An Investigation of Professional Integrity in Pre-registration Nurse Education: A Modified Grounded Theory Research Study.

BACKGROUND: Acting with integrity is a central part of nursing practice. However, literature shows that professional integrity can be absent and where this is present it can face challenges. Governmental Inquiries have revealed deficits in the expression of nursing values which underpin professional integrity, in particular caring, compassionate and competent practice that maintains the dignity of patients. Evidence also suggests that it cannot be taken for granted that pre-registration education will have a positive impact on student nurses' ability to practice with integrity. OBJECTIVES: This research explored students', mentors' and lecturers' experiences of professional integrity in pre-registration nurse education. METHODOLOGY: A grounded theory approach was informed by the work of Charmaz (2004, 2006). CONTEXT: The study, which took place in a UK university, involved four fields of nursing practice: Adult, Children, Mental Health and Learning Disabilities. PARTICIPANTS: 12 student nurses, 5 practice-based mentors and 6 lecturers participated. FINDINGS: Semi-structured interviews and focus groups revealed three main themes: meanings, enactment and growth of professional integrity. CONCLUSIONS: Pre-registration education can influence the growth of professional integrity by improving students' understanding of the boundaries of nursing practice and potential threats to these, skills to speak up on behalf of patients, and knowledge of the processes involved in raising concerns about practice and potential barriers to this. The proactive development of student nurses' strategies to cope, alongside increasing their understanding of the importance of this is also likely to be beneficial.

A phase II trial of low-dose estradiol in postmenopausal women with advanced breast cancer and acquired resistance to aromatase inhibition.

BACKGROUND: High-dose oestrogen (HDE) is effective but toxic in postmenopausal women with advanced breast cancer (ABC). Prolonged oestrogen deprivation sensitises BC cell lines to estrogen and we hypothesised that third-generation aromatase inhibitors (AIs) would sensitise BCs to low-dose estradiol (LDE). METHODS: A single-arm phase II study of LDE (2 mg estradiol valerate daily) in postmenopausal women with estrogen receptor-positive (ER+) ABC. The primary end-point was clinical benefit (CB) rate. If LDE was ineffective, HDE was offered. If LDE was effective, retreatment with the pre-LDE AI was offered on progression. RESULTS: Twenty-one patients were recruited before the trial was closed early due to slow accrual; 19 were assessable for efficacy and toxicity. CB was seen in 5 in 19 patients (26%; 95% confidence interval 9.1-51.2%), all with prolonged SD (median duration 16.8 months; range 11.0-29.6). Treatment was discontinued for toxicity in 4 in 19 patients (21%) and 8 in 11 women without hysterectomy experienced vaginal bleeding (VB). After primary LDE failure, three patients received HDE and one achieved a partial response (PR). Following CB on LDE, four patients restarted pre-LDE AI and three achieved CB including one PR. Those with CB to LDE had a significantly longer duration of first-line endocrine therapy for ABC than those without (54.9 versus 16.8 months; p < 0.01) CONCLUSION: LDE is an effective endocrine option in women with evidence of prolonged sensitivity to AI therapy. LDE is reasonably well tolerated although VB is an issue. Re-challenge with the pre-LDE AI following progression confirms re-sensitisation as a true phenomenon.