Detection of AmpC beta-lactamase in Escherichia coli: comparison of three phenotypic confirmation assays and genetic analysis.

Two mechanisms account for AmpC activity in Escherichia coli, namely, mutations in the ampC promoter and attenuator regions resulting in ampC overexpression and acquisition of plasmid-carried ampC genes. In this study, we analyzed 51 clinical E. coli isolates with reduced susceptibility to amoxicillin-clavulanic acid, piperacillin-tazobactam, or extended-spectrum cephalosporins for the presence of AmpC production. Three phenotypic AmpC confirmation assays (cefoxitin-cloxacillin disk diffusion test, cefoxitin-EDTA disk diffusion test, and AmpC Etest) were compared for the detection of AmpC activity. All 51 isolates were characterized genetically by mutational analysis of the chromosomal ampC promoter/attenuator region and by PCR detection of plasmid-carried ampC genes. Altogether, 21/51 (41%) E. coli isolates were considered true AmpC producers. AmpC activity due to chromosomal ampC promoter/attenuator mutations was found in 12/21 strains, and plasmid-carried ampC genes were detected in 8/21 isolates. One strain contained both ampC promoter mutations and a plasmid-carried ampC gene. All three phenotypic tests were able to detect the majority (>90%) of AmpC-positive strains correctly. Cefoxitin resistance was found to be a discriminative parameter, detecting 20/21 AmpC-producing strains. Susceptibility to extended-spectrum cephalosporins, e.g., ceftriaxone, ceftazidime, and cefotaxime, was found in 9 of the 21 AmpC-positive strains. Considering the elevated zone diameter breakpoints of the 2010 CLSI guidelines, 2/21 AmpC-positive strains were categorized as susceptible to extended-spectrum cephalosporins.

Social problem-solving telephone partnerships with family caregivers of persons with stroke.

As individuals with significant functional deficits are discharged earlier from the hospital, health care professionals are challenged to develop cost-effective intervention programmes that will assist family members to manage caregiving problems in the home. The literature suggests that social problem-solving can positively influence the physical and psychological well-being of individuals. This paper describes a social problem-solving training procedure provided primarily by telephone to assist family caregivers to manage caregiving issues in the home.

Educating the culturally diverse healthcare student.

Diversity among healthcare students is increasing as the population of the United States changes in composition. Preparation of the culturally diverse healthcare student presents a challenge for recruitment, education, and retention. The problems of education can be ameliorated by a thorough assessment of the culturally diverse student using the Giger and Davidhizar model. The student should be assessed for differences by considering six interrelated factors: communication, space, time, social organization, environmental control, and biological variations. Understanding the differences that exist in these areas is a first step toward appreciating the diversity among people of varied cultures.

Health promotion among ethnic minorities: the importance of cultural phenomena.

Ethnic minority groups have varying health promotion needs, which differ according to six cultural phenomena outlined in the nursing literature: communication, space, social organization, time, environmental control, and biological variations. This article reports on some of the research available in each of these areas in relation to ethnic minorities. If health promotion is to be improved for people in all sectors of the population, it is important for rehabilitation nurses to learn how to assess the needs of ethnic minorities and to respond to those needs with appropriate interventions.

Fat distribution and cardiovascular disease risk in African-American women.

We have previously shown that in Caucasian men and women fat in the trunk, and especially visceral fat, was related to cardiovascular disease (CVD) risk even after adjusting for fat in other depots. We also found that leg fat was negatively related to CVD. In order to determine if these relationships also exist in African-American women, blood lipids, insulin, and blood pressure in 26 pre-menopausal African-American women were evaluated. In addition, magnetic resonance imaging measured fat distribution was evaluated from the lateral malleolus to top of the shoulder. Percent fat was related to VLDL cholesterol, VLDL3 cholesterol, triglycerides, insulin, and diastolic blood pressure. Inclusion of visceral and trunk fat together in multiple regression did little to improve the relationship with CVD risk. Leg fat, however, tended to be negatively related to CVD risk after adjusting for trunk fat and visceral fat. Partial correlations indicated that leg fat was negatively related to VLDL cholesterol (r = -0.36), triglycerides (r = -0.36), insulin (r = -0.46), and diastolic blood pressure (r = -0.43). These results indicate that in African-American women, visceral fat may be less atherogenic than in Caucasian men and women since it was poorly related to CVD risk after adjusting for fat in the trunk. In addition, consistent with results from Caucasians, leg fat is inversely related to CVD risk after adjusting for fat in other parts of the body. Caution must be made in the interpretation of correlational data. Further research is warranted to explore these intriguing relationships.

