The Middle Care Round

As an experiment in postgraduate education a 25-week course in weekly ward rounds for general practitioners and local authority nurses was established at a district general hospital of 340 beds. A total of 73 rounds were held, divided into 12-, 4-, and 9-week courses, from January to December 1969. Ninety-nine general practitioners and district nurses (including health visitors) attended one or more of these rounds. Seventeen consultants participated and there were 273 doctor attendances and 190 nurse attendances. The average attendance per round was four doctors and two nurses. The number of rounds conducted by each of the consultants throughout the course varied from two to six. This paper presents an evaluation of the course.     

Nurse therapists in behavioural psychotherapy.

Five registered mental nurses (R.M.N.s) were trained over two years to become behavioural psychotherapists for adult neurotic disorders. They achieved results comparable to those obtained with similar patients and methods by psychologists and psychiatrists. Similar results were maintained when over a third year the therapists were seconded to work in four hospitals and a general practice. Patients were satisfied at being treated by nurses. After initial teething difficulties nurse therapists became valuable members of treatment teams during both training and secondment, becoming accepted by most nurses, psychologists, and psychiatrists with whom they came into contact. The training of further nurse therapists would facilitate treatment of many disabled neurotics who would otherwise go without effective treatment. Training nurse therapists takes less time and money than training psychologists and psychiatrists because less of their education is redundant to the skills involved. The pool of R.M.N.s suitable for training is much larger than that of psychiatrists and psychologists. The nurse therapists can be integrated relatively easily into treatment teams. The present nursing structure imposes restrictions on the advancement of clinical nurse specialists and a clinical tree is badly needed parallel with present administrative and teaching hierarchies. An 18-month course in adult behavioural psychotherapy has been recognized by the Joint Board of Clinical Nursing Studies for England and Wales so that nurse therapists seem destined to be a lasting feature of future treatment teams.     

Circulating Antibody Response in BCG Vaccination,Tuberculous Infection and Sarcoidosis

The bentonite flocculation test was used to differentiate antibodies formed by BCG vaccination from those produced by infections with virulent tubercle bacilli. Of 116 BCG-vaccinated nurses, only two (1.7%) showed antibody titres higher (1:128) than the threshold titre of 1:64 established for tuberculous patients.The bentonite test was also used to follow the course of infection in 54 patients with tuberculosis. A good correlation was found between the clinical course of the disease and O.T.-bentonite titres on repeated serological testing.Tuberculosis-like antibodies were demonstrated in sarcoidosis patients. These antibodies, however, are globulins (7S), in contrast to the macroglobulins (19S) found in tuberculous patients.     

Innovations in human genetics education. Genetic applications for health professionals: an outreach continuing-education model program

A system for extending continuing education in genetics to nurses and other practicing health professionals was developed in an eight-state area. Coordinators from state agencies received special training at the University of Colorado to administer the course in local communities. A combination of classroom instruction, independent study, computer-assisted instruction, and case-study methods for course delivery was included. More than 300 health professionals have completed the course, and 14 coordinators from seven states have been prepared to administer future courses. The model has demonstrated high potential for replication in other regions.     

Ignoring the obvious: doctors' wives as patients.

There is a widely held belief among doctors and nurses that when a colleague is in hospital, if anything can go wrong during the course of his illness it invariably will. To investigate this belief, we studied prospectively a group of pregnant doctors and doctors'' wives, comparing the number of obstetric, paediatric, and psychiatric complications with those in two control groups of similar social class, race, and parity. These were teachers and lecturers and a group of State registered nurses. The occurrence of obstetric and paediatric problems was similar in the three groups. Psychiatric problems, however, were more common among teachers and lecturers (p less than 0.001); this difference was due to the way the nurses on the postnatal wards failed to report mild psychiatric problems among doctors'' wives to their colleagues. This difference was not related to the amount of preferential treatment that doctors and doctors'' wives received while in hospital.     

Practitioner attitudes in the United States and United Kingdom toward decisions at the end of life: are medical ethicists out of touch?

Objective To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing or withholding treatment, ordinary or extraordinary interventions, and the doctrine of double effect. Design, subjects, and setting Answers to a 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” were compared with those of a similar questionnaire administered to 759 US nurses and 687 US physicians taking the Hastings Center course on “Decisions Near the End of Life.” Results Practitioners accept the relevance of concepts widely disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic and ordinary interventions and withholding and withdrawing treatment. Within the UK nurses'' group, the responses of a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment. Conclusions Professionals'' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners.     

