Learning in the workplace: Development of a simple language statement assessment tool that supports second-level nurse practice.

AIM: To focus learning through clarity of the enrolled nurse (EN) role (a second tier nurse position) through development of a user-friendly workplace performance assessment tool commensurate with EN standards for practice. BACKGROUND: Internationally, the nursing workforce comprises regulated and unregulated staff. In Australia, similar to other western countries, there are two tiers of regulated workforce, namely Registered Nurses (RNs) and Enrolled Nurses (ENs). Differences in RN and EN standards based on the education preparation are not always clearly differentiated in workplace practice. Roles are often seen as interchangeable: Improved clarity of both regulated and unregulated roles, when numbers of healthcare workers are burgeoning, assists performance assessment that guides further learning and safe practice. DESIGN: Two phase sequential, non-experimental design. METHODS: Phase one used focus groups (n=48), expert reference panel (n=8) and end-users (n=16) to develop simple language statements. Phase two involved field testing of the statements. FINDINGS: A 30-item, criterion-based workplace performance tool was developed. Principal component analysis of completed tools indicated work could be organised around three key areas of practice, namely, higher order thinking and problem solving, routine daily activities of care and personal and social attributes. DISCUSSION: Participants reported the statement items assisted in determining suitable activities and accompanying cues in discussing learning needs. Analysis assisted with discriminating broader elements of EN workplace performance. CONCLUSIONS: Workplace learning is important for nurses to continue to build their capacity to deliver optimum care. Assessment tools that describe professional capability in plain language statements and provide examples of supportive behavioural cues help guide on-going learning through improving the validity and thereby consistency of assessment processes. Furthermore, comprehensible and meaningful statements and cues can readily be adopted by students and educators to target learning and feedback thereby enhancing clarity of the EN role, to distinguish from other nursing roles.

Microbes in mercury-enriched geothermal springs in western North America.

Because geothermal environments contain mercury (Hg) from natural sources, microorganisms that evolved in these systems have likely adapted to this element. Knowledge of the interactions between microorganisms and Hg in geothermal systems may assist in understanding the long-term evolution of microbial adaptation to Hg with relevance to other environments where Hg is introduced from anthropogenic sources. A number of microbiological studies with supporting geochemistry have been conducted in geothermal systems across western North America. Approximately 1 in 5 study sites include measurements of Hg. Of all prokaryotic taxa reported across sites with microbiological and accompanying physicochemical data, 42% have been detected at sites in which Hg was measured. Genes specifying Hg reduction and detoxification by microorganisms were detected in a number of hot springs across the region. Archaeal-like sequences, representing two crenarchaeal orders and one order each of the Euryarchaeota and Thaumarchaeota, dominated in metagenomes' MerA (the mercuric reductase protein) inventories, while bacterial homologs were mostly found in one deeply sequenced metagenome. MerA homologs were more frequently found in metagenomes of microbial communities in acidic springs than in circumneutral or high pH geothermal systems, possibly reflecting higher bioavailability of Hg under acidic conditions. MerA homologs were found in hot springs prokaryotic isolates affiliated with Bacteria and Archaea taxa. Acidic sites with high Hg concentrations contain more of Archaea than Bacteria taxa, while the reverse appears to be the case in circumneutral and high pH sites with high Hg concentrations. However, MerA was detected in only a small fraction of the Archaea and Bacteria taxa inhabiting sites containing Hg. Nevertheless, the presence of MerA homologs and their distribution patterns in systems, in which Hg has yet to be measured, demonstrates the potential for detoxification by Hg reduction in these geothermal systems, particularly the low pH springs that are dominated by Archaea.

Perceptions and use of maternal health services by women in rural coastal Madang Province.

Maternal mortality remains exceptionally high in Papua New Guinea (PNG) at 733 per 100,000 live births. There has been little, if any, improvement in maternal mortality or maternity services since the 1980s. In 1992-1993 a survey of 550 women in rural coastal areas of Madang Province was undertaken to investigate the prevalence of maternal risk factors and parous women's utilization of and attitudes towards the existing health services. Women were classified as at risk on the basis of previous obstetric complications, parity, stillbirths and neonatal deaths. On this basis 67% of women were classified as being at risk in a future pregnancy. High rates of obstetric complications were reported, with only 42% of women delivering their most recent child in a health facility. There was no statistical difference between those not at risk and those at risk in terms of their use of antenatal care or having been referred for a health centre delivery. The most common reason given for not utilizing the existing health services was lack of access. Most commonly expressed positive perceptions of a health centre delivery were the availability of medical help (59%) and the physical comfort of the health centre (48%). Most common negative views expressed were lack of physical comfort (29%) and the attitudes of staff (11%). Women's opinion on village births was divided. Many (47%) thought that there was nothing good about a village birth and the same percentage cited lack of medical care if problems arose. On the other hand 36% of women thought there was nothing wrong with a village delivery, and 30% cited the care and respect received from relatives as a positive aspect. When asked for suggestions on how services could be improved only a minority of respondents expressed an opinion. Those who did wanted better access, more information on family planning and improved care and respect from staff.

