ABSTRACT
United Kingdom (UK) health policy has adopted an increasing community and primary care focus over recent years (Department of Health, 1997; Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visitor Contribution to Health and Health Care. Department of Health, London; Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London). Nursing practice, education and workforce planning are called upon to adapt accordingly (Department of Health, 2004. The NHS Knowledge and Skills Framework (NHS KSF). Department of Health, London; Kenyon, V., Smith, E., Hefty, L., Bell, M., Martaus, T., 1990. Clinical competencies for community health nursing. Public Health Nursing 7(1), 33-39; United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986. Project 2000: A New Preparation for Practice. UKCC, London). Such changes have major implications for pre-registration nursing education, including its practice placement element. From an educational perspective, the need for increased community nursing capacity must be balanced with adequate support for student nurses' learning needs during community-based placements. This qualitative study explored six second year student nurses' experiences of 12 week community-based practice placements and the extent to which these placements were seen to meet their perceived learning needs. The data came from contemporaneous reflective diaries, completed by participants to reflect their 'lived experience' during their practice placements (Landeen, J., Byrne, Brown, B., 1995. Exploring the lived experiences of psychiatric nursing students through self-reflective journals. Journal of Advanced Nursing 21(5), 878-885; Kok, J., Chabeli, M.M., 2002. Reflective journal writing: how it promotes reflective thinking in clinical nursing education: a students' perspective. Curationis 25(3), 35-42; Löfmark, A., Wikblad, K., 2001. Facilitating and obstructing factors for development of learning in clinical practice: a student perspective. Issues and innovations in Nursing Education. Journal of Advanced Nursing 34(1), 43-50; Priest, H., 2004. Phenomenology. Nurse Researcher 11(4), 4-6; Stockhausen, L., 2005. Learning to become a nurse: student nurses' reflections on their clinical experiences. Australian Journal of Nursing 22(3), 8-14). The data were analysed using content analysis techniques, exploring their contextual meaning through the development of emergent themes (Neuendorf, K.A., 2002. The Content Analysis Guidebook. Sage Publications, London). The identified themes related to elements of students' basic skill acquisition, the development of their working relationships with mentors, patients and others, the learning opportunities offered by community practice placements and the effects that such placements had on their confidence to practice. These themes are discussed with regard to the published literature, to arrive at conclusions and implications for future nursing education, practice and research.
Subject(s)
Clinical Clerkship , Community Health Services , Education, Nursing/organization & administration , Students, Nursing/psychology , Adult , Consumer Behavior , Female , Humans , Interviews as Topic , London , Mentors , Qualitative Research , Young AdultABSTRACT
The routine detection of chronic alcoholism is necessary during any medical examination whether private or in hospital, or in occupational medicine. The practitionner now has available a simple reliable and cheap test. It consists of the serum estimation of gamma-glutamyl-transferase (gammaGT) and interpretation of the average red cell volume supplied by automatic counting of the red cell. Out of 120 chronic alcoholic subjects ; 67% has a gammaGT increased and 44% had macrocytosis. Under the influence of weaning, there was a rapid fall in gammaGT and a slower reduction in average red cell volume. gammaGT estimation was thus a more sensitive test than M.C.V. for the detection of chronic alcoholics and the control of withdrawal. Its association with the rise in immunoglobulin A-transferrin ratio which we have suggested permits the detection of almost all chronic alcoholics in the population studied.
Subject(s)
Acyltransferases/metabolism , Alcoholism/diagnosis , Erythrocytes , Substance Withdrawal Syndrome/diagnosis , gamma-Glutamylcyclotransferase/metabolism , Alcohol Drinking , Blood Volume , Chronic Disease , Humans , Mass ScreeningABSTRACT
53 percent of ethanol drinkers had, before detoxication, a gamma-GT higher than the upper limit of the reference interval at the 2.5 percent risk level (36 mU/ml). 44 percent had a mean corpuscular volume (MCV) higher than the limit (99.2 mum3). In alcoholics not previously "weaned" during a rest cure or in a hospital the proportion becomes 67 percent for gamma-GT but remains at 44 percent for MCV. gamma-GT thus seems a better test for the screening of an excessive ethanol intake than MCV, especially when the subject has not been previously weaned.
Subject(s)
Alcoholism/diagnosis , gamma-Glutamyltransferase/blood , Alcoholism/enzymology , Blood Cell Count , HumansABSTRACT
44 patients were studied during a 2-year period following a cure for alcohol detoxification. 29 patients (group A) did not start drinking again while 15 relapsed less than one year after their cure (group R). The average gamma GT activity (m) in mU per ml serum was, in group A, 148 (standard deviation, S.D. 184) at the beginning of the cure, 21 (S.D. 14) after one year and 19 (S.D. 13) after 2 years. During the same period there was no significant decrease in group R (cure: m 140, S.D. 161: 1 year: m 166, S.D. 164; 2 years: m 162, S.D. 163). On the other hand, all the subjects of group A who had a high gamma GT activity (greater than 29 mU/ml) at the start of the cure showed a decrease after one year.
Subject(s)
Alcohol Drinking , gamma-Glutamyltransferase/blood , Follow-Up Studies , Humans , Methods , Time FactorsABSTRACT
Gamma-Glutamyltranspeptidase activity of patients having an ascitic cirrhosis due to ethanol consumption is high (139 mU/ml) when the patient is still drinking at the time of the assay; it is lower when the patient had stopped drinking at least two months before the assay (49 mU/ml). On the other hand, in 10 patients out of the 11 who submitted to a second assay gamma-glutamyltranspeptidase decreases as soon as the patient abstains from alcohol. In 4 abstinent patients re-examined one year after the first measurement, the gamma-glutamyltranspeptidase activity had decreased to the reference values of Szasz. The half time of the return to normal has been estimated by extrapolation from the ethylic model at between 11 and 54 days. We conclude that the hyper gamma-glutamyltranspeptidase in cirrhotics is due to the ethanol impregnation and that repeated assays of the enzyme show whether the patient abstains from alcohol or not.
Subject(s)
Alcohol Drinking , Liver Cirrhosis/enzymology , gamma-Glutamyltransferase/metabolism , Haptoglobins/metabolism , Humans , Immunoglobulin A/metabolism , Liver Cirrhosis/blood , Time Factors , Transferrin/metabolismABSTRACT
The gammaGT of a generally healthy population is abnormally high due to the presence of ethanol in the diet. We confirm Rosalki's finding that a high proportion of alchoholics show an increased gammaGT activity. After alcohol deprivation, the gammaGT of alcoholics decreases in the first few days according to an exponential law with a half-time of return to normal of 5-17 days. Among past alcoholics, those who stopped drinking for a year have a lower GT activity (mean: 21 mU/ml) than a generally healthy population and in the range of Szasz's reference values. Alcoholics who did not stop drinking have a higher gammaGT activity (mean: 172). Ascitic cirrhotics who drink at least 1 liter of wine per day have also a high activity (mean: 139) while those who stopped drinking for at least 2 months have a much lower activity (mean: 49) and those who stopped for a year a normal activity. In 10 out of 11 alcoholic cirrhotics who stopped drinking, the gammaGT decreased (half-time: 11-54 days). These results show that the determination of gammaGT activity is a good test for the detection of ethanol impregnation.
