Nurses' potential to lead in non-communicable disease global crisis.

BACKGROUND: The incidence and projected rise of non-communicable diseases (NCDs) are a significant global public health threat. Nurses as health educators are well positioned to support health promotion and prevention efforts. The intent was to understand nurses' interest, challenges and enabling factors in carrying out this important role in addressing the NCD crisis. METHOD: A stratified representative survey of 1600 nurses in eight countries was conducted to better understand how nurses perceive their role in addressing risk factors associated with NCDs, as well as the types of supports required in order to facilitate this work. The study also explores nurses' changing views of the profession and their practice environment. The structured survey was administered via telephone and face-to-face interviews composed primarily of multiple choice closed-ended questions. RESULTS: Key findings included that 95% of nurses wanted to use their knowledge, skills and time to educate individuals on the threat and prevention of NCDs. They expressed their belief that they should be spending significantly more time, on average almost twice the amount as they currently are able to devote, on preventing the development or escalation of NCDs. However, nurses' potential to do this is diluted by heavy workloads; over one third reported that their workload had worsened over the last 5 years, and 95% of nurses are experiencing time pressures. Nurses believe these constraints, almost unanimously (98%), keep them from being able to spend more time with patients in an educational capacity. CONCLUSIONS: Nurses are interested in spending more time addressing NCD prevention, but workload, time constraints and their perception towards the job of nursing hinder them from achieving their potential. Unhealthy lifestyle choices are a risk factor for NCDs; through awareness and education, positive behaviour change is possible. Research has demonstrated that nurses are effective at supporting individuals to make behaviour change, administering disease management programmes and enabling self-care as well as self-management. Practice environment issues that prevent nurses from fully reaching their potential in addressing the NCD crisis need to be addressed.

Nurses in the workplace: expectations and needs.

BACKGROUND: It is important to understand nurses' attitudes toward their work environment. Prior studies in this area have been conducted. The interest was to identify a relative assessment of workplace challenges by studying nurses within developed and developing economies. METHOD: A representative survey of 2203 nurses in 11 countries was conducted via a structured survey. Data from open-ended questions were content analysed and grouped thematically. The overall margin of error is +/-2.1% and +/-6.9% for country level results. RESULTS: Key findings included that 92% of nurses say they face time constraints and 96% say that spending more time with individual patients would have a significant impact on patient health. Forty-six per cent of nurses say their workload is worse today than it was 5 years ago. While only 53% of nurses say it is very likely they will be practising nursing in 5 years, national differences existed. Statistically significant parameters influencing the likelihood to stay in nursing included having greater independence and control over their practice area, sufficient staff, greater involvement in decisions impacting their work and patient care, and improved work-life balance. CONCLUSIONS: There is agreement across the surveyed countries regarding the existence of high workloads that are contributing to time constraints and the belief that patient outcomes are significantly impacted. These conditions contribute to nurses' lack of firm commitment to their profession. The systemic changes required to deliver quality health care to patients require these challenges to be addressed.

Safety and efficacy of guanabenz in hypertensive patients with moderate renal insufficiency.

Eight hypertensive patients with moderate renal insufficiency were treated with gradually increasing oral doses of guanabenz acetate to a maximum dose of 8 mg BID. Patients' medications were titrated over 8 weeks. Once blood pressure control was achieved (seated diastolic blood pressure, 90 mmHg, or decrease of 10 mmHg from baseline values), drug dosages were maintained for up to a 12-week total treatment phase. Patients had significant reductions of blood pressure during treatment with guanabenz as compared to that during pretreatment levels. No changes in body weight or creatinine clearance were evident, as compared to baseline values. Our data suggest that guanabenz, in relatively small doses, can be used as safe and effective monotherapy of essential hypertension in patients with moderate renal insufficiency.