Disentangling the relationships between staff nurses' workplace empowerment and job satisfaction.

AIM: The primary aim of this study was to examine the relationships between structural empowerment, psychological empowerment and job satisfaction among staff nurses, after controlling for their leaders' use of empowering behaviours. BACKGROUND: Nurses' job satisfaction is a critical factor in health-care organisations because of its association with nurse turnover and quality of patient care. Nurses continue to report high levels of job dissatisfaction. METHODS: Cross-sectional data for 1007 Canadian staff nurses were analysed using hierarchical multiple regression. RESULTS: Structural empowerment was the strongest independent predictor of job satisfaction, followed by leader empowering behaviours and psychological empowerment. After accounting for the effects of structural empowerment and leader empowering behaviours, the four dimensions of psychological empowerment showed only small independent effects on job satisfaction. Psychological empowerment did not mediate the effects of structural empowerment on job satisfaction. CONCLUSION: Nurses' job satisfaction is most influenced by their access to organisational empowerment structures. Leader empowering behaviours, structural empowerment, and psychological empowerment, operating together, enhance nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should use a variety of empowerment strategies that are important to nurses' job satisfaction and potentially to the quality of patient care and nurse turnover.

A method for obtaining and culturing large numbers of purified organ-derived murine endothelial cells.

Fibroblast growth factor 1 (FGF-1)-coated collagen-gelatin sponges were affixed to various tissues to generate vascular beds, in which the vessels originated in the tissue to which the sponges were affixed. Organ-derived endothelium was obtained from vascularized sponges implanted in or on the skin, peritoneal wall, abdominal mesentery, epimysium, spleen, and liver. Collagenase digestion yielded single-cell suspensions that were analyzed by flow cytometry. Approximately 25% of the cells were positive for the endothelial cell (EC) markers MECA-32 and Sca-1 and for uptake of diIAcLDL. Similar results were obtained when sponges were implanted in several different mouse strains, although there was some evidence of heterogeneity in the degree of vascularization and EC recovery. Long-term cultures of high purity were obtained when the ECs were grown on mitomycin C-treated L929 feeder layers, in medium supplemented with cis-hydroxyproline and FGF-1. These cells have been utilized in preliminary studies of T cell-EC binding. Thus we have developed a generalized method for the recovery and culture of organ-derived murine endothelial cells. This technique should greatly improve the feasibility of studies of the interactions between murine endothelial and immune effector cells.

Skin window chambers, a novel method for recovering the cells involved in delayed-type hypersensitivity.

A method is described for the recovery of cells involved in the delayed-type hypersensitivity (DTH) reaction in man. A small plastic chamber was placed over DTH sites from which the stratum corneum had been removed by tape stripping. The chambers were then filled with serum. Analysis of cells harvested at 24 and 48 h has shown an antigen-dependent increment in mononuclear and polymorphonuclear cells in donors with a DTH response. T cell clones were established from the recovered cells; these will provide a useful adjunct to a functional analysis of cells participating in the DTH reaction.

Quality-of-life factors in adolescent inflammatory bowel disease.

Little is known about the specific psychosocial factors that influence quality of life in adolescents with newly diagnosed inflammatory bowel disease (IBD). We adapted a model by Garrett and Drossman to assess adolescent adjustment to recent-onset IBD. Thirty adolescent-parent pairs completed a set of standardized questionnaires. The inclusion criteria were adolescents 12-18 years of age with Crohn's disease or ulcerative colitis of < 5 years' duration. Adolescents' health-related quality-of-life scores significantly correlated with satisfaction and degree of closeness with their social support members, such as parents. An unexpected finding was that the adolescents included more extended family than peers in their social support networks. Also of note was that parental coping styles rather than adolescent coping styles significantly correlated with adolescents' quality-of-life health scores. Severity of illness did not correlate with adolescent quality-of-life health scores. There was significant agreement between adolescent and parental quality-of-life health scores and stressful event ratings. Adolescents with recent-onset IBD rely more on family members than their peers for emotional support, and they depend more on their parents' coping skills than their own. These findings may indicate lags in normal adolescent development. Adolescents and parents do communicate and share concerns with each other. Support programs for adolescents with IBD should reinforce existing coping skills and parent-adolescent communication while promoting normative development.

