Evidence into action: a policy brief exemplar supporting attainment of nursing now.

AIM: To provide a framework for the production of policy briefs, and offer a practical example of how evidence can be turned into a succinct document to inform policy and bring about change targeted at delivering universal health coverage. INTRODUCTION: Policymakers are too busy, or do not have the necessary expertise, to read and comprehend complex scientific papers. As a result, policy briefs that capture and present the essential points are needed if evidence-informed policy is to be developed and implemented. METHOD: A two-page example of how evidence from meta-analytical and systematic reviews can be presented to identify options and recommendations to address a major global disease burden. RESULTS: The example uses a simple, seven-section template for developing a policy brief. The essential characteristics of each section are provided. The briefing, targeted at the global level, provides information on the major challenges associated with the treatment of individuals with diabetes. DISCUSSION AND CONCLUSIONS: This paper demonstrates how to use existing research evidence to address the pursuit of UHC relevant to a wide range of geographies, settings or disadvantaged groups. IMPLICATIONS FOR POLICY: Gaps in universal health coverage and major disease burdens such as diabetes can be pursued through entities such as country-based Nursing Now groups. In addition, ongoing opportunities exist through the International Council of Nurses annual International Nurses Day and WHO's regular regional meetings to inform and influence policy discussions at national and subnational levels. By focusing on a small number of global topics each year, measurable changes in addressing the burden of disease can be achieved while simultaneously keeping the nursing profession's contribution centre stage.

Evidence-based policy: nursing now and the importance of research synthesis.

AIM: This study explores how scholarship relating to meta-analytical studies and systematic and integrative reviews can inform nursing's contribution to universal health coverage. INTRODUCTION: As nursing globally embraces the 200th anniversary of the birth of Florence Nightingale, the Nursing Now social movement has called for the profession to improve universal health coverage through increasing nursing's policy voice. METHODS: In determining how the Nursing Now social movement could pursue the aim of this study, researchers undertook a comparative bibliometric analysis of scholarship relating to the systematic curation of evidence. This study uses a mixed-method analysis of the bibliometric data available through extracting and synthesizing information from one of the commercially produced indexing and citation databases. RESULTS: Generally, medicine has contributed far more synthesized contributions than nursing, except in the case of integrative reviews. Co-occurrence analysis of nursing literature through examination of key terms yielded a complex visualization of 11 specific clusters of scholarship (Care of the Older Person, Nurse Education, Emergency and Critical Care, Occupational Health and Safety, Rural Services, Anxiety and Depression, Measurement, Newborn and Post-natal Health, Cardiovascular Disease, Preventative Health and Cancer Care). DISCUSSION AND CONCLUSIONS: Bibliometric analysis of curated evidence demonstrates that there is ample nursing-relevant material to inform evidence-based policy change directed towards the attainment of universal health coverage and several of the Sustainable Development Goals. IMPLICATIONS FOR POLICY: Nursing literature is available to support policy change directed towards the pursuit of universal health coverage and sustainable development goals. Leveraging existing networks of research collaboration to increase research capacity through communities of scholarship or by twinning experienced and neophyte contributors is possible. Further work is needed to equip nurses with the competencies to navigate the policy environment and develop and deliver impactful policy messaging.

Sustaining a Global Social Network: a quasi-experimental study.

AIM: To examine the longer term impact on the social network of participating nurses in the Global Nursing Leadership Institute (GNLI2013) through using differing frequencies of follow-up to assess impact on maintenance of network cohesion. BACKGROUND: Social network analysis is increasingly been used by nurse researchers, however, studies tend to use single point-in-time descriptive methods. METHOD: This study utilizes a repeated measures, block group, control-intervention, quasi-experimental design. Twenty-eight nurse leaders, competitively selected through a double-blind peer review process, were allocated to five action learning-based learning groups. Network architecture, measures of cohesion and node degree frequency were all used to assess programme impact. RESULTS: The programme initiated and sustained connections between nurse leaders drawn from a geographically dispersed heterogeneous group. Modest inputs of two to three e-mails over a 6-month period seem sufficient to maintain connectivity as indicated by measures of network density, diameter and path length. LIMITATIONS: Due to the teaching methodology used, the study sample was relatively small and the follow-up data collection took place after a relatively short time. Replication and further cohort data collection would be advantageous. CONCLUSIONS AND POLICY IMPLICATIONS: In an era where many policy solutions are being debated and initiated at the global level, action learning leadership development that utilizes new technology follow-up appears to show significant impact and is worthy of wider application. The approach warrants further inquiry and testing as to its longer term effects on nursing's influence on policy formulation and implementation.

