The digestive system: part 2.

This article, which forms part of the life sciences series and is the second of two articles on the digestive system, explores the structure and function of the liver, gall bladder and pancreas. It is important that nurses understand how the digestive system works and identify its role in maintaining health. The gross structures of the liver, gall bladder and pancreas associated with the gastrointestinal tract are described, along with relevant physiology and pathologies.

The digestive system: part 1.

This article, which forms part of the life sciences series and is the first of two articles on the digestive system, explores the structure and function of the digestive system. It is important that nurses understand how the digestive system works and its role in maintaining health. The article describes the gross structure of the gastrointestinal tract along with relevant physiology. It also outlines several disorders of the gastrointestinal tract and their treatment and nursing management. The second article will explain the liver, pancreas and gall bladder and their digestive functions, and provides a brief overview of the disorders of chronic liver disease, pancreatitis and gallstones.

The urinary system.

The urinary system plays an important role in regulating fluid and electrolyte balance and maintaining homeostatic balance within the body. Assessment and management of fluid and electrolyte balance is a vital part of the nurses' role, therefore it is important that nurses understand the functions of the urinary system. This article explores the anatomy and physiology of the urinary system, with reference to the production and excretion of urine. It also provides an overview of urinary tract infection.

Nervous system: part 1.

This article, which forms part of the life sciences series and is the first of three articles on the nervous system, explores the major divisions of the nervous system and their functions. The basic structure of a nerve cell is described, and generation and conduction of nerve impulses is discussed. Blood supply to the brain is also covered. The second article will examine the central nervous system (CNS) in greater detail, including protection of the CNS, and the structure and function of the cerebral cortex and cerebellum. The third article will examine the peripheral nervous system and the autonomic nervous system, and provides an overview of some of the disorders of the nervous system.

Fluid and electrolyte balance.

Assessment and careful maintenance of fluid and electrolyte balance in patients is an essential part of the nurse's role. This article explores fluid and electrolyte balance with reference to the normal physiology of body fluids and regulation of fluids and electrolytes. It also considers some common conditions associated with fluid imbalance.

Function of the immune system.

This article, which forms part of the life sciences series, explores the function of the immune system. It is important that nurses understand how the immune system works and its role in the prevention of infection. Innate and adaptive immunity are described and the differences between these two types of immune response are discussed. The acquisition and development of a competent immune system are also explored.

Respiratory system part 1: pulmonary ventilation.

This article, which forms part of the life sciences series and is the first of two articles on the respiratory system, describes the anatomy of the respiratory system and explains the mechanics of respiration. It provides a brief overview of three common respiratory disorders: pneumonia, pulmonary embolism and pulmonary tuberculosis. The second article discusses gaseous exchange and the control of ventilation in more detail.

Respiratory system. Part 2: Gaseous exchange.

This article, which isthe last in the life sciences series and the second of two articles on the respiratory system, describes gaseous exchange in the lungs, transport of oxygen and carbon dioxide, and internal and external respiration. The article concludes with a brief consideration of two conditions that affect gas exchange and transport: carbon monoxide poisoning and chronic obstructive pulmonary disease.

Seeking Approval from Universities to Research the Views of Their Staff. Do Gatekeepers Provide a Barrier to Ethical Research?

A "gatekeeper" controls access to an organization; "gatekeeper approval" is often needed before external research can take place within an organization. We explore the need for gatekeeper approval for research with university staff employing, as a case study, a project which collected data in Australia. This case study addresses known issues, seemingly rarely addressed in the literature. The Human Research Ethics Committee (HREC)'s requirement for approval from individual universities to approach their staff brought significant consequences, exacerbated by the lack of university procedures for such approvals. Simultaneously, since invitations could legitimately be distributed via other avenues, such approval was superfluous. We recommend the HREC's blanket requirement for institutional approval instead be considered on a case-by-case basis depending on the risk of the research, and perhaps waived for low-risk research where participants are able to provide informed consent, and that universities establish processes to deal with requests from external researchers.

Indicators of acute deterioration in adult patients nursed in acute wards: a factorial survey.

OBJECTIVES: The primary objective of the study was to determine which professional, situational and patient characteristics predict nurses' judgements of patient acuity and likelihood of referral for further review. A secondary aim was to test the feasibility of the factorial survey method in an acute area. BACKGROUND: There is increasing recognition that indicators of deterioration in acutely unwell adults are being missed and referrals delayed. The reasons for this are unclear and require exploration. Assessing nurses' clinical decision-making or judgements in a 'real-world' situation is problematic. DESIGN: The study used a factorial survey design where participants completed randomly generated paper-based vignettes on one occasion. METHODS: The dependent variables were assessment of patient acuity and likelihood of referral. Independent variables consisted of a number of patient characteristics, i.e. heart rate, blood pressure, nurse characteristics, i.e. clinical experience, and situational characteristics i.e. staffing. SETTING AND PARTICIPANTS: Participants were registered nurses working in acute areas excluding intensive care and theatre. Ninety-nine participants responded resulting in 1940 completed vignettes. RESULTS: An early warning score was the single most significant predictor of referral behaviour accounting for 9.6% of the variance. When this was not included in the vignette, nurses used physiological characteristics e.g. respiratory rate, urine output, neurological status. These explained 12% of the variance in the model predicting assessment of patient acuity and 9.4% or the variance predicting likelihood of referral. CONCLUSIONS: When given a series of vignettes, nurses appear to use appropriate physiological parameters to make decisions about patient acuity and need for referral. Our results support the use of early warning scoring systems. Education and professional development should focus more on developing and maximising clinical experience and expertise rather than knowledge acquisition alone. A factorial survey method is feasible to explore decision-making in this area. RELEVANCE TO PRACTICE: This study has several implications for practice. The emergence of an early warning scoring system as a significant individual predictor supports the use of such systems. However, the small amount of explained variance suggests that there are other influences on nurses' assessment of patient acuity and referral decisions that were not measured by the factorial survey approach. Educational provision might focus not just on knowledge acquisition but include educational delivery methods that incorporate or mimic real-ward settings.