Quantitative and qualitative study of the restoration by cytokines of mononuclear cell delivery to skin test sites in anergic surgical patients.

We tested the hypothesis that anergy is associated with reduced delivery of mononuclear cells (MNCs) to delayed-type hypersensitivity sites and that cytokine (CK)-rich supernatants from mixed lymphocyte cultures overcome the defect. Significantly fewer MNCs were delivered to skin window chambers placed over purified protein derivative (PPD) injection sites of previously sensitized anergic patients compared with hospitalized PPD-reactive patients; coinjection of CK with PPD restored the MNC delivery in anergic patients to normal levels. The T cells cloned from a PPD + CK site of an anergic patient consisted of CD4+ and CD8+ cells whose capacities included cytotoxicity and lymphokine production. The frequency of PPD-reactive cells was 15 times greater than in the blood. Thus, the restoration by CK of the delivery of antigen-specific cells capable of participating in cell-mediated immunity in anergic patients may be feasible.

Efficacy of a dry fibrin sealant dressing for hemorrhage control after ballistic injury.

OBJECTIVE: To determine if a dry fibrin sealant dressing (DFSD) will provide superior hemostasis when compared with regular gauze in a ballistic injury animal model. DESIGN: A nonsurvival randomized goat study. SETTING: A federal biomedical research institute. SUBJECTS: Eighteen anesthetized Angora goats. INTERVENTIONS: Uncontrolled hemorrhage was induced by a complex ballistic extremity injury. Control of hemorrhage was achieved by applying and holding pressure with the DFSD or regular gauze for 2 minutes. The dressings were left in place for 1 hour. MAIN OUTCOME MEASURES: Total blood loss, mean arterial pressure, ballistic injury, and mortality were recorded after 1 hour. RESULTS: The injuries were equivalent for the 2 groups. No animal mortality was seen. After 1 hour, the mean (+/-SEM) blood loss was 124+/-64 mL in the DFSD-treated group and 377+/-64 mL in the gauze dressings-treated group (P=.01). Twenty minutes after injury, the mean arterial pressure was 95.0 mm Hg (+/-SEM, +/-4.7 mm Hg) in the DFSD-treated group and 70.0+/-5.0 mm Hg in the gauze dressings-treated group. The difference persisted for the remainder of the study (P=.01). CONCLUSION: The DFSD was superior to gauze in decreasing blood loss and maintaining blood pressure while retaining the simplicity of standard dressing application.

Implications of new dry fibrin sealant technology for trauma surgery.

Trauma patients have been bleeding to death for thousands of years. The methods used to control hemorrhage (tourniquets, pressure, bandages, and ligatures) have not changed for 2000 years. Technology now exists to amplify the normal clotting system with human proteins, thus providing almost instant hemorrhage control in the face of bleeding. The increasing body of clinical and animal research and safety data regarding new fibrin sealant technologies is compelling. When combined with the evolving concepts of extended trauma resuscitation, acceptance of this technology will finally add a new method of rapid, easy hemostasis to the armamentarium of the surgeon faced with an unstable hemorrhaging patient. Several important issues remain unresolved, such as optimal thrombin and fibrinogen content, amount of material required for hemostasis, long-term effects, distribution of breakdown products, and role of recombinant proteins. These issues are under active investigation. Despite these unanswered questions, the field of absorbable, off-the-shelf, rapidly active hemostatic agents that do not require refrigeration is an exciting area that should yield significant improvements in the care of injured patients.

Fibrin sealant: current and potential clinical applications.

