Use of a think-aloud procedure to explore the relationship between clinical reasoning and solution-focused training in self-harm for emergency nurses

Self-harm is a risk factor for further episodes of self-harm and suicide. The most common service used by self-injurers is the emergency department. However, very often, nurses have received no special training to identify and address the needs of these patients. In addition this care context is typically biomedical and without psychosocial skills, nurses can tend to feel unprepared and lacking in confidence, particularly on the issue of self-harm. In a study that aimed to improve understanding and teach solution-focused skills to emergency nurses so that they may be more helpful with patients who self-harm, several outcome measures were considered, including knowledge, professional identity and clinical reasoning. The think-aloud procedure was used as a way of exploring and improving the solution-focused nature of nurses' clinical reasoning in a range of self-harm scenarios. A total of 28 emergency nurses completed the activity. Data were audiotaped, transcribed and analysed. The results indicated that significant improvements were noted in nurses' ability to consider the patients' psychosocial needs following the intervention. Thus this study has shown that interactive education not only improves attitude and confidence but enlarges nurses' reasoning skills to include psychosocial needs. This is likely to improve the quality of care provided to patients with mental health problems who present to emergency settings, reducing stigma for patients and providing the important first steps to enduring change - acknowledgment and respect.

Dietary fructooligosaccharides alter the cultivable faecal population of rats but do not stimulate the growth of intestinal bifidobacteria

The effect of fructans on the cultivable faecal community of Bio Breeding rats fed diets containing 5% (m/v) food-grade fructooligosaccharide (FOS) was investigated. Culturing of faecal material using chicory inulin as the sole carbohydrate source revealed the presence of a greater diversity of inulin-utilizing bacterial species in FOS-fed rats as compared with the control rats, although both contained species which effectively utilized inulin. The majority of cultivable inulin-utilizing species fell within the Clostridium coccoides group and Clostridium leptum subgroup, some of which were related to previously cultured butyrate-producing bacteria from the intestines of various animals. The impact of FOS on the growth of the indigenous bifidobacteria community and three inulin-utilizing isolates was assessed using real-time polymerase chain reaction. While dietary FOS was found to stimulate the growth of all three inulin-utilizing isolates, no growth stimulation of the indigenous bifidobacteria community occurred over the duration of the feeding trial.

HPLC purification of recombinant NcGRA6 antigen improves enzyme-linked immunosorbent assay for serodiagnosis of bovine neosporosis

The gene for a dense granule protein (NcGRA6) of Neospora caninum was expressed in Escherichia coli as a His-tag fusion protein and purified by NiNTA affinity chromatography. In a preliminary study, high binding of antibodies from N. caninum-negative cows was observed in enzyme-linked immunosorbent assay (ELISA) using NiNTA-purified NcGRA6. Analysis of NiNTA eluates revealed a significant number of E. coli proteins that co-purified with recombinant NcGRA6. In an attempt to improve the relative sensitivity and specificity of the NcGRA6-based ELISA, the rNcGRA6 eluates were subjected to a secondary purification using reverse phase-high performance liquid chromatography (RP-HPLC). Analysis of RP-HPLC eluates by SDS-PAGE/silver staining revealed the purification of recombinant NcGRA6 from contaminating E. coli proteins. ELISAs using the RP-HPLC purified NcGRA6 (dELISA) or singly purified NcGRA6 (sELISA) for identifying seropositive and seronegative cows in a beef herd experiencing an epidemic outbreak of neosporosis were compared to standard assays based on native tachyzoite protein-immunofluorescence antibody test, immunoblot assay, and ISCOM-ELISA. The relative sensitivity, specificity, and kappa value of the NcGRA6d-ELISA were greatly improved over the NcGRA6s-ELISA when compared to the three native antigen immunoassays. These results indicate that removal of contaminating E. coli proteins improves the performance of recombinant NcGRA6 ELISA in diagnosing bovine neosporosis, and may have applicability to the use of recombinant proteins in diagnosing other infectious agents.

