Effectiveness of a 12-week school-based educational preventive programme on weight and fasting blood glucose in "at-risk" adolescents of type 2 diabetes mellitus: Randomized controlled trial.

To assess the effectiveness of a 12-week school-based educational preventive programme for type 2 diabetes by change in weight and fasting blood glucose level in Jordanian adolescents. Sixteen percent of Jordanian adults have obesity-related type 2 diabetes and 5.6% of obese adolescents examined, however one-third unexamined. Rates in Arabic countries will double in 20 years, but this can be prevented and reversed by controlling obesity. A single-blinded randomized controlled trial was conducted in 2 unisex high schools in Irbid, Jordan, in 2012. Intervention and control participants, aged 12 to 18 years, were visibly overweight/obese. They were randomly allocated to the intervention (n = 205) or control (n = 196) groups. At-risk students were assessed before and after the 12-week intervention, for change in weight and fasting blood glucose level following preventive instruction and parent-supported changes. Mean age of participants was 15.3 years with equal percentages of both males (49.4%) and females. Post intervention, the intervention group, demonstrated statistically significant reductions: mean difference of 3.3 kg in weight (P < .000) and 1.36 mg/dL (0.075 mmol/L) in fasting blood glucose (P < .000). School-based early prevention intervention effectively reduced weight and fasting blood glucose in Jordanian at-risk adolescents.

The use of the trendelenburg position in the surgical treatment of extreme cerebellar slump.

BACKGROUND: State-of-the-art treatment for Chiari Malformation I (CM-I) consists of decompression by posterior fossa craniectomy. A rare but severe complication that develops over months to years after this procedure is cerebellar slump. Treatment options for this condition are limited. We present a new and promising approach to treat this rare condition. METHODS: The patients were placed in the Trendelenburg position to facilitate ascent of the cerebellum. After almost complete dissolution of neurologic symptoms, surgical reconstruction was performed by tonsillar resection and the creation of a new structural support using a bone graft. RESULTS: Both patients experienced good clinical and morphological outcomes immediately after surgery, and for two years thereafter. CONCLUSIONS: Neurological symptoms related to cerebellar or brainstem slump can be adequately reversed by placing the patient in the Trendelenburg position. After uneventful gravitational reversal of the slump, safe surgical reconstruction of the cerebellar support can be performed to securely preserve the anatomical reversal.

A novel design for steerable instruments based on laser-cut nitinol.

OBJECTIVE: Omnidirectional articulated instruments enhance dexterity. In neurosurgery, for example, the simultaneous use of 2 instruments through the same endoscopic shaft remains a difficult feat. It is, however, very challenging to manufacture steerable instruments of the requisite small diameter. We present a new technique to produce such instruments by means of laser cutting. Only 3 coaxial tubes are used. The middle tube has a cutting pattern that allows the steering forces to be transmitted from the proximal to the distal end. In this way the steering part is concealed in the wall of the tube. Large diameter articulated instruments such as for laparoscopy might benefit from the excellent tip stability provided by the same economical technology. METHOD: Coaxial nitinol tubes are laser-cut with a Rofin Stent Cutter in a specific pattern. The 3 tubes are assembled by sliding them over one another, forming a single composite tube. In a surgical simulator, the neurosurgical microinstruments and laparoscopic needle drivers were evaluated on surgical convenience. RESULTS: Simultaneous use of 2 neurosurgical instruments (1.5 mm diameter) through the same endoscopic shaft proved to be very intuitive. The tip of the steerable laparoscopic instruments (10 mm diameter) could resist a lateral force of more than 20 N. The angle of motion for either instrument was at least 70° in any direction. CONCLUSIONS: A new design for steerable endoscopic instruments is presented. It allows the construction in a range from microinstruments to 10-mm laparoscopic devices with excellent tip stability.

Factoring patients' beliefs and values into decisions around anticoagulation: a community-led multi-cycle quality improvement project.

