Watchful waiting: role of disease progression on uncertainty and depressive symptoms in patients with chronic hepatitis C.

BACKGROUND AND AIMS: New therapies for HCV are rapidly emerging and providers are advising select patients to defer treatment and elect 'watchful waiting'. During the watchful waiting period, patients have been shown to have high rates of illness uncertainty and depression. We sought to answer the question of whether reassuring histological data (showing minimal fibrosis or no fibrosis progression over time) is associated with less illness uncertainty and depressive symptoms. METHODS: This was a single-centre outpatient prospective cohort study to determine whether stage of fibrosis, fibrosis progression and reasons for treatment deferral were related to illness uncertainty and depressive symptoms in patients following watchful waiting. RESULTS: Illness uncertainty was significantly related to depressive symptoms (r = 0.49, P < 0.01). More than half of the participants (54%) had moderate levels of uncertainty. About 40% of the participants were at risk for clinical depression (21.7% at mild to moderate risk and 18.5% at high risk). Treatment naïve subjects had lower mean scores on both the CES-D (depressive symptoms measure) and the MUIS-A (illness uncertainty measure) total score, MUIS-A Ambiguity subscale and MUIS-A Inconsistency subscale than subjects who failed treatment or were interferon intolerant or ineligible. Surprisingly, liver fibrosis stage and progression were not significantly associated with overall illness uncertainty or depressive symptoms. CONCLUSION: Patients with chronic hepatitis C on watchful waiting are at high risk for significant illness uncertainty and depressive symptoms. Reassuring histological data does not seem to correlate with less uncertainty or depressive symptoms.

Palauans who chew betel nut: social impact of oral disease.

BACKGROUND: Chewing betel nut is a tradition extending from Southeast Asia to the Pacific. Globally, betel nut is the fourth main psychotropic substance containing a stimulant, arecoline, that has a similar effect to nicotine. In Palau, there is broad acceptance of betel nut chewing. One of the largest immigrant groups in Hawaii is the Palauans. Chewing betel nut has significant social implications that make it difficult for those who engage in this practice to separate potential oral disease from the social importance. However, little is known about the social impact of oral disease from chewing betel nut on Palauans in Hawaii. AIM: The study aimed to describe the perceptions of betel-chewing Palauans in Hawaii regarding betel nut and to determine the social impact of oral disease among these individuals. METHODS: Descriptive study conducted on the island of Oahu, Hawaii with 30 adult Palauans. Data were collected using the Oral Health Impact Profile-14 to measure perceptions of social impact of oral disease on well-being. Demographic and general health information was collected. RESULTS: Participants perceived little negative social impact of oral disease on well-being. DISCUSSION: Families, peers and society exert a strong influence on the decision to chew betel nut, a known carcinogen. Participants in this study showed little concern on the impact of betel nut chewing on their oral health. They continue the habit in spite of the awareness of potential for oral disease. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurses face challenges in educating Palauans about the negative aspects of betel nut, particularly those related to oral health especially when they do not perceive problems. Nurses must be involved in the development of health policies to design and implement strategies to promote behavioural change, and to ensure clinical services that are culturally sensitive to betel nut chewers.

Nurses' preferred end-of-life treatment choices in five countries.

BACKGROUND: Previous research has focused on physician's perspectives of end-of-life (EOL) decision making as well as patient and family EOL decision making. There is a lack of research pertaining to the EOL treatment preferences of nurses and especially nurses working in a variety of care settings. AIM: The aim of this study was to compare nurses' EOL treatment preferences in Hong Kong, Ireland, Israel, Italy and the USA. METHODS: A comparative descriptive design was used with a convenience sample of nurses (n = 1089). A survey questionnaire using EOL hypothetical clinical case scenarios was used to collect data between June 2011 and July 2012. RESULTS: Nurses in every country consistently chose a more aggressive option for patients than for themselves or for a parent. The treatment preferences of nurses varied from country to country. Lack of knowledge of patients' wishes and duty of care were the main influencing factors on treatment preferences. STUDY LIMITATIONS: The study was limited to the hypothetical nature of the scenarios; however, the study highlights numerous future research questions. CONCLUSIONS: This study is the first to examine and compare nurses' preferred EOL treatment choices in five countries from three different continents. The findings of this study raise several important questions for healthcare researchers, for policy development, and highlight the need for further international collaboration.

Job satisfaction among immigrant nurses in Israel and the United States of America.

