Integrating Disaster Management Into Curricula: A Successful Collaboration With Community Partners.

ABSTRACT: Millions of people are killed annually in disasters, and even more are injured, displaced, and in need of emergency assistance. Communities continue to need nurses who can respond effectively during times of disaster. A one-credit course was developed to provide a collaborative and engaging approach to prepare students for disaster and mass casualty situations. Student evaluation responses regarding all segments of the course indicate satisfaction and quality learning. The course prepared and qualified students to volunteer for a community service organization and provide community-based care.

Nursing Staff Perceptions of Fall Risk: The Emergence of Learned Helplessness as a Theme.

Nurses and unlicensed assistive personnel on 2 medical-surgical units were asked about their perceptions regarding patient falls. Their responses reflect learned helplessness and a lack of nurse empowerment that are relevant findings as nurse executives work to decrease patient falls.

Nutritional basis for colonization resistance by human commensal Escherichia coli strains HS and Nissle 1917 against E. coli O157:H7 in the mouse intestine.

Escherichia coli is a single species consisting of many biotypes, some of which are commensal colonizers of mammals and others that cause disease. Humans are colonized on average with five commensal biotypes, and it is widely thought that the commensals serve as a barrier to infection by pathogens. Previous studies showed that a combination of three pre-colonized commensal E. coli strains prevents colonization of E. coli O157:H7 in a mouse model (Leatham, et al., 2010, Infect Immun 77: 2876-7886). The commensal biotypes included E. coli HS, which is known to successfully colonize humans at high doses with no adverse effects, and E. coli Nissle 1917, a human commensal strain that is used in Europe as a preventative of traveler's diarrhea. We hypothesized that commensal biotypes could exert colonization resistance by consuming nutrients needed by E. coli O157:H7 to colonize, thus preventing this first step in infection. Here we report that to colonize streptomycin-treated mice E. coli HS consumes six of the twelve sugars tested and E. coli Nissle 1917 uses a complementary yet divergent set of seven sugars to colonize, thus establishing a nutritional basis for the ability of E. coli HS and Nissle 1917 to occupy distinct niches in the mouse intestine. Together these two commensals use the five sugars previously determined to be most important for colonization of E. coli EDL933, an O157:H7 strain. As predicted, the two commensals prevented E. coli EDL933 colonization. The results support a model in which invading pathogenic E. coli must compete with the gut microbiota to obtain the nutrients needed to colonize and establish infection; accordingly, the outcome of the challenge is determined by the aggregate capacity of the native microbiota to consume the nutrients required by the pathogen.

The entrepreneurial rationalities of governing and the construction of the enterprising nurse.

Drawing from a wider study exploring the role of registered nurses (RNs) in managing hospital care of older people, I present an analysis of some discursive mechanisms through which an enterprising nursing subjectivity was cultivated in RNs working in an Australian hospital. Data comprised information from the hospital Web site, policy documents, job descriptions, and interviews with 26 RNs. The analysis highlighted how texts such as nursing vision statements and job descriptions were not neutral or innocuous, but mechanisms that individually and collectively specified norms of enterprising conduct for RNs working in that hospital. Although the findings detailed how entrepreneurial rationalities and discourses governing health care actively transformed the meaning and practice of nursing, they also illustrated how factors such as role location and ward culture diluted the take up of enterprise discourses, suggesting that it was not possible to guarantee RNs as particular kinds of enterprising subjects.

Anaerobic respiration of Escherichia coli in the mouse intestine.

The intestine is inhabited by a large microbial community consisting primarily of anaerobes and, to a lesser extent, facultative anaerobes, such as Escherichia coli, which we have shown requires aerobic respiration to compete successfully in the mouse intestine (S. A. Jones et al., Infect. Immun. 75:4891-4899, 2007). If facultative anaerobes efficiently lower oxygen availability in the intestine, then their sustained growth must also depend on anaerobic metabolism. In support of this idea, mutants lacking nitrate reductase or fumarate reductase have extreme colonization defects. Here, we further explore the role of anaerobic respiration in colonization using the streptomycin-treated mouse model. We found that respiratory electron flow is primarily via the naphthoquinones, which pass electrons to cytochrome bd oxidase and the anaerobic terminal reductases. We found that E. coli uses nitrate and fumarate in the intestine, but not nitrite, dimethyl sulfoxide, or trimethylamine N-oxide. Competitive colonizations revealed that cytochrome bd oxidase is more advantageous than nitrate reductase or fumarate reductase. Strains lacking nitrate reductase outcompeted fumarate reductase mutants once the nitrate concentration in cecal mucus reached submillimolar levels, indicating that fumarate is the more important anaerobic electron acceptor in the intestine because nitrate is limiting. Since nitrate is highest in the absence of E. coli, we conclude that E. coli is the only bacterium in the streptomycin-treated mouse large intestine that respires nitrate. Lastly, we demonstrated that a mutant lacking the NarXL regulator (activator of the NarG system), but not a mutant lacking the NarP-NarQ regulator, has a colonization defect, consistent with the advantage provided by NarG. The emerging picture is one in which gene regulation is tuned to balance expression of the terminal reductases that E. coli uses to maximize its competitiveness and achieve the highest possible population in the intestine.

Competency standards and educational requirements for specialist breast nurses in Australia.

