A comparison of education in Greek and English nurses.

BACKGROUND: Curriculum is an important component of nurse education and is thought to vary from country to country. AIM: To determine the level of cardiac knowledge in Greek and English final-year student nurses. METHOD: Subjects were final-year diploma and degree student nurses (n = 161) from Greece and England. Pictographs (testing knowledge in a pictorial form) were used as a method of data collection. Three anatomical cardiac diagrams were used. Students were asked to label 20 anatomical parts. RESULTS: Final-year English student nurses have better knowledge in the discrete area of cardiac anatomy and physiology (P < 0.05) than their Greek counterparts. Problems associated with translation and interpretation were avoided using pictographs and were shown to be useful measures for determining knowledge in nurses from different countries. CONCLUSION: The findings of the study are important because they show differences in anatomical knowledge levels between Greek and English students. More research is needed to explore further different levels of knowledge and education within the European Union and the consequences for nurse decision-making and patient outcomes.

Decision making in Greek and English registered nurses in coronary care units.

Clinical decision-making is an integral component of the role of the professional nurse. The aim of the study was to identify the quality of decision making of Greek and English coronary care nurses during the acute and recovery phases post-myocardial infarction (MI), and determine factors that best predict clinical decision-making in these two discrete groups of nurses. By identifying best practice from standard textbooks and expert practitioners, Clinical Decision-Making cards were developed and employed to explore nurse decision-making. A questionnaire (influencing factor questionnaire-IFQ) was also administered to determine which factors predicted quality nurse decision-making in the acute and recovery phase of post-MI patient care. The results showed that nurses in England made better quality clinical decisions in the recovery phase of MI than the Greek counterparts (p<0.001). Variables were identified which best-predicted decision-making. Interestingly, the main finding of this study was that English nurses had greater autonomy in the recovery phase and therefore made more clinical decisions concerning the patient psychosocial recovery than Greek nurses. Nurses perceived clinical experience as the strongest factor influencing decision-making.

Emotions and illness.

AIM: This paper discusses issues central to emotional expression in illness. Its aim is to challenge the psychopathological paradigm currently utilized within healthcare and propose an alternative model based on healthy emotions. BACKGROUND: Emotions are important to human survival. It is argued that most patients will have an emotional response to their illness but anxiety and depression are unlikely to be representative of most patients experience. The paper focuses on two important negative emotions, fear and sadness, and their psychopathological associates, anxiety and depression. Problems of diagnosing anxiety and depression in practice are highlighted. It is contended that emotional reaction to illness is normal and that emotions expressed are likely to hold clues to individual adaptation. It is argued that in health care, emotions should be assessed as healthy reactions to a survival threat and merit study from this perspective if we wish to understand individual patient illness reaction and adaptation better. Literature from cardiology is used to illustrate clinical problems. RATIONALE: Given the present knowledge of emotions, it should be possible to utilize emotion theory as a paradigm for studying human reaction to illness. This in turn could help shape studies on adherence and adaptation. CONCLUSION: The reaction and experience of patient illness is unlikely to be understood through the psychopathology paradigm. A better understanding of patient reaction to their illness is more likely to emerge through the study of basic emotions during acute life-threatening episodes.

Evidence for the effectiveness of cardiac rehabilitation.

Cardiac rehabilitation is a relatively recent development and, though it is increasingly being recognized as an important part of comprehensive cardiac care, there remains some scepticism regarding its effectiveness and some ignorance of its potential. This article reviews the literature pertaining to the effectiveness of cardiac rehabilitation for patients with coronary heart disease (CHD).

The development and testing of a cardiac rehabilitation audit tool.