An integrative review of pursing policy and political competence.

INTRODUCTION: For several decades, there have been repeated calls for nurses to become more involved in policy and political processes. AIMS: The purpose of this article is to conduct an integrative review to identify and assess the current state of the science relating to supporting the pursuit of greater involvement by the nursing profession in policy and political processes. DESIGN: Standard integrative review procedures were used to identify studies that examined how policy competence could be achieved. A comparative thematic approach to synthesis was used. Both published and grey literature written in English between January 1965 and January 2015 were identified via a structured search of CINAHL, SCOPUS, Science Direct and Google Scholar. RESULTS: Forty-five primary studies were identified with literature from North America dominating, but contributions from low- and middle-income countries have recently started to feature. Studies tended to focus on the immediate impact of didactic and action learning-based approaches. The majority of articles were descriptive survey designs utilizing small convenience samples. CONCLUSIONS AND POLICY IMPLICATION: Many programmes of education have focused on developing an understanding of legislative policy and political processes, but the development of policy and political competencies at team and institutional levels has been ignored. Existing research have looked at the short-term effects of educational programmes. At this time, there are conflicting reports on the impact of variables such as gender and educational preparation on policy and political competence. There is an urgent need to address these major gaps if nurses at all levels are to play a full role in shaping policy and political process.

A bibliographic exploration of nursing's scope of practice.

AIM: To conduct a bibliographic analysis of the indexed literature relating to scope of practice in nursing so as to identify underlying patterns in journal publication, volume of scholarly work over time, countries of origin, central contributors, academic affiliation and the major dimension of the studies conducted. METHODS: A systematic search of the Scopus database provided data that was then extracted and utilized to undertake a bibliometric analysis of published work relating to scope of practice. In addition to identification of aggregated metrics relating to the most frequently occurring journals and most cited authors, a co-word analysis was conducted. RESULTS: A total of 2730 articles with the term Scope of Practice in the Title, Abstract or Keywords were identified. Co-word analysis revealed five major themes - Changing Regulatory Environment; Health Care Drivers; Competence & Role Implementation; Policy Context; and Role Evolution & Role Differentiation. CONCLUSIONS AND POLICY IMPLICATIONS: From a policy perspective, we conclude that bibliographic analysis of the indexed literature is a useful technique that can augment our understanding of key regulatory issues such as scope of practice. However, the overemphasis on advanced practice in the scope of practice literature coupled with the increased interest in task shifting to support-personnel as governments pursue the goal of universal health coverage may leave nursing inadequately prepared to inform any evidence-based policy change.

Analysis of a global random stratified sample of nurse legislation.

AIM: To identify, compare and contrast the major component parts of heterogeneous stratified sample of nursing legislation. BACKGROUND: Nursing legislation varies from one jurisdiction to another. Up until now no research exists into whether the variations of such legislation are random or if variations are related to a set of key attributes. METHODS: This mixed method study used a random stratified sample of legislation to map through documentary analysis the content of 14 nursing acts and then explored, using quantitative techniques, whether the material contained relates to a number of key attributes. These attributes include: legal tradition of the jurisdiction; model of regulation; administrative approach; area of the world; and the economic status of the jurisdiction. FINDINGS: Twelve component parts of nursing legislation were identified. These were remarkably similar irrespective of attributes of interest. However, not all component parts were specified in the same level of detail and the manner by which the elements were addressed did vary. A number of potential relationships between the structure of the legislation and the key attributes of interest were identified. CONCLUSIONS AND IMPLICATIONS FOR POLICY: This study generated a comprehensive and integrated map of a global sample of nursing legislation. It provides a set of descriptors to be used to undertake further quantitative work and provides an important policy tool to facilitate dialogue between regulatory bodies. At the individual nurse level it offers insights that can help nurses pursue recognition of credentials across jurisdictions.

A systematic review of nurse-related social network analysis studies.