Conversation starters: re-examining and reconstructing first encounters within the therapeutic relationship

This paper describes, analyses and reconstructs early encounters between nurse and client. Too often nurses take for granted ordinary encounters with clients and thus overlook opportunities to develop the nurse-client relationship. Common encounters, drawn from reflection on practice, are analysed using contemporary cultural theories. Creative alternatives are suggested and we argue that they represent opportunities to make meaningful connections with and for clients. As conversation starters, these ideas may be used by nurses to facilitate a more trusting therapeutic relationship. They may help to deepen understanding or insight into mental health problems and help to reveal hidden strengths and solutions. By noticing, valuing, discussing and developing this space, we as mental health nurses are extending our discipline base and articulating, with more precision and persuasion, exactly how we contribute to better health outcomes.

Neuropsychological functioning in end-stage renal disease

AIMS

To compare the neuropsychological functioning and behaviour of children with non-syndromic end-stage renal disease (ESRD) and sibling controls.

METHODS

The study was carried out at two tertiary care paediatric teaching hospitals, in Halifax and Vancouver, Canada. Children with ESRD were on a renal transplant waiting list and either pending dialysis or on dialysis therapy. Twenty two patient-sibling pairs were evaluated. Neuropsychological assessments consisting of measures of intelligence, academic achievement, memory, and motor abilities were carried out. Maternal ratings of behaviour and self-report rating of self-esteem were collected.

RESULTS

The Verbal, Performance, and Full Scale IQs of patients with ESRD were significantly lower than the IQs of the sibling controls. The mean differences were 8.6, 11.7, and 10.9 points, respectively. ESRD patients also had significantly more difficulty on measures of fine motor coordination and ability to copy geometric designs than sibling controls. There were no differences between groups on measures of academic achievement, memory, behaviour, or self-esteem.

CONCLUSIONS

Although children with ESRD exhibited mild deficits on measures of intelligence and some measures of motor abilities, their neuropsychological outcome was more favourable than earlier reports indicated.

Culture-independent phylogenetic analysis of the faecal flora of the rat

The dominant faecal flora of the rat was determined using randomly cloned 16S rDNA comparative sequence analysis. A total of 109 near full-length 16S rDNA clones were sequenced, representing 69 unique 16S rRNA phylotypes or operational taxonomic units (OTUs). Estimates of species richness indicated that approximately 338 species were present in the faeces, suggesting that only 20% of species were identified. Only two of 39 Gram-negative clones aligned with previously cultured species, the remainder fell into a separate lineage within the Bacteroides-Cytophaga phylum. Several clones within this new group were related to 16S rDNA sequences previously identified from mouse faeces. Lactobacilli were the most abundant Gram-positive species, representing 23% of the total clones but only 7% of OTUs. The remaining Gram-positive clones were distributed among the Clostridium coccoides group (9%), the Clostridium leptum subgroup (18%), and throughout the low GC Gram-positive bacteria (13%). The majority of OTUs (63/69 or 91%) were less than 97% homologous to previously cultured bacteria. Faecal samples were also cultured using a variety of anaerobic media. With the exception of the lactobacilli, the cultured isolates demonstrated low species diversity and poorly reflected the population, as defined through comparative sequence analysis.

Personal theories of inheritance, coping strategies, risk perception and engagement in hereditary non-polyposis colon cancer families offered genetic testing

From the geneticist's (or 'genetic counsellor's') perspective, lay models of inheritance can be perceived as problematic because they might interfere with understanding and acceptance of the explanation of inheritance provided in genetic counselling. The work presented here forms part of a larger qualitative grounded-theory study where the aim was to develop theory that could explain variations in adjustment to genetic testing for hereditary non-polyposis colon cancer (HNPCC). Ten of the 29 individuals interviewed who were at 50% or 25% risk used a 'personal theory of inheritance' to justify or explain a belief that they did, or did not, carry the family mutation. Two others indicated that, as a coping strategy, they chose to believe themselves to be carriers. This article presents part of the theory of engagement that was constructed using this data, relating to the process of development of risk perception. The theory suggests that for some individuals, these beliefs can form part of a process of coping and coming to terms with risk. An exploration of these processes may help practitioners to better understand the complexity of risk perception in individuals at genetic risk for cancer, particularly those preparing for predictive test results. Further development and testing of the theory is discussed.