Empowerment: a tool for black nursing faculty.

This article explores the concept of power and applies it to Black nursing faculty members. Recognizing that although the number of Black Americans teaching in schools of nursing is not proportional to the number in the general population, the authors state that the number entering the teaching field is increasing. With so few in nursing and subsequently in teaching, problems are inherent in the teaching role. The authors address some of these problems and offer suggestions for how Black nursing faculty members can empower themselves.

Developing communication skills for use with Black patients.

The purpose of this article is twofold: 1) to familiarize nurses with the conceptual and historical development of Black English; and 2) to improve communication between nurses and Black patients. A plea is made for the introduction of these concepts into the curricular of all Schools of Nursing.

Black American folk medicine health care beliefs: implication for nursing plans of care.

Even in this age of information, some African Americans equate good health with luck or success. An illness or disease, viewed as undesirable, may be equated with bad luck, chance, fate, poverty, domestic turmoil, or unemployment, and in such case, Black Americans will consult a physician only after attempts with home remedies have failed. It is important for the nurse when working with Black patients, remember that when this patient enters the traditional bio-medical health care delivery system, it is best to assume that all known and available cultural home remedies have been tried. According to Bloch (1976), some Black Americans believe that the nurse should recognize cultural medical practices and the western medical remedies based on these beliefs. It is essential that the nurse determine whether these home remedies will interact or interfere with orthodox medical approaches. If home remedies are found to be efficacious or neutral. they may be kept at the patient's bedside. However, if they are found to be harmful, the nurse should assist the patient in developing an understanding about the remedies' dangers. With an emphasis on education, the patient can be navigated toward modern medical preventive techniques and cures, and the nurse may observe and judge the variety and efficacy of age-old culturally entrenched health care practices. Future studies may just substantiate the science behind the folklore.

Changing nursing students' attitudes--an exploratory study.

Stereotypes, competition, and limited contact can contribute to nursing students from different programs developing negative attitudes about one another. This study applies an attitude change model to a small sample of nursing students in different programs to determine if this negative attitude can be changed.

Understanding monochronic and polychronic individuals in the workplace.

Patterning of time is a frequently ignored aspect of human behavior. Individuals handle time durations differently. Responses to time durations were first outlined in the classic work of Hall (in 1959) and include urgency, activity, variety, and whether multiple or isolated tasks are attempted in the same time duration. When patients or other staff vary from the nurse in the way in which time or time perception is handled, difficulty can occur. Understanding the way individuals handle time can assist in dealing with patients and colleagues and is of particular significance in interacting with people from other cultures and races.

A program for water-intoxicated patients at a state hospital.

During normal circumstances, individuals have a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. If fluid intake continues uncurbed, an extreme condition may result known as self-induced water intoxication and psychoses. If untreated, complications may develop, including dilated and hypotonic bowel and bladder, hydronephrosis, renal failure, congestive heart failure, mild confusion, acute delirium, seizures, coma, and death. The ongoing problem of water intoxication presents a modern day nursing challenge to psychiatric nurses. The present study monitors nine chronically ill patients in a special program for water intoxication involving control and monitoring and a psychoeducational group approach in a closed unit of a state hospital. At the end of 3 months serum electrolytes, serum osmolality, and urine specific gravity were within normal limits since the start of the program. Anxiety, as evidenced by restlessness, pacing, increased talking, demanding behavior, hyperactivity, yelling, and irritability, had lessened. This improvement was accompanied by a stabilization of psychotic behavior. The use of restraints dropped from 1303 hr in the 3 months before the program to 20 hr and 55 min for the nine patients in the first 3 months of the program. Progress in relation to the study hypothesis will be evaluated every 3 months.

Nursing clients of Greek ethnicity at home.