Evalution of Home Nurse Attachment in Bristol

By the end of June 1969 home nurses in Bristol were attached to 18 general practices caring for about 137,000 patients, or about one-third of the city''s population. Attachment was associated with an increase by about one-third in the number of patients referred by general practitioners for home nursing. Additional benefits derived from attachment during the nine months from January to September 1969 were 2,047 items of service performed by nurses in general practitioners'' surgeries, 65 home visits to patients who were not receiving domiciliary nursing care, improved communications between general practitioners and nurses, and opportunities for both doctors and nurses to widen their fields of work. The travelling expenses paid to Bristol''s nurses increased by 9·5%.It is suggested that the benefits to patients, doctors, and nurses of attachment far outweigh the costs and that there is scope for extending the role of the attached nurse in the surgery and in home visiting.     

Incidence of RS virus infections in premature children's ward

In the course of two years (1974-76) four outbreaks of acute respiratory disease in the premature children's ward of a Prague hospital were studied virologically and clinically. RS virus (RSV) was found to be the aetiological agent. The highest isolation rate of RSV was achieved when using two heteroploid cell lines (L-132 and HEp-2 cells) simultaneously. Of the 30 children examined, 60% showed a severe course of disease (pneumonia and/or bronchiolitis) while in 40% of the children the disease had the form of rhinitis with striking abundance of whitish foamy secretions. In one of the outbreaks under study, two nurses with mild afebrile pharyngitis were detected as the source of RSV infection.     

Nurses and nursing in primary medical care in England.

In 1974 we sent questionnaires on attachment and employment of nurses to 9214 general practices in England. There were 7863 replies (85%), of which 551 were excluded from the study. A total of 2654 nurses were directly employed by 24% (1774) of the practices, and 68% (4972) had attached nurses. Practices in health centres were larger and had greater nursing resources than those in other premises. We suggest that practices may employ nurses to compensate for ineffective nursing attachments, and we conclude that general-practice-employed nurses are becoming "professionalised".     

护士职业压力与职业倦怠的相关性研究

目的:了解护士职业压力、职业倦怠现状;探讨两者之间的关系。方法:方便抽样,抽取哈尔滨市5所三级医院的468名护士进行问卷调查。采用护士一般情况调查表、护士工作压力源量表、职业倦怠量表进行调查。结果:护士职业倦怠程度为中等,去人格化属于中度倦怠,情感衰竭、低成就感程度达到了高度倦怠;职业压力得分为87.56±20.43,以工作量及时间分配维度压力最高,病人护理维度压力最低。情感耗竭与除工作环境及资源之外的职业压力维度呈显著正相关;去人格化与职业压力各维度均呈显著正相关;低成就感与职业压力中护理专业及工作、病人护理呈显著负相关(P0.05)。护士职业压力各维度对其职业倦怠的3个维度均有较好的预测作用,尤其对护士情感耗竭的解释程度达25.5%。结论:护士职业倦怠现象不容忽视,护理管理者有针对性的对护士进行管理,鼓励护士加强自身修养、学会自我疏导,适当授权等是降低护士职业倦怠的正性激励措施。     

The impact of shift work on eating patterns and self-care strategies utilised by experienced and inexperienced nurses

ABSTRACT

For nurses, shift work is a necessity, required to provide 24-h continuous care for patients. Research posits that fatigue amongst shift-working nurses is associated with inadequate and poorly timed sleep and also strongly influenced by the timing, quality and quantity of food consumed. The aim of this investigation was to examine differences and similarities in the food choices and eating patterns of nurses exposed to different lengths of time in shift work, as a means of understanding how nurses can adapt their eating patterns to better manage fatigue and sleep loss. Qualitative methodology was utilised to study and capture in-depth information about nurses’ daily working lives. A case study approach allowed for the investigation of nurses with limited and extensive experience of shift work. Increased food craving, caffeine consumption and snacking behaviours during night shifts were described by both groups of nurses, as was the inability to drink enough fluids at work. Meal skipping at work, associated with high workload, was detailed more by experienced nurses. Experienced nurses described shopping and preparing home cooked meals in advance to manage food intake and associated fatigue, contrasting with patterns from inexperienced nurses. Experienced nurses recounted drinking alcohol as a way to rest and recover from shift work, unlike their less inexperienced colleagues. These findings indicate organisational and work place issues such as shift work and rostering influence the food choices and eating patterns of shift-working nurses. Experienced nurses, however, draw on a greater range of strategies around diet and eating patterns to minimise these impacts.     

