Research utilization in a small, rural, community hospital.

Professional nursing organizations and nursing leaders value the importance of research-based nursing practice. The urgency for nurses to use research in practice applies to all, regardless of institution size. In this article, unique characteristics of small, rural, community hospital settings are described in relation to research utilization. The successful initiation and maintenance of a valued research utilization program in a small, rural hospital is presented, and suggestions on overcoming perceived barriers to the facilitation of research utilization activities are reviewed.

Building healthy families: a program for single mothers.

With the ever-increasing number of single-parent families, innovative and creative strategies aimed to improve family health must be developed. The stress-producing lifestyle of single-parent families offers great challenges to family CNSs. In this article, a project designed to teach positive health behaviors and life skills to female-headed single-parent families is described. The project, development and implementation of an education/support group, combines health education and small group discussion for an effective therapeutic intervention for single-parent female participants.

Research utilization: the development of a preoperative teaching protocol.

A research-based preoperative teaching protocol was designed for use with surgical patients at a rural midwestern hospital. A strong research base supported the development of a protocol which included an individual teaching plan adapted to the patient's fear/anxiety level. A practice-level model was designed to guide the staff nurse through the preoperative teaching process. Expected outcomes were established and an evaluation tool developed. This research utilization project improved patient outcomes and benefitted nurses and the organization.

A family-focused perspective on chronic illness.

The care of the chronically ill traditionally has focused on the individual who has the illness. Nursing has always emphasized including the family in care, but very few protocols dealing with chronic illness focus on the family as the unit of care. In this article, the author presents a new approach to the care of families affected by chronic illness, applying concepts of the family health system (Anderson & Tomlinson, 1992) to chronic illness. The protocol described, which includes nursing assessments and interventions, groups areas of family experience into five types of processes: interactive, developmental, coping integrity, and health processes. The protocol presented is an example of an innovative, holistic, family-focused perspective on the care of those with chronic illness.

Mild bleeding disorders. A clinical and laboratory study.

OBJECTIVE: To investigate in-vitro haemostasis in subjects with symptoms suggesting a mild bleeding disorder. DESIGN: A prospective study in which an extensive range of in-vitro tests were applied unselectively. SETTING: Patients were referred from community-based practices and hospital outpatient services. PATIENTS: Ninety-three consecutive patients were examined. Hospital patients with severe illness were excluded. CLINICAL FEATURES: Patients presented with easy bruising (68%), epistaxis (12%), excessive operative bleeding (7%), menorrhagia (4%), haematuria (3%), dental bleeding (1%) and bleeding from other sites (5%). In no instance was the bleeding life threatening. OUTCOME MEASURES: Results of laboratory tests for patients presenting with the symptoms of a mild bleeding disorder were compared with the results for a healthy reference group. RESULTS: Abnormal results of in-vitro tests were found in 53% of the subjects. Thirteen per cent had a prolonged bleeding time, of whom the majority had abnormal results of other in-vitro tests. Von Willebrand's disease was diagnosed in 7% of patients, although only half of these had a prolonged bleeding time. CONCLUSIONS: Abnormal results of in-vitro tests were prevalent among subjects with symptoms of mild bleeding disorder. Easy bruising was as powerful a clue as any other bleeding manifestation to the presence of an abnormal in-vitro test result.

The effects of very low fat diets enriched with fish or kangaroo meat on cold-induced vasoconstriction and platelet function.

Eighteen healthy volunteers consumed very low fat diets (less than 7% of daily energy) enriched with different sources of long chain (C20 and C22) polyunsaturated fatty acids (PUFA). Three diets provided 500 g/day of fish caught in the tropical waters of Australia (rich in arachidonic acid and docosahexaenoic acid), fish caught in the southern waters of Australia (rich in docosahexaenoic acid), or kangaroo meat (rich in linoleic and arachidonic acids). The fourth diet was vegetarian, similarly low in fat but containing no 20- and 22-carbon PUFA. An increase in the percentage of a particular C20 or C22 PUFA in the plasma phospholipid fraction in subjects consuming these low fat diets corresponded to the dietary PUFA composition. This study examined the effect of dietary modification of the level of arachidonic acid in plasma phospholipids on both traditional measures of platelet function and on cold-induced vasoconstriction. The cold pressor response, measured by venous occlusion plethysmography, was depressed in diets which elevated the levels of arachidonic acid in plasma lipids (kangaroo and tropical fish), enhanced after subjects consumed a diet which increased the levels of docosahexaenoic acid and eicosapentaenoic acid (southern fish diet), and was unchanged by the low fat vegetarian diet. There was no effect on bleeding time or platelet responsiveness.

Use of research based knowledge in clinical practice.

The authors describe three research utilization projects that used a knowledge-driven approach to nursing practice. The activities involved in developing and implementing these research utilization projects included: (1) preparing nurses to read, critique, and use research; (2) identifying and reviewing research studies in a common area to develop a research base; (3) transforming the research based knowledge into a protocol to be used in the clinical area by nurses caring for patients; and (4) evaluating the protocol to see whether it is being implemented as expected and whether it is producing the predicted results. This practical utilization is discussed and illustrated in a systems theory model.

Protein profiles of sarcoplasmic reticulum from normal and dystrophic mouse muscle.

Sarcoplasmic reticulum (SR) was isolated from skeletal muscle of dystrophic (C57BL/6J dy2J/dy2J) mice and the protein composition analysed by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Densitometric analysis of dystrophic SR preparations indicated a decrease in the Ca2+-ATPase and calsequestrin, and the appearance of a protein with molecular weight 72 000. These differences in the protein profiles between normal and dystrophic SR became more apparent as the disease progressed. The observations are discussed in relation to secondary changes in the dystrophic process such as changes in fibre type and the presence of immature fibres.

A comparison of silver staining methods for detecting proteins in ultrathin polyacrylamide gels on support film after isoelectric focusing.

The application of silver staining methods to the detection of proteins on ultrathin isoelectric focusing gel systems requires the optimization of many steps in the procedure in order to obtain reproducible staining of proteins with acceptable levels of background. Three different methods which have been reported for detecting proteins by silver staining in sodium dodecyl sulfate-polyacrylamide gel systems were investigated. A major problem with staining ultrathin isoelectric focusing gels was found to be surface staining that was associated with gels cast on support films. A modification of the method of Poehling and Neuhoff (H.-M. Poehling and V. Neuhoff, 1981, Electrophoresis 2, 141-147) was found to give the best results.