Nurses' creativity, tedium and burnout during 1 year of clinical supervision and implementation of individually planned nursing care: comparisons between a ward for severely demented patients and a similar control ward

The aim of this study was to study creativity and innovative climate, tedium and burnout among the nurses on two wards during 1 year of systematic clinic supervision combined with the implementation of individualized care on an experimental ward (EW) for severely demented patients, as compared with a similar control ward (CW) EW nurses had systematic clinic supervision and each patient had his/her nursing care carefully planned, documented and evaluated The intervention was evaluated by means of the Creative Climate Questionnaire, Burnout Measure and the Maslach Burnout Inventory Creativity and innovative climate improved significantly among the EW nurses ( n = 19) in eight out of 10 factors during the year of intervention while there was no change on the control ward ( n = 20) Tedium and burnout decreased significantly among the EW nurses while no change was seen in this respect among the CW nurses It seems reasonable to assume that systematic clinical supervision and individualized planned care decreases the negative outcome of stress caused by the psychological burden imposed by nursing care It also increases nurses' creativity, which, in turn, may benefit patient care The findings of this study point to the necessity for a support system that focuses on the work itself, i e the nursing care Individualized planned care and systematic clinical supervision may offer this kind of support     

Elderly care recipients in a Swedish municipality living in their own homes: their diseases, functional health status and care provided as reported by formal carers

The aim of this study was to investigate from the perspective of formal carers the care given to people aged 65 and over, who are cared for in their own homes by informal care. Thirty-three district nurses (DNs) and 20 home service assistants in a municipality with 13500 inhabitants (over 65 years old), were interviewed about the location of care recipients and 398 care recipients were located. Most of them were over 80 years old and had more than one disease (62%), mostly related to the circulatory system (27%). Dependence in three or more of the Katz ADL categories was seen in 30%, reduced mobility in 67%, reduced memory in 34% to a degree that restricted their everyday life and 34% of them could seldom or never be alone. Care had been given for three years or more for 57% of these people. The monitoring of the disabilities and reduced functional health status differed significantly between the diagnostic groups. Home help service was associated with the care recipients' ADL index but not with their need for continuous monitoring. The DNs' care did not relate to any of the variables. In conclusion, diagnoses, the care recipients ability to be alone and functional health status are important variables to include when assessing the demands for home care and when planning supplementary care for home care recipients and their informal caregivers.     

A case study of the effectiveness of nurse-led screening programmes for cervical cancer among Hong Kong Chinese women

Cervical cancer remains a cause of morbidity and mortality among women despite the efficacy of Pap smear screening. Uptake rates for Papanicolaou (Pap) smears among Hong Kong Chinese women remain low and evidence suggests that both intrinsic and extrinsic factors influence women's attendance for Pap smear screening, particularly the practitioner taking the smear. This study examined the experiences and perceptions of Hong Kong Chinese women of having a Pap smear taken by a female doctor or a female nurse using a case study design. A convenience sample of 50 women was selected from the two case study settings. Data collection involved a confidential structured interview, followed by focus group interviews with a sample of women participating in the structured interview. The findings relating to the technical quality and outcome of care provide the focus for this paper. Although women were highly satisfied with the care provided by both practitioners, women were more satisfied with the information given about the procedure by the nurse (P = 0.0130) and had more confidence in the nurse (P = 0.024). One of the five criteria used to assess the quality of smears demonstrated the doctor achieved a statistically significant higher number of smears containing the required percentage of endocervical cells (P = 0. 0180). Nevertheless, none of the smears taken by the nurse required repeating due to an inadequate specimen. These findings suggest, despite the need for audit of Pap smears, that appropriately qualified nurses can make an important contribution to the uptake of Pap smears among this population.     

Concept analysis of expertise of occupational health nurses applying Rodgers''s evolutionary model

The purpose of this study was to clarify the concept of expertise among occupational health nurses. The material consisted of 24 research articles and one theory article published between 1983 and 1997.These were analysed using Rodgers's concept analysis model. The analysis revealed that the surrogate term was authority, and the related concepts were specialist, professional, practitioner and generalist. The attributes of the concept of expertise were associated with roles, profession, position, title and functions. The antecedents of the expertise were identified as knowledge and skills, education, training, experience, personal characteristics and work-related opportunities. The consequences of the expertise were economic and health benefits. Most commonly, the expertise of occupational health nurses referred to clients, workplaces and health-care units. Changes in the concept of expertise were also examined and a definition of expertise formed. Concept clarification is necessary for the development of occupational health education, practice and theory building.     