BACKGROUND: Nurses frequently work as part of both uni- and multidisciplinary teams. Communication between team members is critical in the delivery of quality care. Social network analysis is increasingly being used to explore such communication. AIM: To explore the use of social network analysis involving nurses either as subjects of the study or as researchers. METHODS: Standard systematic review procedures were applied to identify nurse-related studies that utilize social network analysis. A comparative thematic approach to synthesis was used. Both published and grey literature written in English, Spanish and Portuguese between January 1965 and December 2013 were identified via a structured search of CINAHL, SciELO and PubMed. In addition, Google and Yahoo search engines were used to identify additional grey literature using the same search strategy. RESULTS: Forty-three primary studies were identified with literature from North America dominating the published work. So far it would appear that no author or group of authors have developed a programme of research in the nursing field using the social network analysis approach although several authors may be in the process of doing so. LIMITATIONS: The dominance of literature from North America may be viewed as problematic as the underlying structures and themes may be an artefact of cultural communication norms from this region. CONCLUSIONS: The use of social network analysis in relation to nursing and by nurse researchers has increased rapidly over the past two decades. The lack of longitudinal studies and the absence of replication across multiple sites should be seen as an opportunity for further research. IMPLICATION FOR NURSING AND HEALTH POLICY: This analytical approach is relatively new in the field of nursing but does show considerable promise in offering insights into the way information flows between individuals, teams, institutions and other structures. An understanding of these structures provides a means of improving communication.

Defining nurse regulation and regulatory body performance: a policy Delphi study.

CONTEXT: Professional self-regulation is a privilege and needs to deliver against the underpinning social contract between the professional and citizens who are receiving care and services. AIMS: The aims of this study were to generate, international consensus on a contemporary definition of professional nurse regulation; and to articulate the key features of a highly performing regulatory body, and postulate which regulatory model and administrative arrangements are best suited to attain the key features. METHOD: A highly diverse and globally recruited random stratified sample of 75 experts was approached to participate in a classic three-round policy Delphi study. Quantitative and qualitative data were generated and subjected to thematic and statistical analysis. Both non-parametric and descriptive statistical techniques were used in relation to quantitative data. RESULTS: Consensus on a revision of the current International Council of Nurses definition of professional nurse regulation was developed and a set of 47 key features of high-performing regulatory bodies was agreed. Although a strong preference for the delegated self-regulatory model (43%) and single-board administrative approach (48%) was expressed the underlying rationale for such a preference was unclear. CONCLUSION: The research makes an important contribution to an underdeveloped field of study. The case for conducting more quantitative investigations to ascertain the best regulatory model and associated administrative approach has been made.

Nurse faculty migration: a systematic review of the literature.

BACKGROUND: To undertake a systematic review of English and Spanish literature relating to nurse faculty migration. METHODS: A systematic review of both published literature, using CINAHL, EMBASE, ERIC and MEDLINE, and grey literature, using Google and Yahoo search engines, utilizing a defined search strategy with key terms, wild card strings and logical operators, was undertaken. An initial limitation of searching for material published in the last ten years was removed due to the poor yield of relevant papers. In total, 18 research-based studies were identified, retrieved and reviewed. Finally, the retrieved material was reviewed and augmented by a group of nurse faculty and migration experts, who offered comments and proposed additional grey literature. With increased globalization, the impact of mutual recognition agreements and associated modes of supply of services as well as those factors influencing clinical nurse migration was also considered. RESULTS: Studies on clinical nurse migration and general academic faculty provided some insights, but nursing faculty differ in a number of key ways and this needs to be considered when interpreting the results. Based on this systematic review, the paper concludes that nurse faculty migration is a neglected topic and one that warrants urgent investigation if health systems redesign and the associated scale-up of nurses are to be achieved. Particular gaps in knowledge relate to nurse faculty workforce planning, and understanding the dynamics and flows of faculty both across and within countries. It is unclear as to the extent to which our knowledge of push and pull factors relating to clinical nurse migration can be used in understanding nurse faculty migration. CONCLUSION: The current policy position of organizations such as the World Health Organization and individual governments to increase nursing numbers is incomplete without due consideration of faculty migration.

A structured policy review of the principles of professional self-regulation.