A survey of early-career researchers in Australia.

Early-career researchers (ECRs) make up a large portion of the academic workforce and their experiences often reflect the wider culture of the research system. Here we surveyed 658 ECRs working in Australia to better understand the needs and challenges faced by this community. Although most respondents indicated a 'love of science', many also expressed an intention to leave their research position. The responses highlight how job insecurity, workplace culture, mentorship and 'questionable research practices' are impacting the job satisfaction of ECRs and potentially compromising science in Australia. We also make recommendations for addressing some of these concerns.

Bronchiectasis: pathophysiology, presentation and management.

Bronchiectasis, although not as common as other respiratory disorders, can be life-limiting and remains a significant problem for many patients, as well as being a considerable challenge for nurses caring for this patient group. This article examines the pathophysiology and presentation of bronchiectasis and identifies various management strategies.

How to undertake a nutritional assessment in adults.

RATIONALE AND KEY POINTS: Nutritional assessment in adults should begin on first contact with the patient, and is an ongoing process that can take place over several hours or days. A comprehensive nutritional assessment involves the nurse examining the patient's physical and psychological state, as well as considering any social issues that may affect their nutrition. REFLECTIVE ACTIVITY: 'How to' articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

Pathophysiology and nursing management of acute pancreatitis.

Acute pancreatitis is a potentially life-threatening condition primarily associated with gallstones or prolonged and excessive alcohol intake. Although the initial triggers of the condition can vary, the resulting pathophysiology is broadly similar irrespective of the cause. This article explores the pathophysiology of the main causes of acute pancreatitis, and discusses nursing management of the condition in the acute setting and the long-term issues to consider. It also outlines the conservative management of the condition, which includes pain management, provision of fluids and nutritional care. In the management of acute pancreatitis, nursing care can often overlap with medical management, especially as the condition deteriorates. Therefore, it is important that nurses develop comprehensive knowledge of the management of acute pancreatitis.

Physiological risk factors, early warning scoring systems and organizational changes.

Currently, medical and surgical wards tend to have a higher number of sicker and more dependent patients. There is also a growing recognition that several indicators of acute deterioration are being missed, leading to adverse consequences for the patients. As a result, many initiatives have been designed to try to reduce these consequences, including the development of early warning scoring or track and trigger systems and medical response and critical care outreach teams. This paper briefly discusses the risk factors associated with acute deterioration, the use of early warning scoring or track and trigger systems and the role of outreach teams. The aim of this paper is to discuss the development and subsequent implementation of early warning scoring systems (EWS) or track and trigger systems. It will also discuss the associated organizational changes; the main organizational change discussed will be the introduction outreach teams. For this paper, a pragmatic search strategy was implemented using the following terms: early warning score and scoring, track and trigger systems, decision-making tools, critical care outreach and medical emergency teams. The databases used included CINHAL (1997-2007), Medline, Blackwell Synergy and Science Direct, as these would enable the retrieval of relevant literature in the area of triggering of response to acute deterioration in clinical condition. A 10-year limit was initially set, although review of the literature identified resulted in a widening of this to include some of the relevant (and occasionally more dated) literature referred to in these papers. A total of 645 were accessed; of these 135 were retrieved as they appeared to meet the inclusion criteria, but only 35 have been included in this review. The term decision-making tools accounted for the largest number (500), but most of these were irrelevant. EWS are not always used to their full potential, raising the question of their impact. The impact of outreach teams and medical emergency teams has yet to be fully defined. For clinical practice, this means that care must be taken when developing and implementing these changes. The rigour of the development process needs to be considered along with reflection upon how to best meet local requirements.

Nurses' role in nutritional assessment and screening (second of a two-part series).

Nutrition is a key issue for healthcare professionals yet the management of nutritional problems by staff is often poor. Malnutrition is recognised as a significant risk for patients in hospital, a risk that nurses have a responsibility to monitor. The first article in this two-part series looked at initial assessment. This article looks at more specific tests that can be used to identify those at risk.

Nurses' role in nutritional assessment and screening: Part one of a two-part series.

This article (part one of two) explores the importance of nutritional assessment and the basic tools for identifying those at risk of malnutrition.

An overview of the management of patients with chronic pancreatitis.

Chronic pancreatitis is a complex inflammatory condition characterised by irreversible damage to the pancreas. This article explores the pathophysiology of this condition and its effects on pancreatic function. It outlines the causes and presenting features of chronic pancreatitis, as well as its effect on patients' quality of life and the changes to their lifestyle that are likely to be required. Chronic pancreatitis cannot be cured; therefore, treatment aims to control pain, manage problems associated with malabsorption, and assess and manage long-term complications that may develop, such as insulin dependence.

The physiological basics of wound healing.

Nurses regularly take the lead in wound management. They should have a good general knowledge of the normal structure and function of skin. This article outlines the process of wound healing to enhance wound care practice. Normal anatomy of the skin is described followed by a review of the four phases of wound healing.