Fostering nursing research among nurse clinicians in an Australian area health service.

BACKGROUND: The Nursing Research Centre for Adaptation in Health and Illness (NRCAHI) is a collaborative effort of the University of Sydney and Central Sydney Area Health Service (CSAHS) in Sydney, Australia. This article reports findings of a research needs-analysis of clinical nursing staff in CSAHS that was conducted to provide research training. METHOD: A questionnaire was administered to a random sample of nurses working in CSAHS. The questionnaire gathered information about employment and demographic information, interest in research participation, current and future levels of research skills, and areas where skill and knowledge enhancement is desired. RESULTS: Overall, nurses expressed low levels of perceived confidence, knowledge, and research skills. Results were used as the basis for developing a range of strategies designed to enhance research confidence and participation. These strategies were sufficiently flexible to cater for the needs of nurses with varying levels of research experience. CONCLUSION: Strategies implemented by the NRCAHI in its first 4 years of operation have produced positive outcomes in terms of increased research participation.

Strategies for promoting research participation among nurses employed as academics in the university sector.

This article documents the process of developing a research culture and enhancing research participation among nurses employed within the Faculty of Nursing at the University of Sydney. It outlines strategies and lessons learned by the researchers in order to provide information useful for others wishing to enhance research productivity. When the Institute of Nursing Studies at the Sydney College of Advanced Education amalgamated with the University of Sydney, the university sector added new dimensions to the job responsibilities of nurse academics. In particular, active research participation became an integral part of academic duties. Previously, relatively few members of academic staff were actively involved in research. This article reports the strategies implemented to promote research. The first step was conduct of an academic staff research needs analysis. Results from this project were used to design a research promotion strategy. A follow-up survey was conducted 2 years later in order to determine level of research skills and participation within faculty staff. Results indicate a substantial change in perceived research skills and confidence.

Infrared thermometry in the diagnosis and treatment of heat exhaustion.

Infrared (IR) thermometers (FirstTemp 2000A, Intelligent Medical Systems, California) were used to monitor tympanic temperature (Tty) in 12 collapsed fun-runners suspected of suffering exertion-induced heat exhaustion (EIHE). Rectal temperature (Tre) was monitored via digital clinical thermometers. Conditions during the fun-run and in the field treatment centre were cool (air temperature 16-18 degrees C, relative humidity 60-65%). On admission, Tty was (mean +/- SEM) 1.2 +/- 0.3 degrees C lower than Tre. For admission plus subsequent monitoring data pooled, although Tty correlated significantly with Tre (r = 0.86, p < 0.001), mean Tty (37.4 +/- 0.2 degrees C) was significantly lower (p < 0.01) than mean Tre (38.4 +/- 0.4 degrees C). Cotton wool ear pads, applied to 10 of the runners on admission to minimise environmental effects on Tty, did not significantly improve the IR monitoring. A Tty > or = 37.1 degrees C predicted a Tre > or = 38 degrees C (an established diagnostic criterion for EIHE) with a sensitivity of 0.93 and a specificity of 0.63. These data indicate that IR tympanic thermometry, when utilised in cool environments, can result in misdiagnosis of heat exhaustion. Although IR thermometry shows some promise as a rapid, non-invasive means of monitoring core temperature, it should not be used in the diagnosis and treatment of heat exhaustion unless further research validates the method.

The effects of All-RN and RN-EN staffing on the quality and cost of patient care.

This paper presents empirical evidence from a study that compared the quality and costs of patient care provided by two staffing regimes in an acute medical and an acute surgical ward in one hospital. As assessed by patient outcomes, there were few significant differences in either ward in the quality of care provided by all registered nursing staff and staff that was comprised of 80% registered nurses and 20% enrolled nurses. In the acute medical ward the all-registered nursing staff was more expensive per day and per hour for patient care adjusted for patient dependency; in the acute surgical ward the registered-enrolled nurse staff mix was more costly. The study found that nurses in both wards were confronted by continuously high workloads. Registered nurses reported that working with enrolled nurses (who were inexperienced in acute medical and surgical nursing) exacerbated their workload and, to a lesser extent, made their work more stressful. Large scale, long term studies are necessary to clarify the issues of cost effectiveness of RN-EN mix and workloads.

