Search

One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person-centred practice (PCP). Although the idealisation of nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient-centred care.

There has long been acceptance within healthcare that one of the roles that nurses fulfil is to do with patient advocacy. This has historically been positioned as part of the philosophical and inherent requirements of the nursing profession at large and is supported through shared conceptualisations of the nursing profession. Such conceptualisations are communicated to nursing professionals by way of first their education, and second their professional codes, guidelines and standards for practice. The focus on advocacy is further embedded within patient-centred care frameworks and concepts of the nurse–patient therapeutic relationship. Nurses have also been considered ideally placed to undertake the work of patient advocacy due to the 24/7 nature and intimacy of the care provided. What this means is that nurses are under the impression that that they must be an advocate for their patients through their nursing practice. However, for a fundamental concept of nursing, advocacy is poorly defined, and practices commonly associated with advocacy are undercut by the professionalisation of nursing and other constraints. In addition, nursing standards and frameworks of care are being actively reframed around ideas of empowerment which do not necessarily fit well with those of advocacy. This article thus suggests that it is time to recognise that the work of advocacy is no longer representative of what nurses (can) do in practice, and to explicitly reorient conceptualisations of nurse practice around empowerment. This article will further analyse what this may look like in practice.

Nursing professionals in a variety of practice settings routinely use implied consent. This form of consent is used in place of or in conjunction with informed or explicit consent. This article looks at one aspect of a qualitative exploratory study conducted in a Day of Surgery Admission unit. This article focuses on the examination of nurses’ understandings of implied consent and its use in patient care in nursing practice. Data were collected through one-on-one interviews and analysed using a thematic analysis. Nurses participating in this study revealed that they routinely used implied consent in their nursing practice. This article will look at whether implied consent supports or impedes a patient’s autonomy.

Differences in the number of functionally and/or phenotypically defined bone marrow cells in inbred mouse strains have been exploited to map quantitative trait loci (QTL) that determine the variation in cell frequency. To extend this approach to the differences in the stem/progenitor cell compartment in CBA/H and C57BL/6 mice, we have exploited the resolution of flow cytometry and the power of QTL analyses in 124 F(2) mice to analyze lineage-negative (Lin(-)) bone marrow cells according to the intensity of labeling with Sca-1 and c-Kit. In the Lin(-) Sca-1(+) c-Kit(+) enriched population, six QTL were identified: one significant and five suggestive. Whereas previous in vitro clonogenic, LTC-IC, day 35 CAFC, and flow cytometry each identified different QTL, our approach identified the same or very similar QTL at all three loci (chromosomes 1, 17, and 18) as well as QTL on chromosomes 6 and 10. In silico analyses implicate hematopoietic stem cell homing involving Cxcr4 and Cxcl12 as being the determining pathway. The mapping of the same or very similar QTL in independent studies using different assay(s) suggests a common genetic determinant, and thus reinforces the biological and genetic significance of the QTL. These data also suggest that mouse bone marrow cell subpopulations can be functionally, phenotypically, and genetically defined.

Background: Nurses worldwide are expected to take a leading role in caring for older people. Considerable literature dedicated to the range and application of assessment skills used by nurses vary. There is limited knowledge of registered nurses' (RNs) views of their assessment of older adults.Aim: The aim of this project was to explore RNs current perceptions of nursing assessment, and the core skills they identified as necessary.Design: A qualitative descriptive design study was conducted in three inpatient units in one regional hospital in Victoria.Method: Date were collected through participant observation of RNs (n = 13) followed by 1:1 semi-structured interviews. Data were analysed thematically.Conclusion: This research has illuminated that an ill-defined repertoire of skills was used by RNs when assessing older persons. Skills identified appeared to be based on years of personal-professional experience. Differences were noted between the descriptions nurses gave and what was observed during interac...

To investigate the influence of genetic and epigenetic factors on allelic loss on chromosomes 2 and 4 in mouse radiation-induced acute myeloid leukaemia (r-AML).r-AML that arose in (CBA/HxC57BL/6)F1xCBA/H and F1xC57BL/6 mice were screened for transcription factor PU1 (also known as SPI-1) gene mutations and methylation of the paired box gene 5 (Pax5) gene promoter. We have increased the statistical significance of a genetic linkage analysis of affected F1xCBA/H mice to test for linkage to loci implicated directly or indirectly with r-AML-susceptibility.There was a statistically significant difference ( p10-4) in the frequency of PU1 gene mutations in F1xCBA/H and F1xC57BL/6 r-AML, implicating a second linked but genotype-dependent myeloid leukaemia suppressor gene on chromosome 2. A suggestive CBA/H r-AML-resistance locus maps within 10 cM of the minimally deleted region on chromosome 4. The Pax5 gene promoter is subject to ongoing subclonal promoter methylation in the r-AML, evidence that Pax5 gene silencing confers a selective advantage during clonal expansion in vivo.Allelic loss in mouse r-AML and subsequent tumour suppressor gene mutation (PU1) or silencing (Pax5) is strongly influenced by genetic background and/or epigenetic factors, and driven by in vivo clonal selection.