Low-molecular-weight heparin (LMWH), prescribed for prophylaxis of venous thromboembolism, is derived from porcine animal products. An audit in our Trust showed that most healthcare professionals (95%, n=58/61) did not consider religious or dietary preferences when prescribing LMWH. Focus groups with local stakeholders helped develop project aims. Quality improvement methods were used to develop, test and optimise interventions over two cycles in our medical unit. Interventions included written and audiovisual information for patients, a staff eLearning module, a policy to guide switching from LMWH to a synthetic alternative and a written prompt reminding doctors to consent patients before prescribing LMWH. The proportion of patients being appropriately consented for LMWH prescriptions increased following our interventions (from <5% at baseline to >80%). Patient and staff feedback was positive, with high demand for a non-animal-derived alternative to LMWH. Simple measures, increasing awareness and knowledge among staff and patients, can improve the number of patients being appropriately consented for LMWH prescriptions.

Animal-derived medicinal products: community representatives' views of their use.

In the UK, there are a variety of religious or cultural beliefs and preferences that guide people in a range of lifestyle decisions. This qualitative study aimed to better understand the views of the public around prescribing animal-derived products, in particular low-molecular-weight heparin (LMWH), from a potential patient perspective. A series of quality improvement focus groups with stakeholders were undertaken to understand perceptions and to evaluate and inform an established treatment pathway. Stakeholders discussed finding out about the porcine nature of LMWH asking 'Why don't they tell us?', suggesting that they 'shouldn't have to give out clues' about their personal preferences. Participants' thoughts about 'how' information be provided, by 'whom' and 'when' were gained. The stakeholders indicated that current practice is unacceptable for patients. They require greater knowledge and transparency regarding product components and recommend that healthcare professionals provide more dialogue and choice to patients.

Steps towards empowerment: an examination of colleges, health services and universities.

In Australia, nursing educators work across three main contexts - training colleges, health services and universities. Because the pace of change for nursing has increased dramatically and the curriculum is becoming even more crowded, educators in these contexts are likely to be experiencing work-related stress. This study investigated this issue utilising a purposive sampling strategy to interview a cross section of nurse educators and those supporting educators. Eighteen in-depth interviews were completed, which included fourteen nurse educators and four key stakeholders. Qualitative analysis revealed that regardless of context, nurse educators found their role rewarding but there are common challenges. These included: Work role pressures, a non-validating culture, the pace of change, isolation and concern for the profession. There are also differences amongst the cohorts. Finally, participants elaborated on specific solutions to these problems and there is strong support for the establishment of a national community of practice to bring diverse educators together to share, support, extend and evaluate each others' work.

Simulation training programme to improve the integrated response of teams in mental health crisis care.

Background: This report presents the findings of a simulation programme to improve the integrated response of teams working in mental health crisis (MHC) care. The programme consisted of the delivery of five interprofessional training courses that aimed to improve the core skills of teams working in MHC care. Methods: Questionnaires were conducted pre-training and post-training, measuring participants' human factors using the Human Factors SKills for Healthcare Instrument, as well as self-reported learning experience using free text questions. Results: The results found a significant change in human factors scores across all courses. Additionally, thematic analysis of the free text questions showed that participants identified improvements in communication, teamwork and clinical knowledge across all courses, with improvements in other skills in specific courses. Conclusion: Overall, the findings suggest a positive impact of the simulation programme across a range of personal and clinical skills, developing further the case for including simulation training in routine mental healthcare education programmes. Future research should consider the long-term impact of interprofessional simulation training in MHC teams to gain further insight into the efficacy of this training modality.

Clinical decision-making in senior nursing students in Iran.

Clinical decision-making is the basis for professional nursing practice. This can be taught and learned through appropriate teaching and clinical experiences. Unfortunately, it has been observed that many graduates are unable to demonstrate suitable clinical decision-making skills. Research and study on the process of decision-making and factors influencing it assists educators to find the appropriate educational and clinical strategies to teach nursing students. To explore the experience of nursing students and their view points regarding the factors influencing their development of clinical decision-making skills. An exploratory qualitative approach utilizing grounded theory methods was used; focus group interviews were undertaken with 32 fourth year nursing students and data were analysed using constant comparative analysis. Four main themes emerged from the data: clinical instructor incompetency, low self-efficacy, unconducive clinical learning climate and experiencing stress. The data indicated that students could not make clinical decisions independently. The findings of this study support the need to reform aspects of the curriculum in Iran in order to increase theory-practice integration and prepare a conductive clinical learning climate that enhances learning clinical decision-making with less stress.

