Factors influencing the clinical preparation of BS nursing student interns in Iran

Amalgamation of nursing education into universities has raised many questions about the nursing students' clinical preparation. Despite increased academic input into nursing education in Iran in recent years, the public and the government have criticized Iranian nurses regarding the poor quality of patient care. Using grounded theory methodology, in-depth individual interviews were conducted with a theoretical sample of nine participants to better understand the perceptions of factors influencing the clinical preparation of BS nursing student interns. Three main clinical themes emerged from this study: (i) educator incompetency; (ii) nursing staff technical ability; and (iii) a non-conducive learning environment.     

Developing more positive attitudes towards mental health nursing in undergraduate students: part 1 – does more theory help?

Negative attitudes towards mental illness and the mental health nursing profession have deterred many undergraduate nursing students from considering this area as an attractive career option. Positive clinical experience has been identified as the most important factor in producing more favourable attitudes. While the quantity of theory is identified as important, its impact on attitudes has not been examined through research. This study compared two groups of students undertaking different numbers of theoretical and clinical hours in mental health nursing to determine if this increase has an impact on nursing students' attitudes. Anonymous questionnaires were distributed to the total population of students following completion of the theoretical component of the programme but prior to clinical experience. The questionnaire was designed to assess: (1) nursing student's preparedness for and attitudes towards the mental health field; (2) consumers of mental health services; and (3) the students' career preferences. This first paper in a two-part series examines the impact of theoretical hours and suggests that while other attitudes are fairly similar between the two groups, the group exposed to more theory exhibited significantly more positive attitudes towards psychiatric nursing as a career.     

The conceptualization and operationalization of race and ethnicity by health services researchers

Racial and ethnic variables are routinely used in health services research. However, there is a growing debate within nursing and other disciplines about the usefulness of these variables in research. A qualitative study was undertaken (July 2004 – November 2004) to ascertain how researchers conceptualize and operationalize racial and ethnic data. Data were derived from interviews with 33 participants in academic health centers in differing geographic regions. Content analyses extracted manifest and latent meanings to construct categories depicting respondents' understandings of race and ethnicity in research. Race and ethnicity held several meanings but the subtext was often not clear because these terms were not operationalized. Measuring race and ethnicity quantitatively necessitated uniform classifications thus it was often necessary to impose a single racialized identity. Respondents recognized the problems with racial and ethnic variables but the majority still believed these variables were necessary and useful. Several researchers understood that racial and ethnic variables were used in ways that may stigmatize the populations studied. These respondents collected data on variables other than race and ethnicity to ascertain the causes of health differentials. The policy recommendation calls for a shift in thinking about how to use racial and ethnic variables in research.     

Perspectives on midwifery power: an exploration of the findings of the inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda, Ireland

The Lourdes Hospital Inquiry: An inquiry into peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda , Ireland, of 2006 recounts in detail the circumstances within which 188 peripartum hysterectomies were carried out at the hospital between 1974 and 1998. The findings of the inquiry have serious ramifications for Irish healthcare delivery and have implications for many professional groups, including midwives. The findings prompt clear questions about the relative position or power of midwives within maternity care. These questions are examined in this article, through the analysis and application of various theoretical perspectives on power. Critical views of power focus on the socio-political nature of oppressive structures within society and seek mechanisms to address these. Stemming from structure versus agency debates, Giddens's structuration theory examines the agency-structure interaction and stresses the centrality of agents' roles in the social reproduction of structures. Postmodernism, particularly drawing on the work of Michel Foucault, focuses on a fluid conception of power while also describing the nature of disciplinary power. It offers midwives a way of viewing power as productive and dispersed. Drawing on different aspects of these perspectives on power, helps us to understand midwives' relative positions and power relations and how to enhance these to prevent future tragic outcomes such as those reported in the inquiry report.     

