Facilitated engagement approach: A novel approach to guide mentor conversations.

BACKGROUND: Mentorship has been recognized as a strategy to develop leadership competencies in clinical leaders and has been integrated into leadership programs. However, there are few published frameworks to guide mentor conversations with mentees training to assume nursing leadership roles. OBJECTIVE: This study explores mentors' perceptions of 6-month mentorship, a component of the Strengths-Based Nursing Leadership program, the effectiveness of the Facilitated Engagement Approach, a pedagogical strategy developed to facilitate conversation between the mentor and mentee, and the impact of mentorship on leadership practice of mentees. METHODS: A mixed method qualitative and quantitative approach was used with semi-structured interviews and bi-weekly survey among mentors. Data were thematically analyzed. RESULTS: Mentors described the use of the Facilitated Engagement Approach to guide their mentorship conversations and found it to be effective in mentoring program participants. Mentors described techniques used and the process of deepening a reflective mentorship conversation. The Spiraling Process (58 %) and the Story Sharing Process (74 %) were integral aspects of the Facilitated Engagement Approach used. Mentorship was found to be impactful in that mentors reported a change in their mentee. CONCLUSIONS: The Facilitated Engagement Approach was an effective tool for mentees and mentors to develop leadership capacities.

Controlled protonation of iron-molybdenum cofactor by nitrogenase: a structural and theoretical analysis.

Qualitative molecular modelling has been used to identify possible routes for transfer of protons from the surface of the nitrogenase protein to the iron-molybdenum cofactor (FeMoco) and to substrates during catalysis. Three proton-transfer routes have been identified; a water-filled channel running from the protein exterior to the homocitrate ligand of FeMoco, and two hydrogen-bonded chains to specific FeMoco sulphur atoms. It is suggested that the water channel is used for multiple proton deliveries to the substrate, as well as in diffusion of products and substrates between FeMoco and the bulk solvent, whereas the two hydrogen-bonded chains each allow a single proton to be added to, and subsequently depart from, FeMoco during the catalytic cycle. Possible functional differences in the proton-transfer channels are discussed in terms of assessment of the protein environment and specific hydrogen-bonding effects. The implications of these observations are discussed in terms of the suppression of wasteful production of dihydrogen by nitrogenase and the Lowe-Thorneley scheme for dinitrogen reduction.

The integration of research by nurse educators: advancing practice through professional development programs.

BACKGROUND: This article describes how nurse educators at The Hospital for Sick Children, Toronto, have used Benner's findings as a framework to direct the advancement of professional development programs, specifically preceptorship, orientation, and central education programs. METHOD: Narrative methodology was introduced as a key educational strategy to capture the complexity of pediatric clinical practice and enhance learning experiences. RESULTS: The shift in content and structure of the education programs from a structured behavioral teaching-learning framework to the use of narrative methodology has enhanced learning, professional development and clinical practice. CONCLUSION: Participant evaluations of these programs suggest a high level of satisfaction with the use of narrative methodology. Evaluative measures focusing on the relationship between narrative methodology, professional development, and client outcomes is needed. This evaluative approach that measures outcomes is imperative to future directions in program planning.

Development and application of a computerized workload measurement tool for nurse educators.

This paper describes the development and application of a computerized workload measurement tool for use in hospital nursing education departments. The tool was developed in response to a need to gather information to facilitate resource allocation within the nursing education department in times of severe fiscal constraint. Software was developed based on a commercially available spreadsheet to keep track of the time and nature of nursing educator activity as well as its location. Analysis of the results showed that most of the nurse educators' time was spent on educational activities. The workload measurement system provided useful information for both individual educators and for the department in assessing, planning and allocating resources for educators.

Role of soft tissue structures as an etiology of hallux limitus.

The authors establish common mechanical criteria for structures that can adversely affect dorsiflexion of the hallux, examine soft tissue anatomical structures around the first metatarsophalangeal joint that meet the established standards, and propose alternative methods of approaching the deformity surgically.

Effect of exercise on energy intake and eating patterns in lean and obese humans.

Twelve obese and four lean subjects increased their energy expenditure by 100 kcal/day by cycling on a bicycle ergometer. The order of testing was alternated so that half of the subjects did exercise on the first three days and the remainder on the last three days. Ad lib energy intake was measured over six days using an automated food dispensing machine. The obese subjects ate 1196 +/- 517 kcal/day and the lean subjects ate 1162 +/- 301 kcal/day and showed no overall significant difference in energy intake or eating patterns. However, these obese subjects ate 18 kcal/day less and the lean subjects ate 155 kcal/day more during the exercise period. The difference in response confirms the hypothesis that lean subjects tend to regulate energy intake more accurately than obese subjects. Exercise increased the frequency of eating and drinking and decreased hunger and appetite for all subjects. There was a significantly greater decrease in hunger and appetite with exercise for the obese subjects. However, as there was no accompanying decrease in energy intake and some subjects had difficulty in completing the exercise, the value of small increases in voluntary exercise in the treatment of obesity is questioned.

