Staff perceptions of leadership during implementation of task-shifting in three surgical units

Background Registered nurses are difficult to recruit and retain. Task shifting, which involves reallocation of delegation, can reduce demand for registered nurses. Effective leadership is needed for successful task shifting. Objective This study explored leadership styles of three surgical nurse unit managers. Staff completed surveys before and after the implementation of task shifting. Task shifting involved the introduction of endorsed enrolled nurses (licensed nurses who must practise under registered nurse supervision) to better utilize registered nurses. Methods Implementation of task shifting occurred over 4 months in a 700-bed tertiary hospital, in southeast Queensland, Australia. A facilitator assisted nurse unit managers during implementation. The impact was assessed by comparison of data before (n = 49) and after (n = 72) task shifting from registered nurses and endorsed enrolled nurses (n = 121) who completed the Ward Organization Features Survey. Results Significant differences in leadership and staff organization subscales across the settings suggest that how change involving task shifting is implemented influences nurses’ opinions of leadership. Conclusion Leadership behaviours of nurse unit managers is a key consideration in managing change such as task shifting. Implications for nursing management Consistent and clear messages from leaders about practice change are viewed positively by nursing staff. In the short term, incremental change possibly results in staff maintaining confidence in leadership.     

MALE PSEUDOHERMAPHRODITISM WITH HYPERTENSION DUE TO A 17α-HYDROXYLATION DEFICIENCY

A case of male pseudohermaphroditism aged 48 years with systemic hypertension and hypokalaemic alkalosis is described. Results of metabolic studies point to a 17alpha-hydroxylase deficiency demonstrated by low cortisol (0-56 mg/24 h), high corticosterone (270 mg/24 h) and 11-deoxycorticosterone (5 mg/24 h) secretion rates. Adrenocorticotrophin and gonadotrophin levels were markedly raised but plasma androstenedione (3 ng/dl), testosterone (17 ng/dl), oestrone (3 ng/dl) and oestradiol(1-8 ng/dl) were all low. Plasma aldosterone levels and secretion rates in urine were low and were surprisingly unaffected by dexamethasone therapy although low renin levels rose with a marked return of the erect posture effect. Therapeutic levels of dexamethasone were, however, followed by incipient renal failure.     

Development of the FOCUS (Focus on the Outcomes of Communication Under Six), a communication outcome measure for preschool children

Aim Our aim was to develop an outcome measure, called Focus on the Outcomes of Communication Under Six (FOCUS), that captures real‐world changes in preschool children’s communication. Conceptually grounded in the World Health Organization International Classification of Functioning, Disability and Health framework, the FOCUS items were derived from observations of change provided by parents and clinicians after speech–language therapy. Method Participating families (n=165) were drawn from a convenience sample at partner institutions in Ontario, Newfoundland and Labrador, and Nova Scotia. All children had speech, language comprehension, and/or language production disorders and were receiving speech–language therapy. The age of the children ranged from 1 year 2 months to 5 years 6 months (mean=3.8y; SD=0.91y), and 119 children were male. Three test phases were completed. The measure was revised according to item analysis and parent/clinician feedback after phase 1 (n=74) and phase 2 (n=65). In phase 3 (n=26), the Pediatric Quality of Life Inventory (PedsQL), a health‐related quality of life measure, was added to establish construct validity. Results In phase 1, item analysis revealed high internal consistency for both parents (Cronbach’s α=0.87) and clinicians (Cronbach α=0.97). These values indicated redundancy, so 31 items were cut. Five items for young children were added. In phase 2, internal consistency remained high for both parents (Cronbach α=0.98) and clinicians (Cronbach α=0.83), indicating redundancy of items. Twenty‐seven items were removed. In phase 3, parents and clinicians reliably scored the FOCUS in 10 minutes. They stated that it provided an accurate snapshot of the child’s communication. Internal consistency for parents remained high (Cronbach α=0.96). Children with higher FOCUS scores at the end of treatment had higher PedsQL total scores (r=0.466, p=0.029). Interpretation The FOCUS is a usable measure of a child’s ability to communicate and participate in his or her community. It demonstrates high internal consistency and construct validity.     

Linking the clinical presentation of molar‐incisor hypomineralisation to its mineral density

International Journal of Paediatric Dentistry 2010; 20: 353–360 Background. The in vitro methods used for the assessment of the severity of molar‐incisor hypomineralisation (MIH) are not available for clinicians faced with questions regarding the severity in clinical cases, and the best management approach. Aim. To assess whether there is a relation between the severity of the defects in MIH enamel (represented by reduction in the mineral density) and the clinical presentation (represented by the colour of the defect and its laser fluorescence). Design. The colour of enamel was recorded (normal, white, yellow or brown) in specific areas for ten extracted first permanent molars with MIH defects and ten extracted sound teeth. Laser fluorescence (LF) and mineral density (MD) were measured for the same areas. A mixed model, using sample/tooth as a random effect, was used to estimate the relationship between the MD and the colour‐coding, and between the MD and LF readings. Results. The between‐samples correlation coefficient for the colour coding and the MD was 0.99 (P < 0.001), and 0.83 (P < 0.001) for the LF and MD. Conclusions. The degree of staining of MIH enamel, as assessed visually or by LF, may be used clinically to reflect the severity of the defect.