AIM: The aim of this study is to examine perceptions of job satisfaction among immigrant registered nurses (RNs) in Israel and the USA. BACKGROUND: Former Soviet Union (FSU) RNs in Israel and Filipino RNs in the USA make up the majority of the immigrant nursing workforce in their host countries. However, little is known about their perception of job satisfaction. METHODS: Data were gathered using the Index of Work Satisfaction Scale among 71 FSU RNs recruited from three different courses in baccalaureate and master's degree programmes at a central Israeli university, and 96 Filipino RNs attending a national convention hosted by the Philippine Nurses Association of America. The required sample size was obtained by means of the WINPEPI COMPARE2 program, used to determine power and sample size for comparisons of two groups in cross-sectional designs. FINDINGS: The findings show that FSU RNs perceived pay and professional status as important, although they were least satisfied with pay. For Filipino RNs, organizational policies and interactions were most important and they were least satisfied by task requirements. Although the average length of residence in the host country was similar in the two samples, significant differences were found between FSU and Filipino RNs in selected demographic variables and components of job satisfaction. CONCLUSIONS: Different characteristics of immigrant RNs affect their distinct perceptions of job satisfaction. As successful adjustment of international immigrant RNs to their workplace could enhance perceptions of job satisfaction, nursing managers should support professional advancement of immigrant RNs through mentorship and educational programmes. There is a need to conduct longitudinal studies among international immigrant RNs in order to better understand changes in their job satisfaction over time and contributing factors. STUDY LIMITATIONS: Generalization of the findings is limited, because a convenience sample was used to recruit FSU and Filipino immigrant RNs.

Paediatric resuscitation for nurses working in Ghana: an educational intervention.

BACKGROUND: Deficiencies in the paediatric emergency systems of developing countries may contribute to avoidable paediatric mortality. Studies suggest that nurses and doctors may not be educationally prepared to provide immediate paediatric resuscitative care to acutely ill children. The purpose of this study was to determine if a 1-day World Health Organization (WHO) Emergency Triage and Assessment Treatment (ETAT) Program in paediatric resuscitation would increase Ghanaian nurses' knowledge and self-efficacy of paediatric resuscitation. METHODS: A pre-experimental, one-group, pre-test, post-test design was used to assess differences in the nurses' knowledge of paediatric resuscitation, and their perceived self-efficacy of paediatric resuscitation after completing a 1-day educational intervention in paediatric resuscitation. Forty-one nurses from a public teaching hospital in Ghana were recruited and participated in the study. RESULTS: Using a paired samples t-test, there was a statistically significant increase in the nurses' perceived self-efficacy of paediatric resuscitation in general (P < 0.000), perceived self-efficacy of bag and mask ventilation (P < 0.000), and knowledge of paediatric resuscitation (P < 0.000). CONCLUSIONS: Findings from this study suggest that a 1-day WHO ETAT Program may increase self-efficacy of paediatric resuscitation and knowledge of paediatric resuscitation. CLINICAL RELEVANCE: Policy makers in Ghana need to consider implementing education programmes in paediatric resuscitation for nurses as part of a comprehensive strategy to improve emergency systems and address preventable and avoidable infant and child mortality.

The element of naturalness when evaluating image quality of digital photo documentation after sexual assault.

Digital photography is a valuable adjunct to document physical injuries after sexual assault. In order for a digital photograph to have high image quality, there must exist a high level of naturalness. Digital photo documentation has varying degrees of naturalness; however, for a photograph to be natural, specific technical elements for the viewer must be satisfied. No tool was available to rate the naturalness of digital photo documentation of female genital injuries after sexual assault. The Photo Documentation Image Quality Scoring System (PDIQSS) tool was developed to rate technical elements for naturalness. Using this tool, experts evaluated randomly selected digital photographs of female genital injuries captured following sexual assault. Naturalness of female genital injuries following sexual assault was demonstrated when measured in all dimensions.

Emotional distress and health risk behaviours of mothers of United States Marines.

AIM: The aim was to explore emotional distress and health risk behaviours of mothers of servicemen. The study was inspired by the first author's clinical practice in primary care among women who reported significant emotional distress surrounding impending deployment of their sons. BACKGROUND: Thousands of US service members have been deployed in the current wars. The potentially profound effects of deployment on emotional distress of military spouses and children have been documented; however, mothers of servicemen have not been studied. METHODS: This was an exploratory descriptive study to determine self-reported levels of emotional distress and health risk behaviours in the mothers of deployed male US Marines compared with mothers of male Marines not currently deployed. Mothers were accessed via a voluntary online support organization. RESULTS: Mothers of deployed sons reported significantly higher levels of emotional distress and more health risk behaviours compared with mothers of sons not deployed. Many of the mothers in both groups reported high levels of emotional distress. DISCUSSION: As primary care providers, nurses should be alert to the high levels of emotional distress and health risk behaviours among all patients. This exploratory study highlights these dimensions in mothers of servicemen. CONCLUSIONS: This study is the first of mothers of sons serving in the military. While the focus is on mothers of sons serving in the US military, their experience is likely not unique. Mothers of military service members all over the world send their children off to war and wait for their safe return.

Usefulness: forensic photo documentation after sexual assault.