Cardiac rehabilitation is a multidisciplinary activity and as such necessitates the development of audit systems that cut across professional boundaries. The objective of this paper is to describe the development and testing of an audit tool for cardiac rehabilitation. The tool, based on published guidelines, comprised three proformas: one for each patient entering a cardiac rehabilitation programme, one for a summary of a series of patients and one for the facilities available. The proformas were tested in three centres that were assessed as either 'high', 'moderate' or 'low' providers of cardiac rehabilitation. The cardiac rehabilitation programme coordinator of each centre examined a consecutive series of 30 patients' case notes and completed the proformas. The proformas were found to be clear and easy to use. Information was obtained that informed users of current practice and provided pointers to improvements in the provision of care. In conclusion, the cardiac rehabilitation audit tool proved to be effective in determining the documented evidence of practice, was better for determining the level of provision than a purely subjective judgement and provided information indicating an individual programme's strengths and weaknesses. This is the first attempt at producing an audit tool for cardiac rehabilitation. However, further work may be required in its refinement.

Cardiac rehabilitation services in England and Wales: a national survey.

We sent a short postal questionnaire to 244 centres in England and Wales that admitted patients with cardiac conditions. In total, 199 (81%) of the centres claimed to provide a cardiac rehabilitation service. Of these, 25 were randomly selected as a representative sample and visited in order to obtain detailed information concerning the provision of services. Most (18 (72%)) of the centres had commenced their rehabilitation programme within the previous 5 years, usually at the instigation of interested staff. Patient entry to cardiac rehabilitation programmes was restricted; women (who represented only 15% of attenders), elderly people (excluded in 10 (40%) centres), and those with more complex problems, such as angina or heart failure, were under-represented. The central components of all programmes were education and exercise training but there was a wide range in the quantity and quality of service provision. Most (22 (88%)) programmes were hospital out-patient based, one (4%) was hospital in-patient based, one (4%) was community-based and one (4%) was home-based. The staffing and funding of programmes was variable, with 7 (28%) having no identified funding. There are wide variations in the resources currently available for the rehabilitation of patients with coronary heart disease. There is a need for clearer direction of these services, in particular to determine minimum service provision. Guidelines are necessary to give a framework for this relatively new and rapidly expanding service.

The cost of cardiac rehabilitation services in England and Wales.

A random sample of 25 cardiac rehabilitation programmes in England and Wales was surveyed by questionnaire. Using workload and resource data returned, costs were calculated per centre, per patient and per session. Sixteen (64%) of the centres returned full details. Annual staffing costs per cardiac rehabilitation centre were in the range 10,000 Pounds to 62,000 Pounds, with a mean of just under 33,0000 Pounds (median 32,000 Pounds). Mean cost per patient completing the rehabilitation programme was 370 Pounds (median 223 Pounds), and mean cost per patient per session was 47 Pounds (median 26 Pounds). There was substantial intercentre variation in costs. Cost per patient was closely related to patient throughput and hours of contact time. The costs of rehabilitation programmes in this survey exceed earlier estimates. To assess the implications for the cost-effectiveness of such programmes, reliable data on the effectiveness of such programmes are now required.

Cardiac rehabilitation in the United Kingdom: guidelines and audit standards. National Institute for Nursing, the British Cardiac Society and the Royal College of Physicians of London.

This paper summarises a multidisciplinary workshop convened to prepare clinical guidelines and audit standards in cardiac rehabilitation in the United Kingdom. The workshop developed a three element model of the rehabilitation process and identified needs relating to medical and psychosocial care and the potential contributions of exercise, education, secondary prevention, and vocational advice. Draft clinical standards are proposed as a basis for locally developed guidelines and further research.

A telephone survey of medical patients 1 week after discharge from hospital.

The telephone is an effective means of communication and its use is growing as a means of offering members of the public access to health-care agencies for advice and support. Acute hospital beds are at a premium and as lengths of stay in hospital continue to fall there is an increasing need for effective discharge planning and post-discharge support. Eighty-five patients (58 men and 27 women) were interviewed over the telephone 1 week after discharge from a medical ward. Over half of the patients reported health problems and one-fifth reported social problems. Almost half of the patients sought advice. Telephone follow-up would appear to be a useful means of monitoring a patient's progress and providing an opportunity for patients seeking, or nurses offering, advice and support.

Independence through organized self-development.

There is a need for nurses to continuously develop themselves. Self-development supported by the organization is one means of developing a more involved and adaptable workforce. This article describes the introduction of such a scheme in a medical unit.

The development of a classification system for nurses' work methods.