There is substantial evidence that Specialist Breast Nurses (SBNs) make an important contribution to improved outcomes for women with breast cancer, by providing information and support and promoting continuity of care. However, a recent study has identified significant variation in how the role functions across individual nurses and settings, which is likely to contribute to varied outcomes for women with breast cancer. The project reported in this paper illustrates how a set of competency standards for SBNs were developed by the National Breast Cancer Centre. The competency standards were developed through a review of published literature and consultation with key stakeholders. The resulting SBN Competency Standards reflect the core domains and elements of SBN practice seen as integral to achieving optimal outcomes for women with breast cancer. This project identifies the SBN as a registered nurse who applies advanced knowledge of the health needs, preferences and circumstances of women with breast cancer to optimise the individual's health and well-being at various phases across the continuum of care, including diagnosis, treatment, rehabilitation, follow-up and palliative care. The five core domains of practice identified are: Supportive care; Collaborative care; Coordinated care; Information provision and education; and Clinical leadership. A variety of education programs are currently available for nurses who wish to learn about breast cancer nursing. The majority of stakeholders consulted in this project agreed that a Graduate Diploma level of education is required at minimum in order for an SBN to develop the minimum level of competence required to perform the role. The evidence supports the view that as an advanced role, nurses practising as SBNs require high-quality programs of sufficient depth and scope to achieve the required level of competence.

Australian enrolled nurses have their say--Part 1: Teamwork and recognition.

Nurses are a cornerstone to the Australian health care workforce and are under increasing pressure to respond to changes in health care demands, the redistribution of health care funding and shortages in nursing workforce availability and skill mix. It is in this context that the role and function of the enrolled nurse has come under recent scrutiny. This paper reports on the qualitative semi-structured interviews conducted as one aspect of an Australia wide multi-phased investigation of enrolled nursing practice and competency standards for this practice. In the reported phase, enrolled nurses from a variety of settings and from all states and territories participated in telephone interviews exploring their experiences of practice and the role of the enrolled nurse. Findings indicated various enabling and limiting influences on enrolled nurse role and function. In this paper two core themes of teamwork and recognition are described as they illustrate the rich interpersonal rewards of enrolled nursing and the significance of recognition by others of the enrolled nurse contribution to health care delivery. These themes are presented as an introduction to part two of this paper which reports more broadly on the dimensions of the enrolled nurse scope of practice.

Australian enrolled nurses have their say--Part 2: Scope of practice.

Determination of the scope of practice for enrolled nurses has been an ongoing issue in Australia, compounded by the existence of two regulated levels of nurse with often overlapping roles and functions. This paper explores enrolled nurse scope of practice, drawing on findings from national research that examined the role, function and competencies of the enrolled nurse. Enrolled nurses from a range of settings in all states and territories participated in telephone interviews exploring their experiences of practice and the role and function of the enrolled nurse. Findings indicated various influences on enrolled nurse role and function, including geographical location, organisational policy and management practices, registered and enrolled nurse relationships and lack of differentiation between registered and enrolled nurse roles. Following a previous paper exploring issues related to teamwork and recognition of enrolled nurses, these influences are discussed as they relate to enrolled nurse scope of practice. The role and usefulness of decision making frameworks in clarifying the scope of enrolled nurse practice are also explored.

Mentoring for nurses in general practice: an Australian study.

This paper presents findings from a project conducted to recommend a national framework for mentoring for general practice nurses in Australia. The first phase identified challenges and key issues; the second and third phases (reported here) engaged practice nurses and general medical practitioners in discussion to advance thinking on the topic. Outcomes revolved around seven core areas: role confusion and diversity of practice nursing; lack of a defined career pathway for practice nurses; professional isolation of practice nurses; need for general practitioner support; expectations of mentoring; importance of resourcing and infrastructure; and roles, skills and qualities of mentors. Implications of these for the development of a systemic approach to supporting nurses in general practice are discussed, taking into account the inter-professional context and special working relationship between nurses and doctors. Findings revealed keen support for the idea of mentoring for nurses in general practice and indicate success will depend on appropriate resourcing and infrastructure through national, state and local coordination processes.

Mentoring for nurses in general practice: national issues and challenges.

This paper reports the findings of a research project designed to identify national issues impacting on the development of a mentoring framework for nurses in general practice in Australia. The project comprised the first phase of a three-phase study commissioned by the Australian Government Department of Health and Ageing to develop a contemporary, flexible and sustainable mentoring framework that enhances the capacity of nurses to contribute to general practice outcomes. Key stakeholders and influential informants from around Australia were brought together via a national teleconference to identify issues surrounding the development of such a framework. Outcomes focussed on major themes concerning choice, relationships, structures and resources. Here, we consider the issues and challenges identified in light of some contemporary case studies from outside the field of nursing in the hope of sparking new ideas and strategies. A case study from an Australian practice nurse is included. No research has been conducted on mentoring for nurses in general practice in Australia to date, highlighting an urgent need for new models and their evaluation.

Contemporary enrolled nursing practice: opportunities and issues.

Over the last decade, Australia, as with the rest of the developed world, has experienced a widespread labour market decline in the numbers of nurses in the health workforce. Concurrent with this nursing shortage, the second level nurse has, in many countries, ceased to be recognised as a legitimate nursing role. In Australia, recent research indicates that the enrolled nurse role, though contentious, is consolidating as a core component of the health care workforce. This paper reports on national research that examined the role and function of the enrolled nurse in Australia and reviewed the Australian Nursing Council Inc (ANCI) National Competency Standards for Enrolled Nurses. Specific issues related to the contemporary role and function of enrolled nurses, namely supervision, scope of practice and education, are also discussed.