Professional roles and research utilization in paediatric care: newly graduated nurses experiences.

The aim of the study was to describe and analyse how newly graduated nurses perceive themselves as professionals and their perceptions of barriers to research utilization when starting to work within paediatric care. The nurses were employed in two paediatric university hospitals in Sweden and had been working as staff nurses for 1-3 months. They answered two questionnaires: The Professional Self-Description Form and the Barriers Scale. The results showed that in the assessment of their professional level the highest scores were found in consideration, ambition and sensitivity, and the lowest scores in grasp of ideas, leadership and discrimination. In perceptions of research utilization (Barriers Scale), the items with the most common barriers were 'there is insufficient time on the job to implement new ideas', 'the nurse does not have time to read research' and 'the facilities are inadequate for implementation'. These results indicate that newly graduated nurses seem to be prepared for the nursing profession when it concerns themselves as human individuals but not so prepared for the practice in the real day-to-day work. The most common barriers in the research utilization were connected to the work organization and not to themselves as individuals. The evaluation of professional self, barriers to research utilization and the relationship between these aspects indicates a need for further investigation into the significant meaning of professional self and how this influences the implementation and use of research in everyday work. The results so far also raise the question of how to best support and develop newly graduated nurses in their professional role, to help them to be the highly competent nurses that we need in providing the best and evidence-based care to those who need it.

Are the symptoms and severity of head injury predictive of clinical findings three months later?

AIM: To describe symptoms and functional disabilities 3 mo after a minimal, mild or moderate head injury in children, and to analyse relationships between these and initial symptoms and management documented at the time of the injury. METHODS: The sample consisted of all children (0-15 y) admitted to an emergency department during a 1-mo period with a history of head injury. Data were collected from the medical records at the time of the injury, and questionnaires about symptoms/change and functional problems 3 mo after the injury. RESULTS: Symptoms and functional problems were reported in 35% of the children 3 mo after a head injury. Documented altered consciousness (in children less than 5 y) and disorientation (in children 5 y of age or older) at the emergency department were correlated with changes in behaviour at 3 mo. The initial duration of unconsciousness was not predictive of subsequent behaviour. CONCLUSION: The difficulties in predicting outcomes in head-injured children, especially younger ones, indicate the need for a follow-up appointment in order to identify children with special needs. Further studies are needed regarding the early signs and symptoms in different age groups.

Skin protection underneath the pneumatic tourniquet during total knee arthroplasty: a randomized controlled trial of 92 patients.

BACKGROUND: The use of a pneumatic tourniquet to obtain a bloodless field during a total knee arthroplasty (TKA) allows the surgeon to work with greater technical precision in a safe, clear environment. Despite the benefits of surgical tourniquets and many advances in tourniquet equipment, their use is not without risk and complications may still occur. The primary aim of this study was to determine whether there are any differences between an elastic stockinette, cast padding, and no protective material at all regarding skin injuries after a primary TKA in a bloodless field using a pneumatic tourniquet. METHODS: 92 patients were randomized to 1 of 3 groups. In the first group, the limb underneath the pneumatic tourniquet was protected by a two-layer elastic stockinette (E). In the second group, it was protected by cast padding (C), and no protective material (N) was used in the third group. The presence of major skin injuries (blisters) was recorded when the tourniquet was removed after surgery. RESULTS: The two groups with skin protection had fewer skin injuries (p = 0.007). The elastic stockinette was significantly better than having no protective material and there was a trend towards better results in the elastic stockinette group than in the cast padding group. INTERPRETATIONS: Our findings indicate that protective material underneath the tourniquet cuff reduces the risk of skin injuries, i.e. blisters. An elastic stockinette appears to be best.

Quality of life, self-care ability, and sense of coherence in hemodialysis patients: a comparative study.

The number of patients treated for end-stage renal disease has increased in Sweden as in the rest of the world. During the last 6 years, more than 1000 people per year started renal replacement therapy in Sweden. Today hemodialysis (HD) patients have the opportunity to choose from different treatment modalities, home HD, self-care dialysis or conventional dialysis. The aim of the study was to investigate whether there are differences in the way HD patients view their quality of life, self-care ability and sense of coherence if they dialyze themselves at home, dialyze themselves in center (self-care), or if they are dialyzed by nurses in an outpatient dialysis unit. The instruments consisted of the Short Form 36 (SF-36) health survey, the Appraisal of Self-Care Agency questionnaire and the Sense of Coherence questionnaire. Nineteen patients participated in the study (5 patients on home HD, 6 self-care patients and 8 patients on conventional in center dialysis). There was a tendency for those who dialyzed at home to score higher on quality of life, self-care ability and sense of coherence than those who dialyzed themselves in center. Since the number of participants in this study was low, it is necessary for future studies to include more patients to verify the results.

The novice general nurse's view of working in a paediatric setting: a Swedish experience.

The aim of the study was to describe the experiences and perceptions about the role transition in newly graduated general nurses at a paediatric hospital in Sweden. The nurses were requested to write down their perceptions of: responsibility, management of daily and rapidly changing situations and reflection. Eighteen female, newly, generally educated nurses participated. The nurses had been employed for about one month, and were attending an orientation programme. Out of the written text a content analysis was performed and themes were identified. Under the three concepts that were asked for, the themes identified in responsibility were demands toward themselves, the patient and others but also moral issues. In management of daily and rapidly changing situations, the themes that were found concerned knowledge in and management of actions. In reflection, the themes identified were to understand, think, and to have time and the space to do so. The comments were of a general rather than specific nature like looking after the patient as human beings, use of evidencebased practice and the management of daily activities, routines and skills. Moral issues concerned attitudes and values like being the patient's advocate and protecting the patients' integrity. The need of time for reflection was highlighted as well as own responsibility for knowledge development. The comments were in line with previous results indicating that the role transition is independent of country, education or setting. A question of interest is how to best support newly graduated nurses to develop from learner to accountable practitioner.

Self-reported adherence to antiretroviral treatment and degree of sense of coherence in a group of HIV-infected patients.

The goal of this study was to explore the relation between self-reported adherence to antiretroviral treatment and degree of sense of coherence in a group of human immunodeficiency virus (HIV)-infected patients. Ninety-nine patients from an outpatient clinic, all undergoing antiretroviral therapy, participated. Questionnaires were answered twice at a 12-month interval. The 29-item Sense of Coherence (SOC) Scale was used for measuring the ability to cope with stressful life situations. Medication adherence was assessed with self-reported measurements. Clinical characteristics and background variables were collected from the medical records. Results from variables measured with the 12-month interval show a significant concordance with disease stage (p < or = 0.0001), and in HIV-RNA copies per milliliter (p < or = 0.0001) and an increase in CD4 cell count/mm3 (p = < 0.0001). Univariate analysis showed significant differences between nonadherent patients (n = 19) and adherent patients (n = 80) at the last measurement (i.e., the nonadherent group had lower CD4 cell count/mm3 [p = 0.004], higher HIV-1 RNA levels [p 50.029], and lower SOC [p = 0.04] than the adherent group). Finally, multiple regression analyses showed that at measurement 2 the SOC predicted nonadherence, the lower SOC the more missed doses (p < or = 0.01). Because SOC seems to play an important role in this group of patients managing their disease, a caring patient-provider relationship should be developed to minimize nonadherent behaviour. For this reason SOC scale might be of great clinical value to identify patients needing the most support for successful treatment.