CARE: A framework for responding therapeutically to the client who self-harms

The CARE framework is a relevant, flexible and practical tool that can be used to map out a plan of care for helping the client who deliberately self-harms. A clear framework for care is useful for clinicians and consumers because ideally it provides a standard, holistic and considered approach for what is a complex health care issue. This paper recounts a story from clinical experience in which the CARE framework was applied. In this encounter, the nurse was helped to move beyond the limitations of the medical model towards an approach which proved satisfying for the health professional, and awakening for the client.

Expression, purification and preliminary X-ray analysis of the BRCT domain from Rhp9/Crb2

The BRCT domain from Rhp9 (a Schizosaccharomyces pombe DNA-damage checkpoint protein) has been expressed, purified and crystallized. Overexpression in bacterial cells was achieved by minimizing aeration during host cell growth. A robotic screen was used to determine the solubility parameters; concentration of the protein was achieved by exploiting this information. Single crystals suitable for X-ray analysis were obtained in two forms by vapour diffusion (trigonal, unit-cell parameters a = b = 228.04, c = 70.42 A, and tetragonal, P4/m Laue group symmetry, unit-cell parameters a = b = 72.3, c = 91.1 A).

CARE: a framework for mental health practice

Much has been written about care and its centrality to nursing practice. Yet nursing theories and frameworks surrounding care have either been esoteric or prescriptive and are seen as irrelevant to practice. This paper problematizes the notion of care with a view to developing a clearer, flexible framework for mental health practice. The framework is the product of the authors' shared and individual experiences and theorizing as nurses and educators and has not yet been evaluated. The CARE framework (containment, awareness, resilience and engagement) is detailed, with examples of its use in practice. Using the framework offers a way for clinicians and carers to work more strategically with clients, helping them manage and understand their condition or disability, offering support to adapt and cope, and revealing and developing new or hidden strengths to help them endure the experience and find meaning for the recovery process. Taking up the framework within the everyday practice of mental healthcare offers several benefits for clients, clinicians and mental health.

Principles and strategies for teaching therapeutic responses to self-harm

This paper explains the educational principles and strategies underpinning a nursing course offered at an Australian university. The course is entitled 'Self-harm and therapeutic responses' and explores contemporary theories and practices to improve understanding and responses to people who self-harm. The course aims to shape the practices of nurses in developing healthier clinical and social environments for people who self-harm.

Using action research within a school of nursing: exposing tensions in ideologies

This paper examines and critically reflects on a recent curriculum evaluation that took place in 1999 within a school of nursing. Critical theory, and in particular action research, was chosen as an approach for the research. The method aimed to foster participation and reveal and problematise aspects of nursing education which had become taken for granted. Through the process of action research a number of tensions and challenges were revealed. The exposed tensions and challenges are discussed and reframed so that they offer potential for renewed commitment to nursing education, rather than continued constraint and conformity.

Principles for curriculum development in Australian nursing: an examination of the literature

The teaching and learning environment involves a complex interplay of various elements, each of which has been the subject of much educational research. This paper uses a framework for understanding these teaching and learning elements and provides a review of relevant literature. This critical review provided a foundation and focus for the development of a new bachelor of nursing program within a School of Nursing in a Queensland University.

Principles in practice: an Australian initiative in nursing curriculum development

This paper explains how curriculum values distilled from educational and nursing literature have been incorporated into a new bachelor of nursing program in an Australian University. The curriculum philosophy has been constructed to acknowledge the current learning climate and diverse learning styles, the active role teachers must play in developing competent nurses and critical thinkers, as well as the need to celebrate nursing's diversity whilst building a strong identity. The philosophy of this new curriculum is to reclaim the human dimension of nursing and inject renewed vigour and enthusiasm into the work of teachers and students.

Dissociative identity disorder and the nurse-patient relationship in the acute care setting: an action research study

This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

Lisa's lessons: a case study of mental health teaching and learning

Practical approaches to the educational preparation of mental health nurses need to be shared in order to contribute to discipline development. This paper presents the results of an ethnographic study using case study and educational criticism to explore mental health classrooms and share practical approaches to teaching.