Objectives To share the experience of implementing and refining the use of e-portfolios into an undergraduate nursing degree. Design This is a reflective piece that explores the hurdles experienced in introducing and maintaining e-portfolio's into higher education, particularly in undergraduate nursing curricula. Data Sources Nil Review Methods Review of the literature, and comparing and contrasting this against the experience of the authors. Results Hurdles included access to computer and quality internet connections, along with the levels of IT literacy of staff, and the common misconception that all students are IT savvy. What was also evident was how the need for both pedagogical and technical support to both staff and students was paramount in achieving an understanding of the software, and the scope and perspective of e-portfolio pedagogy. With each of these hurdles, staff reluctance to engage in e-portfolio use in the tertiary sector was evident. On reflection of each of these challenges, the authors identified that their experience mirrored other tertiary institutions in that a single hurdle alone is not responsible for fragmented e-portfolio implementation, but a combination of factors. Through exploring recommendations from other tertiary institutions, the authors recognize the limitations within their own working environment that contributed to the pitfalls experienced. Conclusion Despite e-portfolios being introduced into higher education for over a decade, its' successful implementation into undergraduate nursing curricula continues to be fraught with pitfalls, creating the sense of moving backwards more so than forwards. As with any new learning tool, careful consideration needs to be given to comprehensive planning, implementation, review and evaluation to either prevent the hurdles identified, or limit their impact on the quality of the portfolio produced and the learning attained from the process.

Childbearing Poster Presentation Background Maple syrup urine disease (MSUD) is a rare autosomal recessive disorder that affects branched-chain amino acids. Worldwide, there are less than a dozen documented cases of successful pregnancies of women with MSUD. I describe the challenges of caring for a woman with a disease that is rarely seen in obstetrics and the interdisciplinary care that was required for her to have a successful pregnancy and delivery. I will provide education on MSUD and outline a plan of care intended to prevent metabolic decompensation of an obstetric patient with MSUD and to ensure her health and the health of her newborn. Case The woman was 27 years old, gravida 1, para 0, with MSUD and an expected inpatient stay of 10 to 14 days to closely monitor and adjust her amino acid levels. Multiple interdisciplinary meetings were conducted to review laboratory test results and metabolic and nutritional status before her arrival and daily during her admission. Specialists were involved from nursing, obstetrics, metabolic genetics, nutrition, pharmacy, intravenous therapy, laboratory services, and social services. Amino acid levels were drawn daily and couriered to another facility; a peripherally inserted central catheter line was placed before admission; close monitoring of insulin levels and fluids was conducted; weight was checked daily; frequent urinalysis was done for ketones; specialized total parenteral nutrition (TPN) and daily adjusted nutrition were monitored; specialized testing of the newborn was conducted; and continued close monitoring was maintained. This woman did very well until day 10 when her leucine levels started to increase and she was restarted on TPN. She was eventually discharged home on her normal diet. Her newborn required admission to the level II nursery for hypoglycemia, which resolved on day 4 of life, and was discharged home with her parents. Conclusion Very few cases of pregnant women with MSUD are described in the literature. This meant that providing care for a woman with MSUD during labor, delivery, and postpartum was challenging. An in-depth look at the disease, understanding metabolic control, and having a multidisciplinary approach with clear communication helped our team care for this woman and see her through to a safe delivery of a healthy newborn.

Whole body exposure to ionizing radiation increases the risk of radiation-induced acute myeloid leukaemia (r-AML). r-AML is the result of the accumulation of mutations in a single haemopoietic stem cell, so risk is therefore a function of the number of mutations required to transform the stem cell and the mutation rate. There is a genetic component to the risk of AML within the general population, and low penetrance variant alleles encoding DNA repair enzymes have been genetically implicated in therapy-related AML susceptibility. However, what is largely ignored is that target cell number, which defines the number of genomes at risk from DNA damaging agents, is also part of the equation that defines risk. We will review the evidence from genetic studies of inbred mouse models that target cell frequency is a risk factor in radiation leukaemogenesis. Inbred mouse strains that differ in their susceptibility to radiation-induced r-AML and thymic lymphoma (r-TL), spontaneous TL and pristane-induced plasmacytoma (PCT) have been exploited to identify susceptibility loci. The target cell in AML is the haemopoietic stem cell, whereas TLs and PCT arise from more mature lymphoid progenitor cells. Inbred mice also differ significantly in all aspects of haemopoiesis, and these differences have been used to identify quantitative trait loci (QTL) that determine the frequency of specific haemopoietic stem, progenitor or mature blood cells. The co-localization of QTL that determine risk and target cell frequency in all three haemopoietic malignancies is strong evidence that target cell frequency is a risk factor in radiation leukaemogenesis.

