A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Reconciling professional identity: A grounded theory of nurse academics' role modelling for undergraduate students.

Role modelling by experienced nurses, including nurse academics, is a key factor in the process of preparing undergraduate nursing students for practice, and may contribute to longevity in the workforce. A grounded theory study was undertaken to investigate the phenomenon of nurse academics' role modelling for undergraduate students. The study sought to answer the research question: how do nurse academics role model positive professional behaviours for undergraduate students? The aims of this study were to: theorise a process of nurse academic role modelling for undergraduate students; describe the elements that support positive role modelling by nurse academics; and explain the factors that influence the implementation of academic role modelling. The study sample included five second year nursing students and sixteen nurse academics from Australia and the United Kingdom. Data was collected from observation, focus groups and individual interviews. This study found that in order for nurse academics to role model professional behaviours for nursing students, they must reconcile their own professional identity. This paper introduces the theory of reconciling professional identity and discusses the three categories that comprise the theory, creating a context for learning, creating a context for authentic rehearsal and mirroring identity.

Pyrocarbon proximal interphalangeal joint arthroplasty: a medium to long term follow-up of a single surgeon series.

We retrospectively reviewed a consecutive single surgeon series of 57 Ascension pyrocarbon proximal interphalangeal joint arthroplasties, with a mean follow-up of 7.1 years (range 2 years to 11 years 6 months). We assessed the ranges of motion, deformity, stability and pain of the operated joints, grip strength of the hand and patient satisfaction. Of the cases, 44 were for osteoarthritis, five for rheumatoid arthritis and eight for post-traumatic arthritis. The median post-operative active arc of motion was from 0° to 60°. The median post-operative visual analogue pain score was 0.3 out of ten. Thirty six of the joints had no complications; 14 had minor complications (squeak, slight swan neck); three required early reoperation (joint release, flexor tenodesis); and five required implant removal. A total of 69% of our patients would have the same operation if they had to make the decision again. The Kaplan-Meier survival method estimates the mean implant survival to be 10.7 years (95% confidence intervals 9.96-11.37 years). All five failures occurred during the first 2 years.Level of evidence 4 (Case-series).

Making it real: a hands-on approach to teaching research.

AIM: The purpose of this paper was to report on the delivery of a series of seminars in Sarawak, East Malaysia using a unique hands-on approach to the teaching of skills in research and evidence-based health care. These seminars proved to be a meaningful and memorable experience for both the facilitators and participants. BACKGROUND: The international push for the delivery of evidence-based health care has resulted in a growing need for the teaching of skills in the conduct and application of research. Nurses and other health-care professionals recognize that they have a responsibility to contribute to and maintain an evidence base for practice, yet are often stymied by a lack of professional development opportunities. CONCLUSION: The knowledge necessary to understand research, along with skills in the conduct of research, can be made accessible to health-care professionals in diverse locations. The experience reported in this paper demonstrates that opportunities exist to provide education about research and evidence-based practice in an engaging, active and meaningful way.

The incidence and causes of permanent stoma after anterior resection.

AIMS: Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this. METHODS: All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively. RESULTS: Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5-6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01). CONCLUSION: Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre-operatively.

Topical diltiazem ointment in the treatment of chronic anal fissure.

BACKGROUND: Chronic anal fissure has traditionally been treated surgically. Initial enthusiasm for chemical sphincterotomy has waned because of poor outcomes with glyceryl trinitrate ointment. In this study the use of topical 2 per cent diltiazem ointment has been investigated as an alternative method of chemical sphincterotomy. METHODS: A prospective assessment of 71 consecutive patients with a chronic anal fissure treated with 2 per cent topical diltiazem ointment for a median duration of 9 (range 2--16) weeks was performed. RESULTS: Fifty-one patients (75 per cent) experienced healing of the fissure after 2--3 months of treatment with topical diltiazem. Seventeen patients who did not heal were treated for a further 8 weeks with topical diltiazem. Eight of these patients subsequently healed with diltiazem. Fifty-nine of 67 patients who completed follow-up therefore healed on diltiazem ointment. Four patients experienced perianal dermatitis and one patient experienced headaches. No other side-effects were recorded. After a median of 32 (range 14--67) weeks' follow-up following completion of treatment, 27 of 41 patients available remain symptom free. Six of seven patients with recurrent fissure were treated successfully by repeat chemical sphincterotomy. CONCLUSION: Topical 2 per cent diltiazem ointment used as an agent for chemical sphincterotomy for chronic anal fissure offers significant healing rates but does not have a significant side-effect profile, which may aid compliance to treatment. Early recurrences are common but usually amenable to further chemical sphincterotomy.

A clinical trial of the effectiveness of water as a conductive medium in electrocardiography.

A clinical trial was conducted in three hospitals to determine if common tap water is suitable for use as a conductive medium in electrocardiography (ECG). It compares two consecutive ECG recordings of 100 patients, the first recordings were obtained with water as the conductive medium, the second tracings used the electroconductive gel Redux Creme. Analysis involved comparison of the height of the R wave in lead V4 and tracing reports from a cardiologist 'blind' to the medium used. Results indicated that there was no statistically significant difference in the conductive ability of the two media. Analysis of the clinical performance of the media indicated that in 82% of the traces water was equal to or better than gel in clarity, and in 90% of traces water was equal to or better than gel in suitability for diagnosis. One implication of the study is the possibility of significantly reducing the cost of ECG procedures while ensuring the quality of tracings remains at a clinically acceptable level.