Perceptions and use of maternal health services by women in rural coastal Madang Province

Maternal mortality remains exceptionally high in Papua New Guinea (PNG) at 733 per 100,000 live births. There has been little, if any, improvement in maternal mortality or maternity services since the 1980s. In 1992-1993 a survey of 550 women in rural coastal areas of Madang Province was undertaken to investigate the prevalence of maternal risk factors and parous women's utilization of and attitudes towards the existing health services. Women were classified as at risk on the basis of previous obstetric complications, parity, stillbirths and neonatal deaths. On this basis 67% of women were classified as being at risk in a future pregnancy. High rates of obstetric complications were reported, with only 42% of women delivering their most recent child in a health facility. There was no statistical difference between those not at risk and those at risk in terms of their use of antenatal care or having been referred for a health centre delivery. The most common reason given for not utilizing the existing health services was lack of access. Most commonly expressed positive perceptions of a health centre delivery were the availability of medical help (59%) and the physical comfort of the health centre (48%). Most common negative views expressed were lack of physical comfort (29%) and the attitudes of staff (11%). Women's opinion on village births was divided. Many (47%) thought that there was nothing good about a village birth and the same percentage cited lack of medical care if problems arose. On the other hand 36% of women thought there was nothing wrong with a village delivery, and 30% cited the care and respect received from relatives as a positive aspect. When asked for suggestions on how services could be improved only a minority of respondents expressed an opinion. Those who did wanted better access, more information on family planning and improved care and respect from staff.

iCare advanced blood glucose monitoring system.

Health professionals working in the field of diabetes have a wide choice of blood glucose meters to offer patients, with different meters offering different options for monitoring and recording blood glucose results. Self-monitoring of blood glucose levels can be helpful to people with diabetes in helping to maintain day-to-day control, adjusting insulin doses, detecting hypoglycaemia, assessing control during intercurrent illness and helping to provide information that can be used in the prevention of long-term complications. The newly released iCare Advanced Blood Glucose monitoring System is an easy-to-teach and use blood glucose meter using the latest technology to provide people with diabetes with easy and comfortable testing, producing accurate blood glucose test results in just 6 seconds using a small blood sample of only 0.7ul. In the current NHS climate, the iCare Advanced blood Glucose meter offers patients and health professionals the latest technology alongside cost savings by providing a test strip that is low cost but does not compromise on quality.

Effectiveness of best practice implementation in reducing hip arthroplasty length of stay.

A transfer of a best practice model was performed between a new institution in the United Kingdom and a leading orthopedic hospital in the United States. The quality concepts transferred to the UK were surgical and hospital throughput, hospital facility design, an Interdisciplinary Preoperative Patient Education Program, infection control standards, and a standardized rehabilitation model. The new hospital was officially opened in February 2004, and the average length of stay for total hip arthroplasty between February and December 2004 was 6.1 +/- 3.0 days, a substantial reduction of 5 days on average. The infection rate was reduced from 1% to 0.16%. This study supports the notion that the implementation of a best practice approach significantly reduces length of stay as well as infection rate.

'I think PCA is great, but . . .'-Surgical nurses' perceptions of patient-controlled analgesia.

This qualitative study investigated surgical nurses' perceptions of patient-controlled analgesia as a strategy for managing acute pain in a tertiary care hospital. Patient-controlled analgesia is commonly used and nurses play an essential role in caring for patients prescribed it. The study was divided into two parts. First, audiotaped semistructured interviews were conducted with 10 nurses. The interviews were followed by a postal questionnaire to 336 nurses with 171 returned. Thematic analysis was the chosen methodology. The audiotaped transcripts and questionnaires surfaced five themes, with the dominant one being 'I think PCA is great, but . . .'. The paper outlines and explores these themes and addresses the implications arising from the research for both clinical practice and education.

Mapping the kinase domain of Janus Kinase 3.

The utilization and impact of parallel synthesis on lead exploration around initial hit oxindole (1) are described. The emergent SAR, analogue design and functional impact will also be detailed.