔注入沙培林和顺铂前,常规应用地塞米松、止痛剂、止呕剂,以预防药物的毒副反应;对照组:不作预防性用药,待到出现不良反应时做相应处理。分别观察两组毒副反应及体力状况。结果:治疗组发热、胸痛及恶心、呕吐症状发生率分别为12.5%(6/48),10.4%(5/48),10.4%(5/48),均明显低于对照组的31.3%(17/48),27.1%(13/48),25.0%(12/48),两组有显著的统计学差异(P<0.05)。卡氏体力评分≥60分治疗组则明显高于对照组(P<0.01)。结论:在沙培林联合顺铂治疗恶性胸腔积液中,经预防性用药,病人毒副反应轻,机体康复快,容易接受治疗,值得临床推广应用。     

对护理人员"处理错误方式"的调查和思考

提高护理人员防范风险的意识和能力,树立时刻把病人的安全摆在第一位的服务理念,是降低护理差错发生率,提高整体护理质量的关键所在。为此,作者于2005年6月对某三级乙等医院的233名临床护士进行了有关护理人员“处理错误方式”的调查。结果表明,护理人员防范风险的意识和能力有待进一步加强;仍有部分护士在处理“错误”时没有将病人的利益摆在首位,故转变护理人员服务理念,强调以改善系统和程序作为减少风险之策略,建立一种非惩罚性的病人安全的文化环境已迫在眉睫。