The home healthcare nurse who cares for persons with Greek ancestry should be aware of their unique cultural heritage. The nurse should also be aware that Greek people throughout the world are proud and independent, valuing their religious faith and practices, good health, education, and success. Care should be designed to include appreciation of traditions and customs that these clients may have. The nurse should make a special effort to develop trust with the Greek client and family members in order to effectively implement culturally competent healthcare.

Managing a multicultural radiology staff.

Opportunities for minorities in healthcare increased with the Civil Rights movement in the 1960s. More recently, funds from the U.S. Public Health Service have been targeted toward disadvantaged minorities. The workforce in healthcare, and in business in general, has become increasingly multicultural. Much of the literature in healthcare management lacks practical guidelines for managing a diverse workforce. Communication, both verbal and nonverbal, and culture are closely intertwined. Managers, as they develop multicultural teams, will need to understand how culture influences communication in their organizations. Space, spatial behavior, and cultural attitudes influence people's behavior. This is a particularly important consideration for a radiology staff, which must often work in close quarters. For some cultural groups, the family as an organization has more significance than even personal, work-related or national causes. People's orientation to time, whether for the past, present or future, is usually related to the culture in which they grew up. Again, this may become an important issue for a radiology administrator whose organization must run punctually and time-efficiently. How patients feel about their environment, whether they believe they are in control or believe in an external locus of control, is of particular interest to those who attempt therapeutic changes in a patient's healthcare. Does the patient believe that illness is divine will or that suffering is intrinsic to the human condition? There is increasing research in the United States to show that people do differ biologically according to race. Such differences exist among patients as well as among staff members. It has been popular to assume that differences among races do not exist. Unfortunately such an attitude does not allow for different attributes and responses of individuals. Managing a multicultural staff presents a challenge to administrators who must be skilled in working with culturally diverse people and must help their staff members do the same.

Reflections on the elderly African American in health care.

This article discusses the demographics of the elderly in America and how these demographics relate to the minority elderly with specific focus on the African American elderly. The special health risks of this group are discussed. The Giger and Davidhizar Model is used to assess health risks among the African American Elderly.

Canadian transcultural nursing: applying the Giger and Davidhizar model.

Giger and Davidhizar (1995) provide a model for assessing clients from differing cultures in order to be aware of differences and to plan appropriate strategies. This model is appropriate for use with groups of individuals regardless of culture and is particularly useful and appropriate in Canada where society is a mixture of people from different ethnic backgrounds, different political and religious persuasions, and different aspirations. This paper presents an overview of the cultural diversity among Canadians and then applies the model as an assessment tool that can be used by Canadian nurses.

Patients' use of denial: coping with the unacceptable.

Nurses working with terminally ill or bereaved clients and their families need to understand the defence mechanism of denial and how it helps people to cope with unacceptable physical and psychological threats.

Delegating to a transcultural team.

Six cultural phenomena must be considered when delegating to staff with a culturally diverse background. Communication, space, social organization, time, environmental control and biological variations encourage an understanding of unique cultural values, beliefs and practices.

Cultural implications for nursing care of the Amish.

The Amish are a conservative Protestant religious sect with a unique set of culture and traditions. In order to provide culturally appropriate and sensitive health care, it is imperative for nurses and other health care providers to have a basic understanding of variations of Amish lifestyle from other cultural groups. Application of Giger and Davidhizar's Transcultural Assessment Model provides information and nursing implications to assist nurses and other health care personnel when caring for Amish clients.

Finding meaning in illness. Can nurses help?

They are common comments from people facing a life-threatening or chronic illness: "Why did this happen to me? I don't deserve this." "Am I being punished for something? Why do I have to go through this?"

So you've been offered a management position.

As the demand for nurses opens management positions not previously available, nurses are increasingly facing the dilemma created by attractive job offers. Each nurse who is offered a management position needs to carefully assess her/his personal attributes as well as various factors about the position to determine the appropriateness of taking the position at the particular time. While few nurses manage the transition to management with ease, a poor decision can result in more than healthy growing pains. The deep trauma that may be inflicted by a painful experience in management may cause not only managerial burnout but even prompts some nurses to leave nursing. Premature timing in accepting a management position may not be in your best interest. On the other hand, a management position may offer you the challenge you have been waiting for and an opportunity to expand into a rewarding new nursing career.