There are few well-controlled studies of the clinical efficacy of fibrin sealant, defined by lives saved or reduced need for blood transfusions. Evaluation of fibrin sealant in trauma situations, e.g. liver laceration, has been difficult to perform. Only recently has fibrin sealant been actively promoted by US manufacturers as a commercially valuable alternative to the relatively inexpensive crude bovine thrombin and cryoprecipitate that are in current use. Regulatory agencies and manufacturers are aware that patients in the USA are receiving a suboptimal form of fibrin glue since cryoprecipitate is not virally inactivated and has a variable fibrinogen concentration. In addition, bovine thrombin is not regulated with respect to factor V content or any other impurities. During the past year regulatory agencies, together with manufacturers and clinicians, have begun to define clinically valid endpoints for efficacy of a commercially prepared fibrin sealant. These may include improvement in hemostasis compared with a placebo or agents considered to be 'standard of care'. Thus, the regulatory agencies may be willing to consider studies in animals that demonstrate efficacy as well as surrogate endpoints, such as reduced factor concentrate requirements in patients with severe hemophilia requiring dental extraction. As fibrin sealant becomes available in a liquid and potentially in a bandage form, it may also become an essential matrix for recombinant factors that can affect endothelial function.

Delivery of demineralized bone powder by fibrin sealant.

The main purpose of this study was to determine whether the use of fibrin sealant as a delivery vehicle for demineralized bone powder would result in bone induction in heterotopic and orthotopic sites. Rat demineralized bone powder alone or in different concentrations of fibrin sealant matrix (4, 8, 15, and 45 mg/ml) was bioassayed for bone induction by implantation in intramuscular sites. Distribution of treatment groups was as follows: demineralized bone powder alone (n = 12), demineralized bone powder plus 4 mg/ml fibrin sealant (n = 11), demineralized bone powder plus 8 mg/ml fibrin sealant (n = 11), demineralized bone powder plus 15 mg/ml fibrin sealant (n = 11), demineralized bone powder plus 45 mg/ml fibrin sealant (n = 10), 4 mg/ml fibrin sealant (n = 13), and 45 mg/ml fibrin sealant (n = 11). In a second group of rats, 8-mm critical-sized calvarial defects were created and treated with demineralized bone powder plus 30 mg/ml fibrin sealant. Intramuscular implants were retrieved after 28 days, while calvarial implants were retrieved at 28 days (n = 8), 3 months (n = 8), or 4 months (n = 5). Implants were then x-rayed and submitted for histology. Results showed bone formation as evidenced by radiopacity and histology. Radiopacity measurements of demineralized bone powder implants alone or in a fibrin sealant matrix were associated with immature woven bone at the implantation site. Fibrin sealant allowed bone formation by demineralized bone powder to occur, improved the handling of demineralized bone powder, and facilitated the shaping of implants.

Nursing case management for children with failure to thrive.

The case management approach is described for children with nonorganic failure to thrive in the pediatric tertiary care setting. An advanced practice nurse facilitated the organization of a planning committee, the construction of a care path, and the evaluation of the case management model. A 4-day care path is presented to show staff nursing functions in the nurse case manager role. Special issues are discussed for developing care paths for organic-based failure to thrive where parent reports can help guide health care interventions.

Effect of fibrin bandage fibrinogen concentration on blood loss after grade V liver injury in swine.

OBJECTIVE: To determine the effect of fibrinogen concentration of dry fibrin bandages on blood loss after grade V liver injury. METHODS: Twenty-four pigs were used. Grade V liver injuries were induced and treated with dry fibrin bandages containing 0, 4, 8, or 15 mg fibrinogen/cm2. Animals were monitored for 60 minutes. Blood loss, fluid use, hematological data, and hemostasis were assessed. RESULTS: Post-treatment blood losses (mean and 95% confidence interval [CI]) were 1,560 mL (356-6,844), 372 mL (65-2,134), 225 mL (51-992), and 127 mL (22-732) in the 0-, 4-, 8-, and 15-mg groups, respectively. Only the 15-mg group had results significantly lower than the 0-mg group (p < 0.05). Blood loss was negatively related to fibrinogen concentration (p < 0.05). CONCLUSION: Fibrinogen concentration was inversely related to blood loss after grade V liver injury. The 15-mg formulation was the only one that significantly reduced blood loss.

Treatment of spent filter backwash water using dissolved air flotation.