BACKGROUND: The International Council of Nurses (ICN) has, for many years, based its work on professional self-regulation on a set of 12 principles. These principles are research based and were identified nearly three decades ago. ICN has conducted a number of reviews of the principles; however, changes have been minimal. In the past 5-10 years, a number of authors and governments, often as part of the review of regulatory systems, have started to propose principles to guide the way regulatory frameworks are designed and implemented. These principles vary in number and content. OBJECTIVES: This study examines the current policy literature on principle-based regulation and compares this with the set of principles advocated by the ICN. DESIGN AND DATA SOURCES: A systematic search of the literature on principle-based regulation is used as the basis for a qualitative thematic analysis to compare and contrast the 12 principles of self-regulation with more recently published work. RESULTS: A mapping of terms based on a detailed description of the principles used in the various research and policy documents was generated. This mapping forms the basis of a critique of the current ICN principles. A professional self-regulation advocated by the ICN were identified. CONCLUSIONS: A revised and extended set of 13 principles is needed if contemporary developments in the field of regulatory frameworks are to be accommodated. These revised principles should be considered for adoption by the ICN to underpin their advocacy work on professional self-regulation.

SK3 is an important component of K(+) channels mediating the afterhyperpolarization in cultured rat SCG neurones.

1. Our aim was to identify the small-conductance Ca(2+)-activated K(+) channel(s) (SK) underlying the apamin-sensitive afterhyperpolarization (AHP) in rat superior cervical ganglion (SCG) neurones. 2. Degenerate oligonucleotide primers designed to the putative calmodulin-binding domain conserved in all mammalian SK channel sequences were employed to detect SK DNA in a cDNA library from rat SCG. Only a single band, corresponding to a fragment of the rSK3 gene, was amplified. 3. Northern blot analysis employing a PCR-generated rSK3 fragment showed the presence of mRNA coding for SK3 in SCG as well in other rat peripheral tissues including adrenal gland and liver. 4. The same rSK3 fragment enabled the isolation of a full-length rSK3 cDNA from the library. Its sequence was closely similar to, but not identical with, that of the previously reported rSK3 gene. 5. Expression of the rSK3 gene in mammalian cell lines (CHO, HEK cells) caused the appearance of a K(+) conductance with SK channel properties. 6. The application of selective SK blocking agents (including apamin, scyllatoxin and newer non-peptidic compounds) showed these homomeric SK3 channels to have essentially the same pharmacological characteristics as the SCG afterhyperpolarization, but to differ from those of homomeric SK1 and SK2 channels. 7. Immunohistochemistry using a rSK3 antipeptide antibody revealed the presence of SK3 protein in the cell bodies and processes of cultured SCG neurones. 8. Taken together, these results identify SK3 as a major component of the SK channels responsible for the afterhyperpolarization of cultured rat SCG neurones.

Synthesis and structure-activity relationships of cetiedil analogues as blockers of the Ca(2+)-activated K+ permeability of erythrocytes.

Cetiedil, [2-cyclohexyl-2-(3-thienyl)ethanoic acid 2-(hexahydro-1H-azepin-1-yl)ethyl ester], which blocks the intermediate calcium-activated potassium ion permeability (IK(Ca)) in red blood cells, was used as a lead for investigating structure-activity relationships with the aim of determining the pharmacophore and of synthesizing agents of greater potency. A series of compounds having structures related to cetiedil was made and tested on rabbit erythrocytes. Channel blocking activity within the series was found to correlate well with octanol-water partition coefficients but not with the specific chemical structure of the acid moiety. However, whereas log P for the compounds spans a range of values over 4 orders of magnitude, potency only increases by 2 orders. This suggests that hydrophobic interactions with an active site on the channel are probably not the main determinants of activity. It seems more likely that increased lipophilicity enhances access to the channel, probably from within the cell membrane. In keeping with this interpretation, cetiedil methoiodide was found to be inactive. Triphenylethanoic was found to be a more effective acid grouping than 2-cyclohexyl-2-(3-thienyl)ethanoic, and its 2-(hexahydro-1H-azepin-l-yl)ethyl ester (11) was approximately 3 times more potent than cetiedil. The 9-benzylfluoren-9-yl carboxylic acid ester (21) was found to be approximately 9 times more active than cetiedil, and replacing -CO(2)- in 21 by an ethynyl (-C identical to C-) linkage (compound 26, UCL 1608) increased potency by some 15-fold over that of cetiedil.