This study describes the development of a classification system for the clarification, understanding and measurement of nurses' work methods. The theoretical basis of the classification system is described. The system offered distinguishes between three common work methods: primary, team and task nursing; the strength of opportunity for nurse-patient interaction in each method being determined as either 'strong', 'moderate' or 'weak', according to how effectively they are practised. Preliminary testing of the system on 32 wards in 13 hospitals is described. It is concluded that further testing and possible refinement is required for validation of the system.

The influence of a positive environment on the attitudes of student nurses towards the nursing process.

The attitudes of 67 student nurses towards the nursing process were studied by means of a questionnaire. Attitudes became more favourable over the 8-week study period. The results indicate that a positive environment is influential in changing the attitudes of student nurses towards the nursing process. These findings lend further support to our original work.

Nurses' attitudes towards the nursing process.

The attitudes of qualified nursing staff towards the nursing process were studied. Three distinct nursing units received varying degrees of planning and education regarding the principles and practice of the nursing process. The attitudes of the nursing staff of these units were assessed by means of a 20-item questionnaire. Statistically significant differences (P less than 0.001) between the mean attitude scores for the three units were found, but comparison of the overall mean attitude scores for the three grades of nurses within each unit did not result in statistical significance (P greater than 0.35). Further analysis indicated that a structured educational programme was beneficial in creating a positive attitude towards the nursing process whereas a less structured approach had the opposite effect.

Coping with stroke at home.

Relatives of stroke patients were asked about their knowledge and anxieties about strokes at three points in time: 72 hours after hospital admission, immediately prior to discharge, and 6 months post-discharge. During the period of hospitalization relatives were provided with information and encouraged to participate in patient care with the aim of increasing their skills in coping with the stroke patient at home. The relatives reported to be coping with the practical problems of care, but all reported problems with the emotional aspects of caring for the stroke patient.

Cerebral blood flow and oxygen consumption in the newborn dog.

Cerebral blood flow (CBF), CBF responses to changes in arterial CO2 tension, and cerebral metabolic rate for oxygen (CMRO2) were measured in newborn dogs, by means of a modification of the Kety and Schmidt technique employing 133Xe. Mongrel dogs of 1-7 days of age were paralyzed and passively ventilated with 70% N2O and 30% O2. CBF was derived by analysis of paired serial 20-microliter samples of arterial and of cerebral venous blood from the superior sagittal sinus. At an arterial PCO2 of 36.9 +/- 3.7 Torr and a mean arterial blood pressure of 62 +/- 10 Torr, CBF was 23 +/- 8 ml/min per 100 g. The arteriovenous oxygen content difference averaged 5.6 vol%, and CMRO2 was 1.13 +/- 0.30 ml O2/min per 100 g. CBF increased or decreased by 0.58 ml/min/100 g per Torr change in PCO2. Our results suggest that in the newborn, basal CBF and CBF responses to CO2 are considerably lower than in the adult and parallel the lower metabolic needs of the newborn brain.

Cerebral blood flow autoregulation in the rat.

Cerebral blood flow autoregulation (CBFA) to changes in perfusion pressure has not been previously reported in the rat. A modification of the Kety and Schmidt technique employing 133Xenon was used to measure cerebral blood flow (CBF) in paralyzed adult Sprague Dawley rats passively ventilated with 70% nitrous oxide and 30% oxygen. At a mean arterial blood pressure (MABP) of 121 +/- 19 mm Hg, and a mean arterial PCO2 of 36.2 +/- 2.9 mm Hg, mean CBF was 103 +/- 22 ml/min/100 gm of brain. CBF responses to hypercarbia were 4.9 ml/min/100 gm per mm Hg change in arterial PCO2. CBF was measured during steady state levels of hypo- and hypertension induced by phlebotomy, or by intravenous metaraminol, over the MABP range of 48-205 mm Hg. From a MABP of 80 to 160 mm Hg. CBF remained nearly constant, indicating the presence of CBFA. However, when MABP exceeded 160 mm Hg, CBF became pressure dependent, indicating a "breakthrough" of autoregulation in acute severe hypertension.