“情绪管理”在临床护理管理工作中的应用体会

目的：探讨情绪管理在临床护理管理工作中的应用和效果,为临床护理管理的实践提供指导和帮助。方法：选取我院244名护士为研究对象,随机分为常规管理组和情绪管理组,每组各122名护士。常规管理组采取常规的护理管理模式,情绪管理组则对护士进行情绪调节、以适当方式释放压力等情绪管理方法。比较两组研究对象在解决问题、求助、合理化、退避、自责、幻想等方面的评分情况。结果：实施不同的管理措施后,情绪管理组护士在解决问题、求助、合理化、退避、自责、幻想等方面的得分结果明显优于常规管理组护士的得分结果,差异显著有统计学意义（P〈0．05）。结论：情绪管理对临床护理管理工作的实践具有重要意义,可有效调节护理人员的工作情绪,从而提高临床护理的质量。     

Physiological consequences of prolonged nursing in the honey bee

Honey bee workers normally produce brood food at an age of 5 to 15 days. However, natural events like swarming or brood diseases may lead to the occurrence of over-aged nurses. Here we investigated the physiological consequences of prolonged nursing for both the nurses and the brood they rear, and tried to separate the effects of chronological age and of task affiliation on some important physiological parameters. Brood was reared in groups of colonies with either a normal age structure or with moderately over-aged workers.The haemolymph concentrations of total protein and vitellogenin, the development of mandibular and hypopharyngeal glands, and the activity of α-glucosidase in the hypopharyngeal glands of nurses from these groups of colonies were compared. Moreover, we used the fertility of young workers reared by normal- and overaged nurses as a bioindicator for the quality of the brood care they had received. It showed that parameters linked to the production of brood food proteins remained stable in over-aged nurses, whereas the development of mandibular glands regressed. Workers reared by over-aged nurses had more ovarioles and showed stronger ovary development under queenless conditions. Our results indicate that while over-aged nurses remain capable of producing brood food, they are not functionally equivalent to young nurses. The partial degeneration of the mandibular glands normally occurring at the end of the nursing period cannot be prevented by prolonged nursing. The distinct phenotype of workers reared by old nurses raises the question of possible age-related specialisations among nurses in colonies with a normal age structure. Received 14 July 2008; revised 18 November 2008; accepted 21 November 2008.     

Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial

ObjectiveTo determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers.DesignRandomised controlled equivalence/non-inferiority trial.SettingFour NHS hospitals in three trusts. Three of the four were teaching hospitals.ParticipantsAll patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999.InterventionAssessment by one of three appropriately trained nurses or by one of several preregistration house officers.Results1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%).ConclusionsThere is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment.     