Giant cell reparative granuloma of the small bones of the hands and feet: a report of three cases.

Giant cell reparative granuloma (GCRG) involving the small tubular bones of the hands and feet is a rare entity that can have a wide range of morphologic presentations and can be confused with more aggressive tumors. Awareness of this lesion is important to avoid diagnostic errors and potential mismanagement. We report three cases of GCRG that involve the small tubular bones of the hands and feet, with long-term follow-up periods that confirm a benign course. Previous reports included the differential diagnosis of giant cell tumor, brown tumor of hyperparathyroidism, aneurysmal bone cyst, and non-ossifying fibroma. The presence of chondroid material in two of our cases, one of which also shows atypical nuclei and a periosteal reaction, expands the differential diagnosis to include bone- and cartilage-forming neoplasms.

Differences in the actions of some blockers of the calcium-activated potassium permeability in mammalian red cells.

1. The actions of some inhibitors of the Ca2+-activated K+ permeability in mammalian red cells have been compared. 2. Block of the permeability was assessed from the reduction in the net loss of K+ that followed the application of the Ca2+ ionophore A23187 (2 microM) to rabbit red cells suspended at a haematocrit of 1% in a low potassium solution ([K]0 0.12-0.17 mM) at 37 degrees C. Net movement of K+ was measured using a K+-sensitive electrode placed in the suspension. 3. The concentrations (microM +/- s.d.) of the compounds tested causing 50% inhibition of K+ loss were: quinine, 37 +/- 3; cetiedil, 26 +/- 1; the cetiedil congeners UCL 1269, UCL 1274 and UCL 1495, approximately 150, 8.2 +/- 0.1, 0.92 +/- 0.03 respectively; clotrimazole, 1.2 +/- 0.1; nitrendipine, 3.6 +/- 0.5 and charybdotoxin, 0.015 +/- 0.002. 4. The characteristics of the block suggested that compounds could be placed in two groups. For one set (quinine, cetiedil, and the UCL congeners), the concentration-inhibition curves were steeper (Hill coefficient, nH, > or = 2.7) than for the other (clotrimazole, nitrendipine, charybdotoxin) for which nH approximately 1. 5. Compounds in the first set alone became less active on raising the concentration of K+ in the external solution to 5.4 mM. 6. The rate of K+ loss induced by A23187 slowed in the presence of high concentrations of cetiedil and its analogues, suggesting a use-dependent component to the inhibitory action. This was not seen with clotrimazole. 7. The blocking action of the cetiedil analogue UCL 1274 could not be overcome by an increase in external Ca2+ and its potency was unaltered when K+ loss was induced by the application of Pb2+ (10 microM) rather than by A23187. 8. These results, taken with the findings of others, suggest that agents that block the red cell Ca2+-activated K+ permeability can be placed in two groups with different mechanisms of action. The differences can be explained by supposing that clotrimazole and charybdotoxin act at the outer face of the channel whereas cetiedil and its congeners may block within it, either at or near the K+ binding site that determines the flow of K+.

The effects of cetiedil and its congeners on levcromakalim-stimulated 86Rb efflux from smooth and skeletal muscle.

The effects of cetiedil on levcromakalim-stimulated 86Rb efflux from rat aorta, rat anococcygeus and frog sartorius muscle have been investigated. In experiments on rat aorta, cetiedil inhibited the tracer efflux stimulated by 10 microM levcromakalim with an IC50 of 1.3 +/- 0.4 microM. In the rat anococcygeus and frog sartorius 10 microM cetiedil caused 67 +/- 11% and 84 +/- 4% inhibition of the responses to 10 microM and 50 microM levcromakalim respectively. The effect of two analogues of cetiedil, UCL 1285 (cetiedil methiodide) and UCL 1495 (triphenyl acetic acid-2-N[5-ethyl-2-methylpiperidinoethyl] ester) were also tested on rat aorta. UCL 1285 caused inhibition of the response to 10 microM levcromakalim with an IC50 of approximately 6 microM. In contrast, UCL 1495 (10 microM) had no significant effect. It is concluded that cetiedil is an effective blocker of the action of levcromakalim in smooth and skeletal muscle but does not distinguish between tissues. The relative activities of cetiedil, UCL 1285 and UCL 1495 are discussed in relation to their activity at other cetiedil-sensitive K+ channels.