There is increasing interest in treating recovered spent filter backwash water in the drinking water industry. In the USA the Filter Backwash Recycling Rule will come into effect in the near future. The purpose of the Rule is to prevent the concentrated pathogenic agents, potentially in the filter backwash water, from being returned to the head of the water treatment works without some form of treatment or dilution. By treating this flow both public health and financial liability can be better managed by the operating utility. Dissolved Air Flotation (DAF) was investigated as a possible technology alternative to simple or advanced sedimentation techniques. This application is not widespread but sits somewhere in between the two normal applications of DAF as a high solids sludge thickener and a low turbidity clarification system. Given this a pilot plant program, supported by jar testing, was undertaken to determine the process capability and the design parameters for this application. DAF proved to be very suitable for backwash water recovery. DAF effluent turbidities of < 1.0 NTU could be easily obtained, when raw water turbidities were in excess of 50 NTU. Chemical requirements were low with only a single low dose of polymer required to bind the floc particles to form a solids matrix suitable for flotation. Flocculation contact times ranged from 0-10 minutes depending on the nature of the raw water. Recycle rates as low as 5% performed satisfactorily with no significant improvement when increased to 20%. Sludge solids of 3.5-9.6% dry solids were found and very low volumes of sludge, < 0.1% of the incoming flow make the DAF solids handling system very compact.

The family systems approach and pediatric nursing care.

The pediatric nurse is increasingly called upon to function as a family specialist, yet many nurses have assumed this role with little or no training in family systems theory. The family systems approach to pediatric nursing care maximizes family strengths. The nurse and family collaborate to identify important family needs and to match needs with resources. The primary goal is family empowerment. A basic understanding of the family systems approach to assessment and intervention can help pediatric nurses function more effectively in this role.

Teaching nurses about neuromotor development: an evaluative study.

A neuromotor screening tool, The Chandler Movement Assessment of Infants Screening Test (CMAI-ST), was selected to teach nurses who care for premature infants about neuromotor development. After training with the CMAI-ST, the nurses were more adept at recognizing major components of neuromotor development.

Testing the effects of an empowerment-based leadership development programme: part 1 - leader outcomes.

AIM: To determine if a leadership development programme based on an empowerment framework significantly increased leaders' use of empowering behaviours. BACKGROUND: Leadership programmes are effective ways to prepare nurse leaders for their complex roles. Relational competencies, such as leader empowering behaviours, are associated with improved leader, staff and practice environment outcomes. METHODS: A quasi-experimental, pre-test-post-test design was used to compare perceptions and self-reported behaviours of leaders who participated in a year-long leadership programme with those of similar leaders who did not attend the programme. Multiple regression analyses were used to evaluate a conceptual framework of leader empowerment. RESULTS: The leadership programme was directly associated with leaders' perceptions of using more empowering behaviours. Leader empowering behaviours were also associated with feelings of being structurally empowered, mediated through feelings of being psychologically empowered, although the source of empowerment needs further investigation. CONCLUSIONS: Leaders' use of empowering behaviours can be increased through focused training and through a workplace empowerment process. IMPLICATIONS FOR NURSE MANAGEMENT: Leader empowering behaviours have been shown to be associated with more engaged staff and healthier work environments. Based on study results, we suggest that these behaviours are teachable, and they should be emphasized in leadership development programmes.

Testing the effects of an empowerment-based leadership development programme: part 2 - staff outcomes.

AIM: To determine if nurse leaders' attendance at a leadership development programme based on an empowerment framework would increase staff perceptions of organisational support and organisational commitment. BACKGROUND: Leadership empowering behaviours are teachable relational competencies that have been associated with quality leader-staff relationships and positive staff outcomes. METHODS: A quasi-experimental, pre-test-post-test design was used to compare perceptions of staff whose leaders participated in a year-long leadership programme with staff of similar leaders who did not attend the programme. A series of multiple regression analyses were used to test the conceptual model of programme effects. RESULTS: Leaders' programme participation was directly associated with greater staff organisational commitment 1 year after the programme. Both programme attendance and leader-empowering behaviours were found to act as independent catalysts for staff empowerment, with structural empowerment partially mediating the effects of leader empowering behaviours on organisational commitment. CONCLUSIONS: Leader participation in a development programme based on an empowerment framework may be an important means of increasing staff organisational commitment, a key predictor of staff turnover. IMPLICATIONS FOR NURSE MANAGEMENT: Leadership development programmes should emphasize relational competencies, including leader empowering behaviours, given their potential for enhancing organisational commitment.