Cooperation between parents and school nurses in primary schools: parents' perceptions

Introduction: Cooperation between pupils’ parents and school nurses is an important part of health promotion in primary schools. Developing frank and trusting relationships contributes to easy and uninhibited cooperation. Cooperation between parents and school nurses has not been widely researched internationally. Aims: This article reports on parents’ views on cooperation with school nurses in primary schools. The study aims at contributing to school nurses’ work so that instead of focusing only on the children, family nursing approaches could be improved. Methods: Nineteen parents from 13 families from southern Finland were interviewed for the study in 2004. The data were analysed by grounded theory and the constant comparative method was utilized. Findings: Six concepts describing parents’ views on cooperation were generated on the basis of the data. Cooperation consists of supporting the child’s well‐being. School nurses take children’s and parents’ concerns seriously and intervene effectively if the child’s health is threatened. School nurses’ expertise is not very visible within school communities. Hoping to receive information and desiring parental involvement are important concepts of cooperation with the school nurse. The child’s family is not sufficiently known or taken holistically into consideration when the child’s health is promoted. Parents are the initiators of cooperation within school health care and parents describe this by the concept of one‐sided communication. Conclusions: Parents do not know about school nurses’ work and school health services. They would like to be more involved in school nursing activities. When developing children’s health services, parents’ expertise in their children’s well‐being should be paid more attention. This study enhances the knowledge of family nursing by describing Finnish parents’ perceptions of cooperation with school nurses. The findings facilitate the understanding of cooperation in school health services.     

Application of a model of social information processing to nursing theory: how nurses respond to patients

Title. Application of a model of social information processing to nursing theory: how nurses respond to patients. Aim. This paper is a report of a study to assess the applicability of a theoretical model of social information processing in expanding a nursing theory addressing how nurses respond to patients. Background. Nursing communication affects patient outcomes such as anxiety, adherence to treatments and satisfaction with care. Orlando’s theory of nursing process describes nurses’ reactions to patients’ behaviour as generating a perception, thought and feeling in the nurse and then action by the nurse. A model of social information processing describes the sequential steps in the cognitive processes used to respond to social cues and may be useful in describing the nursing process. Methods. Cognitive interviews were conducted in 2006 with a convenience sample of 5 nurses in the United States of America. The data were interpreted using the Crick and Dodge model of social information processing. Findings. Themes arising from cognitive interviews validated concepts of the nursing theory and the constructs of the model of social information processing. The interviews revealed that the support of peers was an additional construct involved in the development of communication skills, creation of a database and enhancement of self‐efficacy. Conclusion. Models of social information processing enhance understanding of the process of how nurses respond to patients and further develop nursing theories further. In combination, the theories are useful in developing research into nurse–patient communication. Future research based on the expansion of nursing theory may identify effective and culturally appropriate nurse response patterns to specific patient interactions with implications for nursing care and patient outcomes.     

Interactions between auditory 'what' and 'where' pathways revealed by enhanced near-threshold discrimination of frequency and position

Partially segregated neuronal pathways ("what" and "where" pathways, respectively) are thought to mediate sound recognition and localization. Less studied are interactions between these pathways. In two experiments, we investigated whether near-threshold pitch discrimination sensitivity (d') is altered by supra-threshold task-irrelevant position differences and likewise whether near-threshold position discrimination sensitivity is altered by supra-threshold task-irrelevant pitch differences. Each experiment followed a 2 x 2 within-subjects design regarding changes/no change in the task-relevant and task-irrelevant stimulus dimensions. In Experiment 1, subjects discriminated between 750 Hz and 752 Hz pure tones, and d' for this near-threshold pitch change significantly increased by a factor of 1.09 when accompanied by a task-irrelevant position change of 65 micros interaural time difference (ITD). No response bias was induced by the task-irrelevant position change. In Experiment 2, subjects discriminated between 385 micros and 431 micros ITDs, and d' for this near-threshold position change significantly increased by a factor of 0.73 when accompanied by task-irrelevant pitch changes (6 Hz). In contrast to Experiment 1, task-irrelevant pitch changes induced a response criterion bias toward responding that the two stimuli differed. The collective results are indicative of facilitative interactions between "what" and "where" pathways. By demonstrating how these pathways may cooperate under impoverished listening conditions, our results bear implications for possible neuro-rehabilitation strategies. We discuss our results in terms of the dual-pathway model of auditory processing.     

