The heparin management test: a new device for monitoring anticoagulation during coronary intervention

Whole blood coagulation analysers are widely used during percutaneous coronary interventions. The precise degree of anticoagulation in patients is important in this setting. The aim of this investigation was to compare the results obtained with ACT (Hemochron) and HMT, the Heparin Management Test (TAS) in patients undergoing percutaneous coronary interventions. Patients (n=100) were enrolled prospectively. Each patient received 10,000 units of heparin. At the end of the procedure, the mean ACT was 284±31 seconds and the mean HMT was 292±33 seconds. The correlation between the two methods was highly significant (r=0.64, p<0.001). The HMT correlates well with ACT values in patients undergoing percutaneous coronary interventions. Its use in the management of these patients should be considered.     

Coping with rheumatoid arthritis. How can specialist nurses influence it and promote better outcomes?

• ? Psychological stressors are said to be an important influence on the outcome of chronic illnesses such as rheumatoid arthritis (Engel, 1977).
• ? Helping patients to cope with stressors is identified as a central concept in the delivery of nursing care (Khan et al., 1994). It is thus reasonable to suggest that rheumatology nurses may be key players in the process of coping with rheumatoid arthritis.
• ? But in order for rheumatology nurses to be effective players in this process, they need to discourage coping behaviour(s) linked to poor outcomes, and/or promote an overall behaviour pattern linked to a better outcome. Literature showing the link between different coping behaviours and outcome is examined, and cognitive restructuring is emphasized as one method nurses could use.
• ? Having identified coping behaviour which is optimal in terms of future outcome, further study of different forms of coping-based educational intervention is suggested, to reveal how such patterns of behaviour can be taught by nurses in the most effective way

     

Training of flight nurses on fixed-wing air ambulance services

Introduction: The purpose of this study was to determine the background of fixed-wing air ambulance nurses, what level of training they receive before assignment as a flight nurse, and how closely supervised these fixed-wing air ambulance programs are by their medical directors.

Methods: In 1993, a retrospective statistical questionnaire was sent to 113 fixed-wing air ambulance programs. Chief flight nurses for all 113 fixed-wing air ambulance transport companies were requested to complete a written survey consisting of 17 multiple choice and fill-in-the-blank questions about previous experience, flight nurse qualifications, and content covered in their initial training program.

Results: Of 113 surveys, 72 (64%) responded. The majority (87%) of the flight crew were 30 to 39 years of age. The crew mix is RN/EMT-P in 49%, RN/RN in 25%, and RN/RT in 25%. Experience before flying showed emergency department/intensive care unit in 87% with 13% specialized to a specific type of patient care. The initial training in classroom hours was less than 21 hours in 50% of programs. Training programs were taught by the chief flight nurse in 75%, the medical directors in 74%, and outside organizations in 30%. Fifty-five percent of programs use pilots or other flight crew members to supplement initial training. Only eight of the programs did not have yearly refresher classes. Programs providing more extensive training appear to be affiliated with hospital-based services. Medical directors were involved with the everyday running of air medical transports in 35 of the pro grams (50%), 20 medical directors (28%) did monthly chart reviews only, and 12 (17%) were not involved with their programs. There were three responses to “Other” and two with no responses.

Conclusions: Although fixed-wing flight nurses appear to be medically experienced personnel with previous intensive care unit or emergency department experience, this survey would suggest that fixed-wing flight programs are variable in the amount of initial training, level of instructors, ongoing medical education, and involvement of the medical director. This survey indicates the need for increased standardization of continuing education, as well as increased involvement of medical directorship in fixed-wing air ambulance services.     

A study of the provision of health checks and health-promotion clinics in 18 general practices

Summary

• ? The objective of this study was to describe the variation in provision of health checks and health-promotion clinics operating under the regulations of the 1990 Contract for general practice in the UK.
• ? Eighteen group practices in three Family Health Service Authority (FHSA) areas of England (two in the South West Thames region and one in the Yorkshire region) were selected for the study. The nurses, largely responsible for the implementation of the health checks at these practices, were interviewed using semi-structured interview schedules. They were asked about age-groups targeted, means of recruiting patients for clinics, duration of clinic appointments, and procedures carried out in clinics.
• ? All practices offered health checks, and 55% had started doing so before introduction of the 1990 Contract. Recruitment for health checks took place in a number of ways: self-referral (83% of practices); opportunistically in those with coronary heart disease risk factors (78%); opportunistically during attendance for cervical smears (62%); screening in at least one patient group (78%). Blood pressure, height, weight, urinalysis and life-style advice were included by all practices. Stress management and quit smoking strategies were offered only by a minority of practices. Duration of first health-check appointment ranged between 15 and 30 minutes.
• ? The basic content of health checks, and life-style advice given appeared consistent between the widely varying practices. However, the resources available for intervention and follow up showed more variation.

     

Closing the theory—practice gap: a model of nursing praxis

Summary

• ? Despite the efforts of nursing theorists, educationalists and practitioners, the theory-practice gap continues to defy resolution. This paper argues that only by reconsidering the relation between theory and practice can the gap be closed.
• ? Drawing upon ideas from teaching and other practice-based disciplines, including nursing, the article suggests that the current model of viewing theory as informing and controlling practice should give way to a mutually enhancing model in which theory is derived from practice, and in turn influences future practice.
• ? This coming together of theory and practice is referred to as nursing praxis, and suggests that informal theory should be unique to each individual encounter with each patient.
• ? The clinical nurse is thus not only a practitioner, but a theorist and researcher, who responds to patients not according to some grand, inflexible theory, but by the process of reflection-in-action, drawing upon their expertise and a repertoire of past experiences and encounters.

     

Evaluating the effectiveness of the coronary care nurses' role in smoking cessation

Summary

• ? The aim of this small-scale study was to assess the feasibility and impact of an individualized smoking cessation intervention among clients admitted to a coronary care unit with severe angina or a first time myocardial infarction.
• ? The intervention involved in-depth nursing assessment interviews related to client beliefs, motivation and experiences of smoking, culminating in an individualized cessation plan. Participants were offered follow up support during the first year post-intervention.
• ? The findings are highly encouraging with a 77% smoking cessation rate for surviving clients within the intervention group at the end of the first year, and with 75% continued successful smoking cessation amongst surviving clients 2 years post-intervention.

     

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.     

Orem自理学说在脑卒中患者临床护理中的应用与探讨

目的:分析护理方式对脑卒中患者自护能力的影响.方法:采用随机分组的方法,观察组以 Orem自理学说为理论框 架,依据马斯洛的需要层次论,针对疾病作用于人体所引起的生理、心理、社会的反应,运用护理程序,围绕护理目 标、实施护理计划;与同期住院按分级护理标准,实施护理计划的对照组比较.结果:两组的并发症有高度显著性差 异( P<0.01)两组的后遗症有显著性差异 (P<0.05).结论:自我护理具有较强的针对性,有利于实现护患双方共同的目标,降低并发症和致残率.     

医疗护理工作中不容忽视医疗废物的管理

目的:探讨在医疗护理工作中废物管理问题.方法:建立管理组织、制度,全员培训,专人管理,分类收集、贮送,加强督查.结果:措施落实,有效预防二次感染.结论:在医疗护理工作中不容忽视医疗废物的管理.