The effect of covert changes in energy density of preloads on subsequent ad libitum energy intake in lean and obese human subjects.

1. Covert changes in energy intake were made by giving preloads of disguised energy density three times daily to 14 obese and 6 lean subjects. 2. The preloads contained 2.51 MJ (600 kcal)/d on days 2 and 3 and either 3.77 MJ (900 kcal)/d or 1.26 MJ (300 kcal/d) on days 4 and 5 and 1.26 MJ (300 kcal)/d or 3.77 MJ (900 kcal)/d on days 6 and 7. The order of testing was alternated for each subject. 3. Subsequent energy intake at each meal (lunch, dinner and breakfast) was measured with an automated food-dispensing machine. 4. Overall the obese subjects ate significantly less from the machine, 3.28 +/- 1.89 MJ (785 +/- 452 kcal)/d, than the lean subjects, 6.03 +/- 1.26 MJ (1442 +/- 300 kcal)/d. 5. Both groups of subjects adjusted their energy intake in the right direction to counterbalance the effect of the preloads but the lean subjects changed their intake by an average of 0.74 MJ (176 kcal)/d compared with the obese subjects who changed their intake by an average of 0.29 MJ (70 kcal)/d. 6. Although the lean subjects were better at adjusting their energy intake than the obese subjects, regulation was still imprecise relative to the 2.51 MJ (600 kcal)/d difference in energy intake that was imposed. 7. There were no significant differences in hunger or appetite between subjects or test situations.

The effect of increasing the relative cost of palatable food with respect to ordinary food on total-energy intake of eight obese inpatients.

1. It has been suggested that obese subjects have a greater relative preference for palatable foods than lean subjects. 2. The food intake of eight obese subjects was measured using an automated food dispensing machine. 3. Subjects ate ad libitum for the first three days from a range of acceptable foods predetermined by questionnaire. 4. On the next three days the food which subjects chose most frequently ('palatable' food) was priced at a level such that if the subjects maintained their intake of that food they were forced to reduce their total energy intake by 50 per cent, but the subjects were able to obtain food sufficient to maintain their energy intake only if they ate exclusively food rated as 'ordinary'. 5. On this differential fixed price schedule the obese subjects reduced total energy intake to a small extent (20 per cent) whereas their intake of palatable food was reduced to a larger extent (65 per cent). Thus obese subjects relatively defended energy intake at the expense of palatability. Hunger and appetite ratings did not differ from each other throughout the study.

The effect of meal frequency and protein concentration on the composition of the weight lost by obese subjects.

1. Nitrogen balance, weight loss and resting metabolic rate were measured in thirty-eight obese inpatients on 3.4 MJ (800 kcal)/d diets over 3 weeks. 2. All subjects were fed on 13% protein-energy in three meals/d for the first week. 3. In weeks 2 or 3, using a cross-over design, ten subjects were fed on 15 or 10% protein-energy as three meals/d; fourteen subjects were fed on five or one meal/d with 13% protein-energy; and fourteen subjects were fed on 15% protein-energy as five meals/d or 10% protein-energy as one meal/d. 4. N loss was least on the high-protein week and frequent-meal week: the largest difference was found when these effects were combined (P less than 0.001). 5. When protein-energy was held constant at 13% N loss decreased significantly (P less than 0.01) between week 2 and 3, but when the protein-energy was manipulated there was no significant N conservation in the third week. This suggests that the protein:energy value is more important than meal frequency in the preservation of lean tissue. 6. Weight loss was also least on the 'high-protein' week and 'frequent-meal' week, but this result reached significance only when the effects were combined (P less than 0.05). 7. Resting metabolic rate decreased with time but was not significantly altered by the dietary regimens. 8. Therefore, during the first 3 weeks at an intake of 3.4 MJ/d, a diet with a high-protein concentration, fed as frequent small meals, is associated with better preservation of lean tissue than an isoenergetic diet with lower-protein concentration fed as fewer meals. There was no evidence that meal frequency or protein concentration affect the rate of fat loss.

Factors influencing the composition of the weight lost by obese patients on a reducing diet.