The synthesis and some pharmacological actions of the enantiomers of the K(+)-channel blocker cetiedil.

Cetiedil ((+/-)-2-cyclohexyl-2-(3-thienyl)ethanoic acid 2-(hexahydro-1 H-azepin-1-yl) ethyl ester) possesses anti-sickling and analgesic, antispasmodic, local anaesthetic and vasodilator activities. A total synthesis and circular dichroism spectra of the enantiomers of cetiedil is described, together with a comparison of their effectiveness as blockers of the Ca(2+)-activated K+ permeability of rabbit erythrocytes; the contractile response of intestinal smooth muscle to acetylcholine; the Ca(2+)-dependent contraction of depolarized intestinal muscle; and the cell volume-sensitive K+ permeability (Kvol) of liver cells. The enantiomers did not differ substantially in their ability to block the Ca(2+)-activated K+ permeability of rabbit red cells or in their effectiveness as blockers of the contractile response of depolarized smooth muscle to externally applied Ca2+. There was a clear difference in the muscarinic blocking activity of the enantiomers, as assessed by inhibition of the contractile response of intestinal smooth muscle to acetylcholine; (+)-cetiedil was 7.7 +/- 0.2 (s.d.) times more active than the (-) from. The enantiomers also differed in their potency as blockers of the increase in membrane conductance which occurs when liver cells swell. The concentration of (+)-cetiedil needed to reduce the conductance increase by 50% was 2.04 +/- 0.54 (s.d.) microM; (-)-cetiedil was 2.6 +/- 0.8 (s.d.) times less active (IC50 of 5.2 +/- 1.2 microM). Differences in the biological actions of the enantiomers of cetiedil indicate that a more extensive study could be rewarding in relation to the use of the enantiomers both in therapeutics and in the study of K+ channels.

Discrimination between subtypes of apamin-sensitive Ca(2+)-activated K+ channels by gallamine and a novel bis-quaternary quinolinium cyclophane, UCL 1530.

1. Gallamine, dequalinium and a novel bis-quaternary cyclophane, UCL 1530 (8,19-diaza-3(1,4),5(1,4)-dibenzena-1 (1,4),7(1,4)-diquinolina-cyclononadecanephanedium) were tested for their ability to block actions mediated by the small conductance, apamin-sensitive Ca(2+)-activated K+ (SKCa) channels in rat cultured sympathetic neurones and guinea-pig isolated hepatocytes. 2. SKCa channel block was assessed in sympathetic neurones by the reduction in the slow afterhyperpolarization (AHP) that follows an action potential, and in hepatocytes by the inhibition of the SKCa mediated net loss of K+ that results from the application of angiotensin II. 3. The order of potency for inhibition of the AHP in sympathetic neurones was UCL 1530 > dequalinium > gallamine, with IC50 values of 0.08 +/- 0.02, 0.60 +/- 0.05 and 68.0 +/- 8.4 microM respectively, giving an equi-effective molar ratio between gallamine and UCL 1530 of 850. 4. The same three compounds inhibited angiotensin II-evoked K+ loss from guinea-pig hepatocytes in the order dequalinium > UCL 1530 > gallamine, with an equi-effective molar ratio for gallamine to UCL 1530 of 5.8, 150 fold less than in sympathetic neurones. 5. Dequalinium and UCL 1530 were as effective on guinea-pig as on rat sympathetic neurones. 6. UCL 1530 at 1 microM had no effect on the voltage-activated Ca2+ current in rat sympathetic neurones, but inhibited the hyperpolarization produced by direct elevation of cytosolic Ca2+. 7. Direct activation of SKCa channels by raising cytosolic Ca2+ in hepatocytes evoked an outward current which was reduced by the three blockers, with dequalinium being the most potent. 8. These results provide evidence that the SKCa channels present in guinea-pig hepatocytes and rat cultured sympathetic neurones are different, and that this is not attributable to species variation. UCL 1530 and gallamine should be useful tools for the investigation of subtypes of apamin-sensitive K+ channels.