Adopting narrative pedagogy to improve the student learning experience in a regional Australian university.

A growing body of work in the literature describes and explains narrative pedagogy within nursing and midwifery programs. This paper continues the conversation by explaining, with examples, how narrative pedagogy has been interpreted and applied within a new nursing faculty in Australia. The aims of our nursing and midwifery programs are to provide students with a clear professional identity and to prepare them for contemporary Australian nursing practice. As part of these aims, we want students to develop their imaginations and to consciously examine, and challenge, nursing and healthcare paradigms and practices such as the enduring illness model of healthcare and the emphasis on technique-oriented care. Members of our teaching team, working together and individually, have used narrative pedagogy in a variety of ways, developing novel teaching and learning activities for use in real time classroom settings as well as online to provide a regionally and globally relevant educational experience.

The 'realities' of part-time nursing: a grounded theory study.

AIM: To develop a theory that explains the 'realities' of part-time nursing. BACKGROUND: While little is known about the phenomenon of part-time nursing, increasing numbers of nurses work in part-time employment. METHODS: Grounded theory. RESULTS: The problem that part-time nurses shared was an inability to achieve their personal optimal nursing potential. Motivators to work part-time, employment hours, specialty, individual and organizational factors formed contextual conditions that led to this problem. Part-time nurses responded to the challenges through a process of adaptation and adjustment. CONCLUSION: Harnessing the full productive potential of part-time nurses requires support to limit the difficulties that they encounter. The developed theory provides a valuable guide to managerial action. IMPLICATIONS FOR NURSING PRACTICE: Nurse Managers need to consider the developed substantive theory when planning and managing nursing workforces.

Nurse-initiated defibrillation? Reality or rhetoric.

Evidence indicates that hospital nurse-initiated defibrillation improves survival following cardiac arrest. Accordingly, hospitals are changing their policies to permit nurses to initiate defibrillation. However, if nurse-initiated defibrillation is to be successful implemented, nurses' beliefs about this practice need to be understood. Therefore, the aim of this study was to explore the attitudes of rural nurses towards defibrillation to assist in the development of nurse-initiated defibrillation programmes. This cross-sectional study examined the defibrillation beliefs of registered nurses in rural areas. A proportionally stratified sample of registered nurses (n = 436) were drawn from 51 rural acute care hospitals in Australia. Most (n = 224; 52%) of the participants were not permitted to initiate defibrillation. A one-way between-groups multivariate analysis of variance showed that nurses who were permitted to initiate defibrillation held stronger positive beliefs towards defibrillation than nurses not permitted (10,410) = 13.88, p < 0.001. Nurses not permitted were more concerned about the challenge of learning rhythms, incurring litigation and harming the patient or themselves. If it is accepted that defibrillation will become an essential part of all nurses' roles, these beliefs should be explored and integrated into educational programmes as inappropriate beliefs about defibrillation may impede implementation and skills development.

Nurses' motivators to work part-time.

There has been a trend of growth in part-time employment within the Australian nursing workforce and currently half of the profession work part-time. While the literature across disciplines has postulated reasons behind preferences for part-time employment, little is known about nurses' motivators to work part-time. In an era of nursing shortages that form considerable barriers to meeting healthcare service demands, a clear understanding of these motivators is critical for the effective planning and management of the nursing workforce. A grounded theory study that explored the phenomenon of part-time nursing found that nurses' motivators to work part-time were complex and identifiable with nursing, establishing that nurses' working time decisions are made in contexts that may be unique to the profession. This paper provides an exhaustive description and explanation of one cohort of part-time nurses that accounts for variations between nurses and provides an understanding of the complexity of factors that contribute to nurses' decisions to work part-time.

Nurses' behaviour regarding CPR and the theories of reasoned action and planned behaviour.

Cardiopulmonary resuscitation (CPR) has been used in hospitals for approximately 40 years. Nurses are generally the first responders to a cardiac arrest and initiate basic life support while waiting for the advanced cardiac life support team to arrive. Speed and competence of the first responder are factors contributing to the initial survival of a person following a cardiac arrest. Attitudes of individual nurses may influence the speed and level of involvement in true emergency situations. This paper uses the theories of reasoned action and planned behaviour to examine some behavioural issues with CPR involvement.