Developing methods and research instruments for assessing physical and psychosocial outcomes of patient care as a function of nursing staff mix.

This paper describes a study which assesses a wide variety of both physical and psychosocial outcomes of patient care against nursing care standards, and as a function of two different staff mixes--an 80% registered nurse (RN) 20% enrolled nurse (EN) mix and an all-RN staffing regimen. The study is divided into three stages: Stage I which concerned the design of the investigation and development of research instruments and procedures; Stage II which concerned the field-testing of all research procedures and assessment of the reliability of research instruments and Stage III which will constitute the main study and is presently being conducted in an acute medical and an acute surgical ward. This paper is confined to a report on Stages I and II and provides the conceptual framework for the study, a description of the research instruments and the ways they were developed and a description of the research methods. The results from Stage II show that the principal research instruments are highly reliable with coefficients always in excess of 0.80, and that all of the research methods and procedures are practical and feasible. The study is significant because outcome-based evaluations, while attractive in principle, are in their infancy and little guidance appears in the literature about how to conduct these types of investigations. This paper attempts to address this deficiency.

The synergistic effect of weight loss and changes in dietary lipids on the serum cholesterol of obese men with hypercholesterolaemia: implications for prevention of coronary heart disease.

The hypolipidaemic effect of a low-fat, low-cholesterol diet, alone and in combination with weight reduction, has been evaluated in two groups of obese men with hypercholesterolaemia. In 41 men who lost 10.3 kg over 11 months and maintained their lower weight for 23.5 months serum cholesterol fell by 1.68 mmol/l and remained steady at lower weight. In 20 similar men, the controls, whose weight fell by 0.8 kg over 39.5 months, serum cholesterol fell by 0.80 mmol/l. There was a significant linear correlation between change in weight and change in serum cholesterol. The change in serum cholesterol in the weight losers was greater than could be accounted for by change in dietary lipids. Weight reduction and low-fat, low-cholesterol diets appear to have a synergistic effect in reducing serum cholesterol.

Is the Australian version of the Feingold diet safe?

Dietary intake data which were collected in the course of a trial on 16 children, who were diagnosed as being hyperactive, are examined. The nutritional adequacy of the children's diets before and during treatment with the Australian version of the Feingold elimination diet is calculated. The mean intakes of all computed nutrients were above the recommended level in the Australian Dietary Allowances for both diets. The nutritional quality, in terms of the level and balance of nutrients in the elimination test diet, was superior to that of the normal diet. With proper dietary counselling, the elimination test diet is safe for use in the treatment of children with hyperkinesis.

Type-IV hyperlipidaemia and weight-gain after maturity.

Twenty men with mild to moderate type-IV hypertriglyceridaemia were compared with normal men of the same age in the Busselton population survey. The type-IV men were not heavier but they were 3-2 cm. shorter and relatively hyperuricaemic. When gives a reducing diet, mean weight declined from 76-8 kg. to 68-7 kg. over 4-4 months and was kept steady over the next 10 months at 67-6 kg. Before, immediately after, and in the 10 months after weight reduction serum-triglycerides were 273, 112, and 126 mg. per 100 ml. and serum-cholesterol was 245, 227, and 226 mg. per 100 ml., respectively. On entry the mean daily calorie intake was 3165 and the contribution of the various nutrients were characteristic of the Australian diet. At lower weight, daily caloric intake was 2335. Protein intake was unchanged, but intake of fat and especially carbohydrate declined significantly. The findings support the view that type-IV hyperlipidaemia is the expression of a metabolic defect brought to light by weight-gain after maturity. In susceptible subjects "normal" weight-gain may be sufficient to induce hyperlipidaemia. Since type-IV and type-IIb hypertriglyceridaemias appear to increase the risk of coronary heart-disease, it is concluded that ideally no weight should be gained after reaching maturity. Avoidance of weight-gain should materially reduce the incidence of coronary disease in affluent western communities. Reduction to truly ideal weight gives much more impressive therapeutic results than drug therapy.