The forensic medical legal evaluation following sexual assault establishes evidence for law enforcement's investigation and criminal prosecution by the legal system. The sexual assault nurse examiner performs the forensic evaluation and uses digital photography to document physical injuries after sexual assault. Photographs have varying degrees of usefulness, but for a photograph to be useful, it must exhibit technical elements for the viewer. There was no tool available to evaluate the usefulness of digital photographs taken during forensic evaluation of genital injuries after sexual assault. The Photo Documentation Image Quality Scoring System (PDIQSS) tool was developed to rate photographic technical elements for usefulness. Using this tool, three experts on two separate occasions evaluated a series of digital photographs taken following sexual assault. The PDIQSS tool predicted usefulness in digital photography of female genital injuries following sexual assault when measured in all dimensions.

PhD Away Days: a component of PhD supervision.

AIM: This paper describes a peer-to-peer and supervisor support and mentoring process that was implemented in one PhD programme in nursing in the Republic of Ireland. BACKGROUND: PhD Away Days are held once per year and attended by all enrolled PhD students and their academic supervisors. Positive evaluations were obtained both from students and supervisors as collective learning occurred and group cohesiveness developed. All participants expressed interest in continuing the PhD Away Days as they learned from others' experiences. In addition, the range of topics provided learning on topics of concern across content areas, e.g. conceptual and theoretical developments, research design, challenges in data collection, and analysis and publication plans. Most importantly, there was a feeling of togetherness among students, thus decreasing the feeling of being alone with the challenges of PhD work. CONCLUSIONS: Plans for the future include the need to have the PhD Away Days continued structured around key topics of concern to both students and supervisors, and to implement content-specific modules in the PhD programme.

Medical emergencies in dental practice.

Serious medical emergencies are fortunately a rare occurrence in the dental practice environment; however, if an emergency situation is encountered a delay in treatment may result in potentially avoidable consequences. The risk of mortality or serious morbidity can be reduced by ensuring that basic emergency equipment and medications are in place, and that the dental team is appropriately trained in basic life support measures. This article aims to provide an overview of the basic emergency medications and equipment that should be present in dental practices, and to discuss specific responses to some of the more common adverse medical events that can present while providing dental treatment.

IV access in dental practice.

Intravenous (IV) access is a valuable skill for dental practitioners in emergency situations and in IV sedation. However, many people feel some apprehension about performing this procedure. This article explains the basic principles behind IV access, and the relevant anatomy and physiology, as well as giving a step-by-step guide to placing an IV cannula.

Renal disease and chronic renal failure in dental practice.

Patients with renal diseases are increasingly common in dental practice. This is due to advances in medicine, and the increasing life expectancy of western populations. Chronic renal failure is a serious condition that general dental practitioners may see in their practice. This article discusses the functions of the kidney, and the causes and medical management of chronic renal failure, as well as considerations in the dental management of these patients. Common complications such as infection and bleeding are discussed. General recommendations are made, based on current evidence with respect to prescribing of medications.

Epilepsy in dental practice.

Epilepsy is a neurological condition characterised by seizure activity. It has an approximate incidence of 1%. General dental practitioners will encounter these patients in practice. This article discusses the types of epilepsy, the medical management and considerations in dental management of epileptic patients. General recommendations are made, based on current evidence, with respect to prescribing of medications. The management of an epileptic seizure is discussed. Status epilepticus is a rare but serious complication of epileptic seizures. An easy-to-follow algorithm is provided to assist the practitioner in managing seizures.

Research development in a university nursing school in Southern Ireland.

AIM: The aim of this paper is to present the strategies used in one newly established university School of Nursing and Midwifery in Southern Ireland to develop research capacity. BACKGROUND: The case study was guided by an agreed strategic plan which included changing the research culture; providing focused and appropriate research training; mentoring of junior staff, employment of an external consultant; provision of funding for PhD progression; and institutional support at all levels. CONCLUSION: Success is profiled in relation to establishment of research themes, publications, research funding awarded, and numbers of students registered for PhDs. Challenges in further improving research productivity are also discussed.

On nursing theories and evidence.

PURPOSE: To expand the understanding of what constitutes evidence for theory-guided, evidence-based nursing practice from a narrow focus on empirics to a more comprehensive focus on diverse patterns of knowing. ORGANIZING CONSTRUCT: Carper's four fundamental patterns of knowing in nursing--empirical, ethical, personal, and aesthetic--are required for nursing practice. A different mode of inquiry is required to develop knowledge about and evidence for each pattern. CONCLUSIONS: Theory, inquiry, and evidence are inextricably linked. Each pattern of knowing can be considered a type of theory, and the modes of inquiry appropriate to the generation and testing of each type of theory provide diverse sources of data for evidence-based nursing practice. Different kinds of nursing theories provide different lenses for critiquing and interpreting the different kinds of evidence essential for theory-guided, evidence-based holistic nursing practice.

Use of telehealth for chronic wound care: a case study.

Use of telehealth in wound care continues to expand as technology is enhanced and clinicians become more familiar with use of the new technology as a supplement to usual care. This article describes the Telehealth Wound Care Program implemented at Mount Sinai Hospital Home Health Agency and Mount Sinai Hospital Wound Care Center. Results of the wound care provided for one patient are included in the case study described in this article. The authors note the many benefits of telehealth as an adjunct to usual therapy in wound care.