The need for a new advanced nursing practice role for Australian adult critical care settings.

The current deficit of knowledge related to advanced nursing practice in Australian adult critical care settings presents a barrier to future role development. This paper reports the findings of one theme identified by a research study that explored issues related to the potential for a new advanced nursing practice role for these settings. The qualitative approach of focus group methodology was used to collect data from a purposive sample of regional Queensland critical care nurses (n = 26). Thematic content analysis of the data identified concepts that progressively contributed to five major themes. This paper will report the findings related to the theme that there is a need for a new advanced nursing practice role for adult critical care settings. Participants perceived that nurses are already practising at advanced levels that may predetermine a new role. There was believed to be a need for recognition of and legal sanction for critical care nurses' present practices that extend beyond the current scope of nursing practice. Participants proposed that critical care nurses may be more competent than inexperienced medical personnel in this environment and participants wanted consistent levels of autonomy for advanced practices. The current career structure was seen to be a failure and many participants perceived the lack of opportunities for critical care nurses to advance up the clinical career pathway as problematic in recruitment and retention issues. The findings of this study provide new information that makes an important contribution to further exploration of advanced nursing practice role development for Australian adult critical care settings.

Confusion prevails in defining 'advanced' nursing practice.

The Australian nursing profession has accepted the challenge to support and encourage advanced nursing practice role development. A critical review of national and international literature highlights that there is no singular definition or understanding of 'advanced' nursing practice. Instead difficulty with nomenclature and clarification of levels of nursing are perpetuated by unclear distinction between 'advanced', 'specialist' and 'expert' nursing practice. This paper presents the findings of a review of the literature and posits that ambiguity and lack of consistency in defining 'advanced' nursing practice is hampering the progression of the profession towards the development of consistent advanced practice roles in Australia. It is proposed that a universally accepted definition would provide a vehicle for future Australian role development so that all advanced practice roles have a common genesis and national consistency results.

Focus group methodology: explanatory notes for the novice nurse researcher.

Focus group methodology is a qualitative research approach that provides the potential for authentic quality data to be captured by using the candour and spontaneity of participants in an atmosphere of dynamic group interaction. The use of this methodology within nursing research is growing as it provides a qualitative approach that can produce quality data and can be used effectively by both experienced and novice researchers. The purpose of this paper is to provide guidance to the novice nurse researcher who may be considering using this methodology so that appropriate use is promoted and practical advice for its use may generate quality data.

In my day II: Reflecting on the transformative potential of incorporating celebrations into the nursing curriculum.

Understanding one's history is a powerful way to build a sense of belonging, identity and connection. Similarly, history learning can be a powerful component in the core curriculum for undergraduate nursing. History learning develops thinking skills transferable to and necessary in nursing practice. Additionally, awareness about the profession's struggles, achievements and enduring concerns is raised and belief that an individual or group can have influence is affirmed. Perseverance, commitment and seeing the big picture gives a nurse's career meaning and purpose. All of these factors can produce a transformed perspective in today's learners, who are often present-focused, isolated and disconnected from the past and the profession. This paper reports an evaluation of a second interactive learning experience held at the University of the Sunshine Coast to celebrate International Nurses Day 2010. In a previous paper, we shared our initial insights after the success of the first event, and now build upon those insights by examining the transformative learning provoked by the experience, from the points of view of students and staff.

The benefits and use of shock advisory defibrillators in hospitals.

Survival to discharge following a cardiac arrest is dependent on rapid and effective basic and advanced life support. Paramount to a rapid response is access to sufficiently trained health care providers, who have a duty to perform basic life support and initiate early defibrillation. In hospitals, defibrillation remains the domain of specially prepared staff and the type of defibrillator used might be crucial to rapid and effective defibrillation. The advent of automatic external defibrillators has increased the range of people who can use a defibrillator successfully. For nurses, arguably a lack of familiarity about the benefits of and the use of automatic external defibrillators are the greatest barriers to nurse-initiated defibrillation programmes. This paper explores the use of automatic external defibrillators, their relationship to the associated defibrillator waveforms and the benefits of their use by registered nurses within the hospital setting.