Nurses' satisfaction with nursing care and work at three care units for severely demented people

Nurses' Satisfaction with nursing care and work at three care units for severely demented people.
The aim of this study is to investigate the degree of job satisfaction, burnout and strain among nurses ( n =134) working in three care units for demented people in southern Sweden. Three questionnaires were used: the Maslach burnout inventory (MBI), the work-related strain inventory (WRSI), and a recently developed measure for assessing job satisfaction. Based on principal component analysis, an eight-factor job satisfaction scale was chosen. Nurses in general were found to be satisfied, with registered nurses (RNs) being most satisfied with their work and the nursing care provided. The nurses in one of the care units were more satisfied than the nurses on the other two. The MBI and WRSI results showed a low degree of burnout and work-related strain and there was little difference between the care units or the categories of nurses. Job satisfaction scores were relatively independent from the MBI and WRSI scores. However, scores from these two inventories of burnout and strain at work were positively correlated. The results of the questionnaires seem to indicate that positive work experience and negative experience are not opposites. This particular method of evaluating job satisfaction needs further development. However, it seems important to include one specific measure for job satisfaction when action is taken in connection with the working situation of nurses.     

LYMPHOGRANULOMA INGUINALE AMONG CHINESF, J

SiTICF; the late nineteenth century climatic bubo has bcen recognised in the tropicaI countrie3 0r the sub-tropici. It ii usually limited to the inguinaI glands ancl is characterisecl by a prolongPd course of .adenopathy, mild intermittent fever and a tendency to formation of multiple fistulac in the groin. Malaria apd climate wcre thoucyht to play a role in deve- lopment of the condition. Its real mode of infection has remained obscure until ig13 when Heiner (i) first published J8 cases of the disease, in all of which a sexual exposure had occurred. In the same year M. Durand, .J. Nicholai and M. Favre (2) described the condilion and also indicatcd its probabk venereal nature, designating it as suh-acute lymphogranuloma inguinale as they were apparently ignorant of clunatic bubo.     

Modulation of Glucose Metabolism in Isolated Rat Hepatocytes by 1,1,1,2-Tetrafluoroethane

Modulation of Glucose Metabolism in Isolated Rat Hepatocytesby 1,1,1,2-Tetrafluoroethane. OLSON, M.J., REIDY,C. A., ANDJOHNSON, J.T. (1990). Fundam Appl Toxicol. 15,270–280.The thennodynamic behavior and lack of ozone-depleting potentialof 1,1,1,2-tetrafluoro-ethane (R-134a) suggest it as a likelyreplacement for dichlorodifluoromethane (R-12), now used asthe refrigerant in many air-conditioning systems. To furtherthe presently incomplete toxicological analysis of R- 134a,the effects of R-134a on cell viability and functional competenceof glucose metabolism were evaluated in suspension culturesof hepatocytes derived from fed or fasted rats. R-134a concentrationsup to and including 75% (750,000 ppm) in the gas phase of sealedculture flasks did not produce evidence of cytolethality (LDHleakage) following 2 hr of exposure; in contrast, halothane(l,l,l-trifluoro-2-bromo-2-chloroethane) caused cell death ata gas phase concentration of only 1250 ppm. In hepatocytes isolatedfrom fed rats, R-134a at concentrations of 12.5 to 75% increasedglycolysis (production of lactate + pyruvate) in a concentration-dependentmanner, no effect was observed at 5%. At 25%, R-12 and 1,1,2,2-tetrafluoro-l,2-dichloroethane(R-l14) were of equal potency to R-134a in stimulating glycolysis;l,l,l,2,2-pentafluoro-2-chloroethane (R-115) depressed glycolysisslightly. Halothane, at concentrations as low as 300 ppm, markedlyincreased rates of glycolysis. Glucose production by hepatocytesof fed rats was decreased by R-134a, R-12, and R-114 only atconcentrations of 25% or more. On the other hand, halothane(>300 ppm) potently decreased glucose production by hepatocytes.In cells isolated from livers of fasted rats, R-134a exposureinhibited gluconeo-genesis in a concentration-dependent manneralthough this effect was not significant until R-134a concentrationsreached 12.5%. Comparative potency studies showed that R-l 34a,R-12, or R-l 14 (25% gas phase) inhibited gluconeogenesis aboutequally while as little as 300 ppm halothane was effective andR-115 (25%) was without effect. Considering that the thresholdfor alteration of the rate of glucose metabolism in this invitro paradigm is about 12.5% R-134a, we conclude that toxicologicallysignificant alteration of glucose-linked bioenergetics is unlikelyat the levels of R-l34a exposure anticipated in workplace orenvironment