Case study: the development of specialist nurse roles in Malta

Specialist nurses play a significant role in healthcare. This study investigated and evaluated the primary and extended roles and the development of specialist nurses in Malta.

METHODS

A qualitative case study design and purposive sampling techniques were used to gain a deep understanding of the complex issues surrounding specialist nurses from multiple data sets. A survey of the total specialist nurse population in 2013 (n=27), in-depth interviews with a group of specialist nurses (n=9) and four focus groups with key professionals and policy stakeholders (total n=28) were carried out. Data were collected between 2013 and 2015 and analysed using thematic analysis.

FINDINGS

Three themes emerged: the roles and attributes of specialist nurses in Malta; the development of specialist nurses; and the influences on the advancement of specialist nursing practice in Malta. Although these data are nearly a decade old, no further research has been carried out.

CONCLUSIONS

A legally accepted set of definitions as well as preparation and evaluation of the specialist nurse role from a national policy perspective is needed. Attitudes and systems that limit specialist nurses need to be challenged.

Nurses' attitudes and barriers to incident reporting in Malta's acute general hospital

Although the science of patient safety has been developed and implemented widely, there remains a large gap in the understanding of the chain of events that lead to safety incidents, as well as their cost to patients, healthcare staff and the organisation as a whole. The aim of the study was to evaluate nurses' knowledge and awareness of the local incident reporting system at Malta's acute general hospital. A quantitative, descriptive cross-sectional design was used and data were collected from nurses through an online survey. A total of 323 questionnaires were received with a response rate of 23%. Various shortages within the local setting were identified, including lack of feedback and awareness of the system. Therefore, it is suggested that incident reporting should be given a higher profile on the organisation's agenda and incorporate employed members of staff rather than volunteers.

The in vitro effect of high-dose recombinant human erythropoietin on granulocyte-macrophage colony production in premature infants using a defined serum deprived cell culture system

Recent reports of neutropenia associated with the use of recombinant human erythropoietin (r-HuEpo) in preterm infants with the anaemia of prematurity have raised concern over the clinical use of this hormone. The present studies were undertaken to determine whether high-dose r-HuEpo has an effect on granulocyte production in vitro. The studies used a serum deprived, optimized semi-solid cell culture system to investigate the effect of lineage specific and non-specific granulocyte and erythroid colony stimulating factors on circulating peripheral blood granulocyte-macrophage colony forming units (CFU-GM), erythroid burst forming units (BFU-E) and multilineage colonies (CFU-Mix) from nine premature infants and seven healthy adults. CFU-GM were grown in the presence of interleukin 3 (IL3) 8 ng/ml, granulocyte-macrophage colony stimulating factor (GM-CSF) 20 ng/ml and granulocyte colony stimulating factor (G-CSF) 15 ng/ml alone and combinations of G-CSF with GM-CSF or IL3. The number, size and differentiation of CFU-GM colonies were then analysed in the presence and absence of high dose r-HuEpo (4 U/ml). High-dose r-HuEpo did not exert any significant modulatory effects on the number of CFU-GM colonies produced in the presence of IL3, GM-CSF and G-CSF alone or in combination. The number of cells within each CFU-GM colony did not change significantly, nor was there a significant change in the degree of differentiation. The combined number of BFU-E, CFU-GM and CFU-Mix colonies increased with r-HuEpo in both adults (1.8 x) and preterm infants (1.4 x), almost exclusively due to an increase in BFU-E derived colonies. Thus, no evidence was found for an r-HuEpo mediated redirection of multipotential haemopoietic stem cells into committed erythroid precursors at the expense of myeloid precursors.

The posteroanterior chest radiograph in depressed sternum

The posteroanterior and lateral chest radiographs of 72 consecutive patients with sternal depression, together with 72 age- and sex-matched controls, have been reviewed. We assessed size and position of the cardiac silhouette, mediastinal contour, radio-opacity in the right lower zone and rib configuration. The degree of depression was determined from the lateral radiograph. The most significant signs of sternal depression on the posteroanterior chest radiograph are a straight left heart border, displacement of the cardiac silhouette to the left and an indistinct right heart border. These three signs have a high specificity for sternal depression and are significantly more commonly seen with increasing severity of depression. The presence of any three, or of more than three, of the described signs was 95.5% specific. However, despite this high specificity, the sensitivity and positive predictive value even for a combination of signs are low. Sternal depression is a relatively common chest deformity and the radiologist should be aware of the changes on the posteroanterior chest radiograph to avoid pitfalls in diagnosis.

The left ascending lumbar vein: a potential pitfall in CT diagnosis

A communication between the left ascending lumbar vein and the left renal vein may be mistaken for a para-aortic mass on abdominal computed tomography due to a localised dilatation at the confluence of these veins. The use of contiguous closely collimated sections and the injection of intravenous contrast medium overcomes this potential pitfall which may be particularly important in the staging of patients with testicular neoplasms.

A potential pitfall of pelvic computed tomography

The cross-sectional areas of the common iliac veins were measured by pelvic computed tomography (CT) in 51 patients. The left common iliac vein was significantly larger than the right (p less than 0.01) and in 35% of patients there was at least a two-fold difference between the cross-sectional areas of the veins. Recognition of this normal asymmetry is important when interpreting pelvic CT scans. It is thought to be due to the oblique course of the left common iliac vein and to partial obstruction of the left common iliac vein by the right common iliac artery.

Crohn's disease limited to the mouth and anus

A young girl developed painful swelling and ulceration of her lips and mouth. She had gingival hyperplasia, an anal fissure, and anal skin tags without evidence of intervening intestinal disease. A diagnosis of Crohn's disease was made. All lesions regressed with appropriate therapy. She remains asymptomatic 14 months after presentation.

Serum amoxycillin levels following oral loading dose prior to outpatient general anaesthesia for dental extractions

Serum amoxycillin levels were measured 4 h after oral administration of a 3 g loading dose given prior to outpatient dental treatment under general anesthesia. A mean level of 8.49 mg/l +/- (1 S.D.) 5.07 mg/l of amoxycillin was obtained, which is adequate at the time of bacteraemia to protect patients susceptible to bacterial endocarditis. A second identical dose of amoxycillin was given following recovery from anaesthesia (mean 18.7 min) and was tolerated by 97.6% of patients.