Is decreased treatment time in hemodialysis patients harmful if solute clearance is maintained?

An association between decreased duration of hemodialysis and increased morbidity and mortality in patients has been suggested. Whether this is due only to decreased solute clearance is unclear. In this prospective randomised study the effect of reducing treatment time whilst maintaining constant solute clearance was examined in fourteen patients. The study lasted for a period of 36 weeks (3x12 week study periods) and used a crossover design. The patients dialysis prescription (KW) was not changed on entering the study and was maintained during short (150 minutes) and long dialysis (240 minutes) by varying blood flow, dialysate flow and dialyzer surface area. The delivered KW was kinetically assessed. Fractional urea clearance was also measured during each treatment period by measurement of urea concentration in spent dialysate and total body water using 3H2O. At the end of each treatment period a full biochemical and hematological profile, nutritional intake and status, 24 h ambulatory blood pressure, nerve conduction studies, and quality of life questionnaire were performed. Within patients the delivered single pool KW was uniform throughout the 3 treatment periods and fractional urea clearance did not vary. However, Kt/W assessed using equilibrated models (Daugardis and Smye) was significantly lower in the short dialysis period. No differences between short and long dialysis sessions were noted in any of the measured variables. Thus, over a 36 week period there is no evidence to suggest that hemodialysis patients are adversely affected by decreased duration of treatment provided that solute clearance is maintained.

Ergonomic nursing workstation design to prevent cumulative trauma disorders.

The introduction of computerized nursing information systems offers health care institutions an opportunity to take a new look at safety issues related to nursing workstation design. Industrial studies have investigated the injuries sustained by clerical workers who spend long periods of time at their computers. Cumulative trauma disorders (CTDs) are the most common injuries associated with computerized workstation use. They account for nearly 90,000 injuries each year in the United States. Typical CTDs include back pain, strain of the neck, shoulders and eyes, and carpal tunnel syndrome. As the information handling work of nurses is increasingly computerized, the incidence of computer-related injury is expected to increase. Injury rates can be reduced by ergonomic workstation design. An assessment of potential risks associated with the equipment installed should be done as part of workstation design. Risk identification is a prerequisite for avoiding injuries by designing workstations that protect human health. The ergonomic principles learned and tested on office workers are addressed and extrapolated to nursing workstation design. Specific suggestions for design of sitting and standing workstations are presented.

Cost-effectiveness of clustered unit vs. unclustered nurse floating.

This study evaluated costs and staffing balance outcomes comparing unrestricted unit floating (UUF) with cluster [by related patient population or technical requirements] unit floating (CUF) practices. Researchers used a computer simulation model with data from a 400 bed VA hospital. Literature suggested a high nurse turnover rate associated with dissatisfaction engendered by forced floating to unfamiliar units. Direct wage cost differences were negligible when UUF and CUF floating patterns were compared, so absolute costs were not the defining issue. UUF staffing patterns produced significantly fewer understaffed shifts (by nursing hours) than CUF floating permitted. The essential quality of care trade-off is between the UUF pattern that provided sufficient nursing hours of care vs. the CUF pattern that provided less absolute availability in hours of nursing care, but a better oriented staff. The author suggests seeking staff input when deciding which of these two floating patterns would be most acceptable in a particular institution.

Computer support for the nursing process.

Due to the increased complexity of nursing care in hospitals, new tools are being sought to aid the nursing process. One such tool is the computer. This article explores the various types of computer systems that can better support the nursing process in hospitals.

The nurse as a sex object in motion pictures, 1930 to 1980.

A content analysis of 191 motion pictures featuring 211 nurses as significant characters was conducted to determine the nature and extent of the motion picture industry's depiction of the nurse as a sex object and to identify changes in that portrayal from 1930 to 1980. Seventy-three percent of the nurse roles characterized nurses as sex objects. The frequency and intensity of stereotypes of nurses as sex objects rose significantly during the 1960s and 1970s (p less than .0001). Exploitation of the nurse as a sex object was more common in the larger nurse roles. However, in films with a strong emphasis on professional nursing in either the story or in character development, sexual stereotyping of nurses was uncommon. It was concluded that the image of the nurse as a professional care giver was incompatible with that of the nurse as sex object, and that the motion picture industry has opted primarily to present the latter image. The extremely negative sexual stereotype of nursing promulgated during the past 20 years is cause for concern. Actions that the nursing profession can employ to counter the unfavorable portrayal of nurses in 1980s motion pictures are suggested.