Hospital networking. Comparing the work of nurses with flexible and traditional schedules.

OBJECTIVE: This research study was conducted to contrast workplace socialization of nurses working flexible (flex) and traditional schedules in an acute care setting. The study illustrates the types of social networks used by both types of nurses in a reengineered healthcare environment. SUMMARY BACKGROUND DATA: Reengineering strategies, such as flex nurse staffing, add a new dimension to workplace change and adaptation. Few studies have examined the similarities and differences between nurses working flex and traditional schedules. The research literature shows that workplace socialization significantly affects job satisfaction, organizational commitment, and retention. No studies have examined how the process of socialization--forming social networks--differs for nurses working traditional or flex schedules. METHODS AND SUBJECTS: A convenience sample of 120 nurses working traditional schedules and 46 nurses working flex schedules from a pediatric, tertiary care setting completed the Social Network Questionnaire (SNQ), a standardized instrument that records individuals' social network composition and function. RESULTS: No significant differences were found in the nurses' social network composition. Both types of nurses constructed peer-based networks and nurse managers were also present in their networks. Nurses working traditional schedules used significantly more peer members for different types of emotional support, such as reassurance and handling emotional upsets. CONCLUSIONS: Workplace networks are important to both types of nurses. Nurses on flex schedules may form less social attachments in order to manage the increased demands of moving among multiple units. This group of nurses can provide clues for adaptive change in reengineered environments.

A clinical tool for nonorganic failure-to-thrive feeding interactions.

An interdisciplinary team of professionals developed and piloted a clinical tool, the Feeding Checklist, for assisting observations of feeding interactions with nonorganic failure-to-thrive (NOFTT) clients. The piloting process involved two phases. During the development phase, content validity and reliability were established with three NOFTT experts. The tool was compared with a standardized feeding interaction assessment instrument to determine concurrent validity. Both tools revealed similar behavior patterns significantly differentiating between NOFTT and Thriving dyads. The results also concurred with NOFTT literature findings. During the second phase of the study, pediatric nursing staff significantly improved the nursing documentation of NOFTT feeding interactions when using the Feeding Checklist.

Change in the hospital setting: adopting a team approach for nonorganic failure-to-thrive.

The change process is described for the adoption of a multidisciplinary team approach to nonorganic failure-to-thrive (NOFTT) management at a pediatric care facility. A member of the nursing staff acted as a change agent. The need for change was documented with medical record audits. A team was developed and a management protocol derived from an external evaluation of successful programs described in the literature. Preliminary outcomes of the project are reported. Box 1 at the end of this article contains criteria for NOFTT diagnosis and an outline of the team's protocol.

Subverting bacterial resistance using high dose, low solubility antibiotics in fibrin.

Antibiotics (ABs) delivered from fibrin were evaluated for control of multi-drug resistant (MDR) Staphylococcus aureus. ABs having low aqueous solubility (< or = 1 mg/ml) were encapsulated by fibrin (composed of fibrinogen, thrombin, Factor XIIIa and calcium chloride) and examined. Electron microscopy revealed fibrin-caged, tetracycline crystals that were 0.26 to 2.8 microns in size and bound within the reticular matrix. Antibiograms documented that S. aureus ATCC 27659 was resistant to erythromycin (ERY), penicillin G (PEN), streptomycin (STR), sulfamethoxazole-trimethoprim (SXT) and tetracycline (TET). However, low solubility formulations of STR (10 mg/ml) or SXT (0.5 mg/ml), delivered from fibrin and evaluated by the agar disk diffusion assay, produced zones of growth inhibition after 18-24 h at 37 degrees C in vitro, indicating renewed susceptibility of S. aureus ATCC 27659 to these ABs. ERY, PEN and TET were unable to overcome resistance at concentrations up to 10 mg/ml. In vivo, intraperitoneal (i.p.) injection of 150 mg/kg STR delivered from fibrin resulted in 100% survival of rats with MDR S. aureus peritonitis as compared with control rats receiving i.p. STR (150 mg/kg) in 0.9% saline. The results demonstrate that some low solubility ABs delivered from fibrin are efficacious in controlling infection mediated by MDR S. aureus.