The role of the angular gyrus in visual conjunction search investigated using signal detection analysis and transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) delivered over the posterior parietal cortex increases choice reaction times in visual search for a target defined by a conjunction of features. Some recent studies of visual search have taken an approach based on signal detection theory, the findings of which are not addressed by studying the disruptive effects of TMS on reaction time. Here we investigated the role of the posterior parietal cortex in visual search by applying TMS while subjects performed unspeeded feature and conjunction visual search tasks matched for level of difficulty. TMS over the right, but not the left angular gyrus (AG) in the parietal cortex, nor vertex decreased subjects' sensitivity on the conjunction but not the feature search task, as measured by the signal detection measure, d'. Changes in bias, specifically the tendency to make false positive responses, were less clear. We consider the findings in terms of four possible explanation: binding, attentional control, spatial localisation and visuomotor co-ordinate transformations.     

Clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large-format histologic sections

BACKGROUND: Breast carcinoma is a heterogeneous group of diseases deviating from each other not only in their clinical manifestations and outcome but also in their histologic appearance. The submacroscopic morphology of breast carcinomas, the distribution of the lesions, and the extent of the disease are seldom studied. Even more infrequently are these parameters included in surgical pathology reports. Conversely, the routine use of large-format histologic sections in workup of operated breast specimens provides better insight into the significance of these parameters. The aim of the study was to identify breast carcinoma growth patterns indicating increased metastatic potential of the tumor and a need for more aggressive therapy. METHODS: In all, 500 consecutive breast cancer cases, all of which were documented on large-format histologic sections, were retrospectively analyzed. The distribution of both in situ and invasive components of the tumors (unifocal/multifocal/diffuse) was defined, determined, and compared with the type of surgical intervention performed and the frequency of ipsilateral lymph node metastasis as endpoints. The extent of the disease, the size of the tumor, the presence or absence of lymphovascular invasion (LVI), and the proportion of invasive lobular carcinomas in the categories with different distributions were also analyzed. RESULTS: Only 34% of the analyzed cases could be categorized as unifocal. This kind of tumor distribution was associated with lymph node metastasis in 28% of the cases, with LVI in 18%, with breast-conserving surgery in 67%, and with a proportion of 4% invasive lobular carcinomas. Tumors with a unifocal invasive component upgraded to multifocal or diffuse because of the distribution of the associated in situ component had similar characteristics. With their larger extent, tumors with a diffuse in situ component required mastectomy in 43% of cases. Multifocal distribution of the invasive component in the tumors was associated with higher frequency of LVI (42%) and lymph node metastases (48%), with a substantially lower number of cases undergoing breast-conserving surgery (33%) and with a higher proportion of lobular carcinomas (25%). If the multifocal invasive foci were associated with a diffuse in situ component, the proportion of invasive lobular carcinomas was only 5%. The extent of the lesions (defined as the area of breast tissue involved by in situ, invasive, and/or intravascular tumor foci) was >or=2 cm in >90% of multifocal cases and >or=4 cm in >70%. Diffusely growing invasive carcinomas were rare (only 20 cases), but were associated with lymph node metastasis in 60% of cases and resulted in mastectomy in 85% of the cases. Approximately two-thirds (65%) of these tumors belonged to invasive lobular carcinomas. The extent of diffusely growing invasive carcinomas was >or=4 cm in 75% of the cases. Although LVI was detected in only 10% of tumors with a diffusely growing invasive component, such tumors were found to have lymph node metastasis significantly more often (odds ratio of 2.33) and required mastectomy much more frequently (odds ratio of 2.58) compared with purely unifocal breast carcinomas. CONCLUSIONS: These results indicate that the distribution of invasive and in situ tumor structures in breast carcinomas as defined in the current study, together with the extent of disease, are important morphologic parameters which determine the required surgical intervention and are related to biologic factors such as metastatic capacity. The method of large-section histology allows the examiner to properly document and demonstrate these important parameters, thus facilitating understanding of their clinical relevance.