Erythropoiesis is under fine control and genetic loci that affect it are likely to be important in a range of conditions. To assess the relative contributions of different genetic loci to parameters of erythropoiesis, we have measured RBC counts in the peripheral circulation and committed erythroid cells (RBC and small normoblasts) in the bone marrow in a cohort of (CBA/H x C57BL/6) F2 mice to map quantitative trait loci (QTL). Candidate genes were assessed using bioinformatics and DNA sequencing. Different autosomal loci affect bone marrow (chromosomes 5, 11 and 19) and peripheral blood (chromosome 4) erythroid cell counts but there may be a common chromosome X locus. Spleen weight QTL were found on chromosomes 3, 15 and 17. Surprisingly, erythropoietin (Epo) is the best candidate quantitative trait gene (QTG) in the chromosome 5 locus that affects bone marrow but not peripheral blood erythroid cell counts. Epo gene expression is known to be genetically regulated in mice, but our data suggest a tissue-specific role for epo in mouse erythropoiesis that is also genetically determined. The identity of the other QTG will be important both to further knowledge of the control of erythropoiesis and as potential modifier genes for haematological disorders.

Objective To examine DNA methylation in mouse hemopoiesis before and after in vivo exposure to a leukemogenic dose of x-rays, and address whether methylation levels are associated with the relative radiosensitivity of tissues in vivo. Methods The methylation status of control CBA/H and C57BL/6 mouse tissues before and after exposure to 3-Gy x-rays, and myeloid and lymphoid leukemias and lymphomas, was assessed by the direct analysis of the 5-methylcytosine (5- Me C) content of DNA, and by Southern blot analysis of genomic repeat sequences. Results The DNA 5- Me C content of bone marrow is 15% lower than spleen. Together with the analyses of stem (myeloid) and progenitor (lymphoid) leukemias and lymphomas, we found a trend of increasing methylation during hemopoietic differentiation. Exposure to x-rays induced greater cell death in the hypomethylated bone marrow (>80%) than spleen (50%) in vivo, supporting the observed correlation found between methylation status and radiosensitivity of other high-turnover hierarchical tissues. Furthermore, there was an 8% DNA 5- Me C content decrease in bone marrow after in vivo exposure to 3-Gy x-rays, but this was genotype dependent, being observed in AML-susceptible (CBA/H) but not AML-resistant (C57BL/6) inbred mice. Conclusion Together these data suggest that methylation status may be related to the relative radiosensitivity of high-turnover hierarchical tissues such as bone marrow and that radiation-induced DNA hypomethylation has a role in radiation leukemogenesis.

Inbred CBA/H mice are susceptible to radiation-induced acute myeloid leukemia (r-AML), and C57BL/6 mice are resistant. A genome-wide screen for linkage between genotype and phenotype (r-AML) of 67 affected (CBA/H × C57BL/6)F1 × CBA/H backcross mice has revealed at least 2 suggestive loci that contribute to the overall lifetime risk for r-AML. Neither is necessary or sufficient for r-AML, but relative risk is the net effect of susceptibility (distal chromosome 1) and resistance (chromosome 6) loci. An excess of chromosome 6 aberrations in mouse r-AML and bone marrow cells up to 6 months after irradiation in vivo suggests the locus confers a proliferative advantage during the leukemogenic process. The stem cell frequency regulator 1 (Scfr1) locus maps to distal chromosome 1 and determines the frequency of hemopoietic stem cells (HSCs) in inbred mice, suggesting that target size may be one factor in determining the relative susceptibility of inbred mice to r-AML.

The National Occupational Information Coordinating Committee (NOICC) ( 1989) has defined career development guidelines for all groups from elementary school students through adulthood. These guidelines have been adopted by over 40 states. Virginia has chosen not to adopt them and currently does not have state standards against which to identify or assess exemplary career development practices in middle schools. Such identification procedures would serve to (a) provide guidelines for program development and expansion, (b) provide a means of accountability, ( c) provide a standard of performance, ( d) provide consistency among middle schools, and ( e) showcase exemplary programs. This study examined exemplary career development practices at 43 middle schools in Virginia during the Fall of 1996. The researcher identified these schools by asking for recommendations from State Department of Education Field Representatives, university faculty with expertise in the fields of counseling, middle school education or both, and current and most recent past officers of the Virginia Counselors Association and the Virginia School Counselor Association. A survey method was used to identify general curriculum design, physical facilities, technological capabilities, activities and strategies used to incorporate career development into the curricula of the identified middle school. Three site visits and one in-depth telephone interview were conducted by the researcher to verify exemplary career development practices. The following common themes were found concerning exemplary career development practices: There were teacher-advisory programs in which a variety of career development activities took place in the academic classrooms. There were middle school teams in which groups of teachers worked together on career development activities which were integrated into the core curriculum through these teaming efforts. There were curriculum design efforts in which career development exploratory classes were offered on either a 6, 9, 12, or 18 week rotation. There were special interest clubs, many of which directly related to career development. There were classroom guidance activities conducted by counselors related to career development. Evaluations of the Survey findings, recommendations and conclusions of this study were reported in the hope that middle school career development programs in Virginia's middle schools will strive for exemplary practices for the benefit of their own students. Ed. D.