Domestic violence: a life-span approach to assessment and intervention

Domestic violence affects millions of Americans, many of whom deny or refuse to admit that that they are victims of abuse. Assessing patients at risk for domestic violence is a critical aspect of providing comprehensive primary care. As social agents, with moral and ethical responsibility, primary care providers must advocate for clients in the fight against domestic violence. Primary health care agencies must adopt uniform policies that assure that all women, children, and elders at risk for abuse are screened using a simple tool that becomes part of the primary care record. Screening for abuse should become part of an annual screening process, not unlike screening patients for high blood pressure or high cholesterol. If patients are suspected of being abused, document this on the problem list so subsequent providers will know to explore the possibility of abuse with patients. Multiple forms of abuse occur in families, and signs of abuse are usually subtle in nature. Abuse may be the reason for failed office visits, noncompliance with medications, depression, and other unexplained physical and psychological signs and symptoms. If we fail to ask, we will never know how many of our patients are victims of abuse and in need of our help.

Validation of the premature infant pain profile in the clinical setting

OBJECTIVE

The Premature Infant Pain Profile (PIPP) is a 7-indicator composite measure developed to assess acute pain in preterm and term neonates. It has been validated in studies using synchronized videotaping of infants undergoing procedures. The purpose of this study was to establish (a) construct validity of the PIPP and (b) inter- and intrarater reliability of the PIPP prospectively in the clinical environment.

DESIGN

A randomized, crossover design was used.

SETTING

The study was conducted in a Level III outborn neonatal intensive care unit.

PARTICIPANTS

A convenience sample of 43 neonates, stratified by gestational age, was studied.

INTERVENTIONS

Each infant experienced three separate, randomly ordered events: baseline, a painful event, and a nonpain event. Infants were videotaped and scored at the bedside using the PIPP by the nurse caring for the infant and the clinical nurse specialist who bad expertise in infant pain. The videotapes were later reviewed by two additional experts; one in real time and one using a second-to-second stop frame technique.

RESULTS

Repeated-measures analysis of the main effects and interactions yielded a statistically significant main effect for event (pain, nonpain, baseline), thus differentiating pain from nonpain and baseline events (F = 48, p = 0.0001) and establishing construct validity. Interrater reliability analysis of individual event scores of the PIPP yielded reliability coefficients of 0.93-0.96. Intrarater reliability coefficients analysis for individual events were equally high at 0.94-0.98.

CONCLUSIONS

This study demonstrates that the PIPP is a pain measure with good construct validity and excellent inter- and intrarater reliability for the assessment of procedural pain of preterm and term infants in clinical settings.

Experimental inoculation of domestic pigeons (Columbia livia) and zebra finches (Poephila guttata) with Neospora caninum tachyzoites

Dogs are a definitive host of Neospora caninum and cattle are intermediate hosts. Alternative life-cycles have not been investigated. Foxes are frequently seropositive, but may not commonly prey upon cattle; therefore, other intermediate hosts may exist that are frequent prey of foxes. Three domestic pigeons (Columbia livia) and three zebra finches (Poephila guttata) were inoculated with N. caninum tachyzoites, to determine if they could serve as intermediate hosts. Tissue culture, PCR, serology, and histology were all positive for one or more pigeons. All finches resisted infection. Further testing of columbiform birds as intermediate hosts of N. caninum is warranted.

Ingestion of Neospora caninum tissue cysts by Mustela species

Dogs are a definitive host of Neospora caninum, a protozoal parasite that causes abortion in cattle. Mustelids were tested to determine if they could also be definitive hosts. The procedures used were the same as those previously used to test dogs. Ermine (Mustela erminea), weasels (Mustela frenata) and ferrets (Mustela putorius) were fed N. caninum-infected mice. Neospora caninum oocysts were not observed. Mustelid faeces were fed to mice. The mice did not seroconvert and N. caninum was not detected in murine brains using tissue culture and PCR. The hypothesis that Mustela spp. are definitive hosts of N. caninum is not supported.

Evaluation of a partnership model of care delivery involving registered nurses and unlicensed assistive personnel

The employment of unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients, caregivers, and hospital organizations. This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included unlicensed assistive personnel. Most of the expected benefits of the newly implemented nursing care delivery system did not materialize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients, caregivers, or hospital organizations. The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are designed to optimize patient, caregiver, and hospital outcomes.