意大利蜜蜂哺育蜂学习记忆相关基因的转录组学分析

【目的】筛选与意大利蜜蜂Apis mellifera ligustica哺育蜂学习记忆密切相关的基因。【方法】在人工组建意大利蜜蜂蜂群中收集10日龄哺育蜂、21日龄哺育蜂、21日龄采集蜂,通过喙伸反应(proboscis extension reflex, PER)实验测定这3组样本之间学习记忆能力的差异。利用RNA-seq技术对具有学习能力和不具有学习能力的10日龄哺育蜂和21日龄哺育蜂脑中基因表达量进行全面分析,筛选出与哺育蜂学习记忆密切相关的差异表达基因(DEGs),并对这些差异表达基因进行GO和KEGG富集分析。qPCR检测随机选取的3个DEGs(上调基因TpnCⅢa和MED23以及下调基因Pkc)在具有学习能力和不具有学习能力的10日龄哺育蜂和21日龄哺育蜂脑中的表达量。【结果】PER实验结果显示,经过5次训练后,意大利蜜蜂21日龄哺育蜂的学习能力显著高于10日龄哺育蜂的,而21日龄哺育蜂和21日龄采集蜂的学习能力无显著差异;同样地,21日龄哺育蜂的记忆能力显著高于10日龄哺育蜂的,而21日龄哺育蜂和21日龄采集蜂的记忆能力无显著差异。RNA-seq分析筛选到88个与哺育蜂学习记忆密切相关的DEGs,其中18个上调表达,70个下调表达。GO富集结果显示,上调DEGs在生物学进程分类中富集的基因数最多,主要富集在信号转导、蛋白质加工修饰相关;下调DEGs也是在生物学进程分类中富集的基因数最多,主要富集在转录、信号转导、蛋白质生物合成相关,其中显著性富集在转录相关。KEGG富集结果显示,下调DEGs显著性富集在吞噬、光转导、AGE-RAGE信号通路。qPCR结果显示差异表达基因TpnCⅢa,MED23和Pkc在具有学习能力和不具有学习能力的10日龄哺育蜂和21日龄哺育蜂脑中的表达水平的变化趋势与RNA-seq数据中的变化趋势一致。【结论】PER实验表明日龄是影响意大利蜜蜂哺育蜂的学习和记忆能力的重要因素;同时本研究获得学习后哺育蜂脑部的基因表达变化趋势和富集分析,为深入研究哺育蜂学习记忆的分子机制奠定了重要的理论基础。     

Diurnal Urinary 6‐Sulfatoxymelatonin Levels among Healthy Danish Nurses during Work and Leisure Time

The present study aims to examine the influence of evening and night shift work, compared to day shift work, on melatonin secretion in nurses in a field setting. Effects were examined during a workday and during a day off. Both fixed schedules and mixed or rotating schedules were studied. In total, 170 nurses were studied: 89 nurses worked fixed schedules, 27 nurses worked the day shift, 12 nurses worked the evening shift, 50 nurses worked the night shift, and 82 nurses worked mixed schedules, with data collected during a day (n=17), evening (n=14), or night shift (n=50). All spot urine samples were collected during 24 h from the participants on a work day and on a day off and were analyzed for 6‐sulphatoxymelatonin. On the day of urine sampling, participants filled in the Karolinska Sleep Diary. Additional information was collected through a telephone interview. Data were analyzed using a mixed procedure with autoregressive covariance structure. The present study showed that shift work affected the concentrations of 6‐sulphatoxymelatonin in the short term by lower excretion in urine from nurses working the night compared to day shift on a workday and on a day off as well. No significant differences were observed between a workday and a day off when doing day and evening shifts, irrespective of mixed and fixed schedules. Sleep length was reduced workdays (from 6.1–6.8 h) among all nurses, compared to days off (from 7.8–8.7 h).     

Diurnal urinary 6-sulfatoxymelatonin levels among healthy Danish nurses during work and leisure time

The present study aims to examine the influence of evening and night shift work, compared to day shift work, on melatonin secretion in nurses in a field setting. Effects were examined during a workday and during a day off. Both fixed schedules and mixed or rotating schedules were studied. In total, 170 nurses were studied: 89 nurses worked fixed schedules, 27 nurses worked the day shift, 12 nurses worked the evening shift, 50 nurses worked the night shift, and 82 nurses worked mixed schedules, with data collected during a day (n=17), evening (n=14), or night shift (n=50). All spot urine samples were collected during 24 h from the participants on a work day and on a day off and were analyzed for 6-sulphatoxymelatonin. On the day of urine sampling, participants filled in the Karolinska Sleep Diary. Additional information was collected through a telephone interview. Data were analyzed using a mixed procedure with autoregressive covariance structure. The present study showed that shift work affected the concentrations of 6-sulphatoxymelatonin in the short term by lower excretion in urine from nurses working the night compared to day shift on a workday and on a day off as well. No significant differences were observed between a workday and a day off when doing day and evening shifts, irrespective of mixed and fixed schedules. Sleep length was reduced workdays (from 6.1-6.8 h) among all nurses, compared to days off (from 7.8-8.7 h).     