1. Weight loss, resting metabolic rate and nitrogen loss were measured in forty obese inpatients on reducing diets. 2. Five subjects ate 3.55 MJ/d for 6 weeks (Expt 1). Twenty-one subjects ate 4.2 MJ/d for the first week, 2.0 MJ/d for the second week and 4.2 MJ/d for the third week (Expt 2). Fourteen subjects ate 3.4 MJ/d for the first week and then 0.87 MJ protein or carbohydrate for the second or third weeks, using a cross-over design for alternate patients (Expt 3). 3. Patients in Expt 1 had highest weight loss and N loss in the first 2 weeks, but adapated to the energy restriction over the remaining weeks. On average subjects were in N balance at the end of the study. 4. In Expt 2 patients eating 2.0 MJ/d in week 2 showed increased weight loss compared with week 1. N loss was not raised but it failed to decrease as it had in Expt 1. Weight loss and N loss were reduced on return to 4.2 MJ/d for a third week. 5. In Expt 3 patients eating 0.87 MJ protein showed significantly more weight loss and less N loss than patients eating 0.87 MJ carbohydrate. 6. Resting metabolic rate decreased with time on the low-energy diet, but the manipulations of energy or protein content did not significantly affect the pattern of decrease. 7. Both weight loss and N loss were greater the lower the energy intake, and both decreased with time. Diets with a high protein:energy value give a favourable value for N:weight loss at each level of energy intake.

The long-term effect of energy intake on salivation, hunger, and appetite ratings, and estimates of energy intake in obese patients.

The relationship between salivation, hunger, appetite, and estimates of energy intake was examined in female obese inpatients undergoing a course of weight reduction. On a constant low-energy intake (800 kcal/day) salivation, hunger, and appetite scores all declined. Estimates of energy intake did not. Sixteen different subjects were fed 1000 kcal/day for seven days, 500 kcal/day for seven days, and 1000 kcal/day for seven days. After acclimatization to the diet for a minimum of five days, salivation was directly related to energy intake; hunger and appetite ratings did not change significantly; and estimates of energy intake were sensitive to the decrease but not increase in energy intake. The limitations of each method of assessment are discussed.

Short-term effects of energy density on salivation, hunger and appetite in obese subjects.

Obese patients were admitted to a metabolic unit for weight loss. On two paired-test days subjects were given disguised preloads of 100 kcal (0.42MJ) or 300 kcal (1.26MJ). When presented with a meal one hour after the preload, subjects salivated more and reported more hunger, but not appetite, after the low compared to the high preload. A different group of 14 subjects were given preloads of the same energy content (200 kcal, 0.84MJ) on paired-test days. On one day they took 1 g methyl cellulose with 100 ml water drink immediately before the preload. Neither the energy-dilution effect of the water, nor the effect of the methyl cellulose caused a significant decrease in salivation, hunger or appetite scores one hour after the preloads of equal energy content. These results show that salivation and hunger are inversely related to short-term changes in energy intake in obese subjects. Alterations in energy density without changing energy intake or the ingestion of methyl cellulose have no effect on salivation, hunger or appetite.

Does adipose tissue cellularity or the age of onset of obesity influence the response to short-term inpatient treatment of obese women?

Thirty-three obese women were admitted as inpatients to a metabolic ward and had an average intake of 3.35 MJ (800 kcal) daily for three weeks. Fat biopsies were taken at three subcutaneous sites and average fat cell mass (CM) and apparent fat cell number (FCN) were calculated. There was no significant correlation between adipose tissue cellularity (CM or FCN) and total weight loss or resting metabolic rate, provided due allowances were made for the severity of obesity in each case. Neither was there any significant correlation between short-term weight loss and the age of onset of obesity. Resting metabolic rate, and not adipose tissue cellularity or age of onset of obesity, is a better indicator of short-term weight loss under controlled inpatient conditions.

Factors determining weight loss in obese patients in a metabolic ward.

A metabolic unit is described in which it is possible to make controlled measurements of energy balance in patients with various types and degrees of obesity. Thirty-seven obese women were studied for three consecutive one-week periods on a diet which provided an average of 3.4MJ (800 kcal) daily, and some also undertook an exercise programme involving the expenditure of 850--1275 kJ (200--300 kcal) extra per day. The distribution of energy intake was varied from week to week, and within the day (nibbling and gorging), but neither these variations in dietary pattern nor the exercise programme significantly affected the total weight loss over the three-week study period. Very large variations were observed between individuals. Total weight loss over the three-week study period ranged from 1.6 to 9.8 kg. The best predictor of weight loss in a patient on a strictly controlled diet is the resting metabolic rate. The previous diet also affects weight loss: patients who had been keeping to a reducing diet before admission lost less weight, especially in the first week, than those who had not been dieting immediately before admission to hospital.