Advocacy in nursing – perceptions of practising nurses

• ? This paper reports on a qualitative study which examined the interpretation of patient advocacy by practising nurses.
• ? Focus group interviews, which allowed respondents to recount and share their particular ‘stories’ of patient advocacy, were used to collect data.
• ? Results indicate that a triadic model of advocacy predominated which involved the nurse in a conflict/potential conflict situation. The patient's requests, the patient's fear, the patient's vulnerability or threats to the patient's human rights provoked an advocacy response in the perceptive nurse. The nurse was sustained in the role through patient recognition, the nurse–patient relationship, emotional strength, moral justification and knowledge/expertise legitimacy.
• ? The nurse used direct and indirect means to protect the patient against incompetent/inappropriate practice and/or represent patient/family choice, the advocacy activity resulting in positive or negative outcomes.
• ? In conclusion it is argued that if the triadic conflict model of advocacy outlined by this research is to be sustained by practising nurses, the potential risks involved should be recognized. Professionalization of the role may be the only way forward if the ethical code (United Kingdom Central Council, 1992) continues to make patient advocacy a mandatory activity for the professional nurse.

     

Professional Bereavement Photographs: One Aspect of a Perinatal Bereavement Program

Although professionals can do little to cushion the emotional trauma for parents and family when an infant dies, many institutions have implemented bereavement programs to offer counseling, support, and assistance. Included In such programs are photographs of the deceased infant. The value of such photographs has been documented In the literature. Some institutions provide parents with instantly developed photos of the deceased infant. Unfortunately, instant prints may blur and often fade with time. To improve services to bereaved families at a hospital in Massachusetts, a program was implemented to use the skills of the hospitals professional biomedical photographers and the nursing team. The perinatal clinical nurse specialist or her designee takes a 35-mm black-and-white photograph of the infant. The biomedical photographers process the negatives and use hand coloring techniques and matting to produce professional-quality photographs. The response by parents and families to the improved photographs has been positive. As the number of photographs taken has increased, the staff have continued to improve the service.     

Proliferation signal inhibitors in the treatment of lupus nephritis: Preliminary experience

Aim: Proliferation signal inhibitors (PSI) have demonstrated efficacy in prevention and treatment in an animal model of lupus nephritis (LN) but there are no data regarding the use of PSI in human LN. We report here our experience of using PSI treatment in seven patients with severe proliferative lupus nephritis. Methods: This is a retrospective study on patients with proliferative lupus nephritis who had received PSI treatment. Results: Seven patients were included. Two patients had concomitant membranous lupus nephropathy. The indications for PSI included mycophenolate mofetil intolerance (n = 4), history of malignancy (n = 2) and leucopoenia (n = 1). Five patients were given PSI when disease was active. Two had treatment discontinued because of acute cholecystitis and leucopoenia, respectively. In the other three patients combined steroid and PSI treatment as induction therapy led to improvements in serology, renal function and proteinuria. In two patients treated with PSI and low‐dose steroid as maintenance immunosuppression, both maintained stable lupus serology, renal function and proteinuria over 18 months. Side‐effects included dyslipidemia and oral ulcers. Conclusion: Proliferation signal inhibitors warrants further investigation as an alternative immunosuppressive treatment in lupus nephritis.     

Comparison of the Effects of Histamine and Nα-Methylhistamine on Neuronal Function in the Guinea-pig Oesophagus and Ileum

The effects of histamine and N^α-methylhistamine, two components of gastric juice, on vagal and transmural stimulation of the guinea-pig isolated oesophagus were compared with their effects on cholinergic and on non-adrenergic-non-cholinergic (NANC) neuronal responses in the isolated ileum, both tissues having been pretreated with mepyramine (1 μm ). Histamine (≤10 μm ) and N^α-methylhistamine (≤1 μm ) had no significant effect on either vagal or transmural stimulation in the oesophagus. Substance P, which produces a contraction by activation of cholinergic nerves in the oesophagus also was unaffected by histamine. In contrast, the agonists inhibited contractions produced by cholinergic nerve stimulation in the ileum; the inhibition produced by histamine (10 μm ) was up to 73 ± 5%, that by N^α-methylhistamine (1 μm ), 48 ± 5%. Histamine also inhibited responses to stimulation of NANC neurons by up to 37 ± 14%. The effects of histamine and N^α-methylhistamine in the ileum were inhibited by clobenpropit (01 μm ). These findings suggest that histamine and N^α-methylhistamine have no role in the modulation of neuronal function in the oesophagus, in contrast with their effect in the ileum.     

A GOOD MAN'S FAULT: ALCOHOL AND IRISH PEOPLE AT HOME AND ABROAD

Long-standing stereotypes portray Irish people as prone to usealcohol to excess. This review traces the historical originsof those stereotypes, and examines evidence drawn from a rangeof secondary sources in Ireland and Britain about alcohol consumption,attributed hospital admissions and mortaliiy. The availabledata indicate that the ‘problem’ of Irish drinkingand Irish attitudes to alcohol are not as straightforward astraditionally supposed. Far from the stereotypical image ofthe Irish embodied in the ubiquitous drunk male labourer, ratesof abstinence from alcohol are higher in Ireland than in Britain.Amongst migrants, the Irish are no more likely to consume alcoholthan the indigenous population. However, those Irish peoplewho do drink alcohol do so at generally higher levels than theirBritish bom counterparts. Analysis of combined years' data fromthe General Household Survey indicates first that people ofIrish birth or parentage are no more likely than the Britishborn to use alcohol at all. However, if they make use of alcoholat all, members of the Irish groups were more likely than theBritish born to consume alcohol at levels greater than 14 or21 units per week. Both the review and the data presented suggestthat a more complex understanding of the dynamics and natureof Irish drinking needs to be developed.     

Paradoxical Autonomic Modulation of Atrioventricular Nodal Conduction During Heart Rate Turbulence

WICHTERLE, D., et al .: Paradoxical Autonomic Modulation of Atrioventricular Nodal Conduction During Heart Rate Turbulence. Heart rate turbulence (HRT) represents a biphasic chronotropic response of sinus rhythm to a single ventricular premature beat (VPB). It consists of early acceleration and late deceleration of heart rate and is predominantly mediated by the autonomic nervous system. The aim of this study was to investigate if autonomic perturbations after a VPB exert a significant effect on AV conduction. Both surface ECG and the high right atrial electrogram were recorded at a sampling frequency of 1000 Hz in 26 patients (24 men, mean age 49 ± 12 years) referred for electrophysiological evaluation. The stimulation protocol consisted of series of single ventricular extrastimuli delivered from the right ventricular apex at decreasing coupling intervals. A biphasic profile of AV intervals after a single VPB was observed. The response of AV conduction to a VPB was approximately 25 times and 15 times weaker in the early and late phase, respectively, than that of R-R intervals. Thus, AV interval dynamics significantly preceded the change in R-R intervals, which is in conflict with the near to zero phase of transfer function between R-R and AV intervals described in previous studies. A significant AV turbulence was observed consisting of early shortening and later prolongation of AV intervals after VPB. Its magnitude was much smaller than that of HRT. Dynamics of AV delay has little impact on the accuracy of HRT assessment from surface ECG. The significant temporal dissociation of R-R and AV interval dynamics after a VPB remains unexplained. (PACE 2003; 26[Pt. II]:440–443)