Micronucleus induction and FISH analysis in buccal cells and lymphocytes of nurses administering antineoplastic drugs

A genotoxic effect for antineoplastic drugs, in particular micronucleus induction, has been shown in several studies. The aim of our study was to assess genotoxic effects in nurses administering different mixtures of antineoplastic drugs in an oncology hospital by evaluating the frequency of micronuclei in exfoliated buccal cells and blood lymphocytes by use of the standard micronucleus (MN) test and by identifying, by means of FISH analysis with centromeric probes, the mechanism of micronucleus induction (clastogenic or aneugenic). The study group comprised 23 nurses, 10 of whom worked in the day-care hospital and 13 in the ward. Twenty healthy subjects were selected as controls. Pan-centromeric FISH analysis was performed on lymphocytes from a selected group of nurses (12/23 subjects) characterized by higher MN frequencies as observed by standard Giemsa staining. A significant increase of micronucleus frequency compared with controls was found in exfoliated buccal cells of both groups of nurses: day-care hospital nurses 0.92 versus 0.45 (p=0.034) and ward nurses 0.94 versus 0.45 (p=0.051). An increase, although not statistically significant, of mean MN frequency was also found by the MN standard test on lymphocytes of the day-care hospital nurses (10.9 versus 7.5; p=0.056), while no differences were found in ward nurses (8.15 versus 7.5; p=0.56). We found that the administration of antineoplastic drugs by nurses in ward units induced a higher frequency of FISH MN+ (43% of subjects) than in the day-care hospital (20%). This was associated with the micronucleus size percentage. This finding could be correlated with the different compositions of administered mixtures of antineoplastic drugs: in ward units the mixtures contained drugs, such as vinorelbine, that were absent in the mixtures administered in the day-care hospital. Our results show genetic damage induced by administration of antineoplastic drugs, particularly in exfoliated buccal cells. This result suggests the useful application of this non-invasive sampling to evaluate genotoxic effects of occupational exposure to mixtures of inhalable chemicals at low doses.     

Coronary Care Units—The Status in California

In order to determine the status of Coronary Care Unit activity in California hospitals, especially as it pertains to nurse training, a survery was conducted by the California State Department of Public Health. More than 95 percent of hospitals that were questioned responded. Only one-third of the hospitals reported they neither had a unit nor plans to build one. All units in operation were either directed by an individual medical director or by a Coronary Care Unit Committee.The survey indicated that in some hospitals with operational units, nurses were not permitted to perform life-saving resuscitative procedures. All operational units reported in-service education programs of some type. Many hospitals indicated they would like to have Coronary Care Unit training programs to which they could send nurses. The reasons why nurses may not perform important resuscitative procedures are discussed as well as the need for Coronary Care Unit training programs for both physicians and nurses in California.     

Power frequency magnetic field exposures among nurses in a neonatal intensive care unit and a normal newborn nursery

Given the current interest in potential carcinogenic and developmental effects of exposure to extremely-low-frequency electromagnetic fields, there is a need to identify cohorts of exposed female workers for future epidemiologic investigations. This study was designed to test the hypothesis that nurses working in neonatal intensive care units (NICU) may be significantly exposed to power-frequency magnetic fields. An electromagnetic field monitor was used to measure magnetic fields at distances of 5, 15, 30, and 60 cm from the surfaces of each device used in the NICU. Six female nurses assigned to the NICU (the “exposed” group) and six female nurses working in the normal newborn nursery (the “referent” group) wore EMDEX dosimeters for the entire duration of their 12 h shifts. An investigator kept a detailed log of each NICU subject's whereabouts for the first one-third of her shift. Magnetic fields at 5 cm from the front (defined by the nurses' usual work area) of the NICU devices ranged from less than 0.1 to 114 μT and in all cases decreased considerably with increasing distance. The geometric mean of the shift-time-weighted average exposure of the NICU nurses was 0.17 μT compared with 0.11 μT for the normal newborn nurses. The percentage of time when subjects were exposed to magnetic fields of 0.4 μT or greater ranged from 5.8% to 15.6% for the NICU nurses, 0.4% to 2.9% for five of the comparison group nurses, and was 9.4% for one of the normal newborn nurses with unidentified aberrantly high exposures. Log data revealed that the vast majority of observed peaks among NICU nurses occurred while subjects were in close proximity to infant bed units. We conclude that NICU nurses represent one female-intensive job sector with intermittent high exposures to ELF magnetic fields and encourage larger exposure studies of nurses in a variety of medical settings. © 1994 Wiley-Liss, Inc.