Medical-surgical nurses' documentation of client teaching and discharge planning at a Jamaican hospital.

AIM: This study sought to review documentation of client teaching and discharge planning performed on the medical wards of an urban Jamaican hospital. BACKGROUND: Amid a chronic disease epidemic in Jamaica, adequate discharge planning and client education among hospitalized clients are essential to ensure optimal health outcomes and reduced healthcare costs. METHOD: A total of 131 records from six medical wards were audited. The audit instrument was developed based on the Ministry of Health, Jamaica guidelines, and appraised the completeness of assessment, use of the nursing process, client teaching and discharge planning. Quota sampling facilitated the selection of medical records which met the inclusion criteria. The SPSS® version 22 for Windows® facilitated data analysis. RESULTS: Eighty-eight adult (67.2%) and 43 (32.8%) paediatric records were audited; 89.3% indicated the clients were diagnosed with at least one non-communicable disease. Fourteen percent of records reflected documented evidence of client teaching within the first 72 h of admission. On the day of discharge, only 18.3% reflected client teaching. Nurses seldom began discharge planning within the first 24 h of admission as only 6.9% records had documented evidence. These trends were common to adult and paediatric units. DISCUSSION AND CONCLUSION: The requisite client teaching and discharge planning appeared to be lacking in the records reviewed and may be contributory to deficiencies noted in self-care management. Research is needed to determine factors which could facilitate improved client teaching and discharge planning in the local context. Failure to address this gap in nursing care can significantly affect the country's ability to the reduce the economic burden associated with chronic diseases. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study highlighted an opportunity for advocacy among nurses and requires nursing leadership to collaboratively develop policies and guidelines to address discharge planning and client education among hospitalized clients. Given the significant health costs associated with non-communicable diseases this should be made a priority in the National Strategic and Action Plan for the Prevention and Control Non-communicable Diseases in Jamaica with clear articulations.

Attitudes towards mental illness of nursing students in a Baccalaureate programme in Jamaica: a questionnaire survey.

There is longstanding evidence of nurses demonstrating negative attitudes towards people with mental illness. Student nurses' fear or discomfort with mentally ill patients results in poorer outcomes for patients and students' dissatisfaction with their experience of mental health nursing. There is evidence of negative attitudes towards mental illness in the Jamaican society; however, no studies have explored whether these attitudes are held by nursing students. The aim of the study was to examine the attitudes of nursing students towards mental illness. A questionnaire survey was conducted with a convenience sample of 143 third-year nursing students who were enrolled in a baccalaureate programme. Data were collected using the Attitudes Towards Acute Mental Health Scale (ATAMHS). A response rate of 71% was achieved for the survey. The findings indicated that the student nurses held an overall negative attitude towards mental illness, with a general perception that mentally ill people are dangerous. The student nurses were divided in their opinions in a number of areas, suggesting a possible conflict of opinions. Negative attitudes towards mental illness impact client outcomes and the career choices made by nurses. This study provides baseline data within the Jamaican context that adds to the evidence on nursing students' attitude to mental illness. Further research is needed to explore whether nursing education and clinical experience enables student nurses in Jamaica to develop a more positive attitude towards mental illness and mental health nursing and whether cultural factors contribute to negative attitudes.

Interrelating of ventricular pressure and intracellular calcium in intact hearts.

Although the mechanistic link between variations in intracellular calcium and its effects on myofilament regulatory proteins and subsequent impact on cardiac muscle force production have been known for some time, characterization of cardiac contractile properties are predominantly confined to phenomenological descriptions of the relationship between either muscle length and force or ventricular pressure and volume. However, as recognition of the limitations of these theories grow, investigators have begun to look toward more fundamental theories of cardiac contraction to explain whole heart function. The goal of the present study was first to explore, on a theoretical level, the degree of complexity required in a biochemical model necessary to adequately explain both equilibrium and twitch contraction behavior of cardiac muscle. Central to this analysis was a critical examination of the evidence for and against the importance of a calcium-free, force-generating state. Next, we determined whether such theories can actually account for the interrelationships between the experimentally measured time courses of pressure generation and the calcium transient measured from intact ventricles during both normal twitches as well as during complex contraction sequences. The results of this analysis provide strong support for a four-state model, including the calcium-free, force-generating state. These results will help guide the continuing quest for a mechanistic theory of ventricular function.

Impact of exercise training on ventricular properties in a canine model of congestive heart failure.

Exercise training improves functional class in patients with chronic heart failure (CHF) via effects on the periphery with no previously documented effect on intrinsic left ventricular (LV) properties. However, because methods used to evaluate in vivo LV function are limited, it is possible that some effects of exercise training on the failing heart have thus far eluded detection. Twelve dogs were instrumented for cardiac pacing and hemodynamic recordings. Hearts were paced rapidly for 4 wk. Six of the dogs received daily treadmill exercise (CHF(EX), 4.4 km/h, 2 h/day) concurrent with rapid pacing, while the other dogs remained sedentary (CHFs). Hemodynamic measurements taken in vivo at the end of 4 wk revealed relative preservation of maximum rate of pressure rise (2,540 +/- 440 vs. 1,720 +/- 300 mmHg/s, P < 0.05) and LV end-diastolic pressure (9 +/- 5 vs. 19 +/- 4 mmHg, P < 0.05) in CHF(EX) compared with CHFs. The hearts were then isolated and cross perfused for in vitro measurement of isovolumic pressure-volume relations; these results were compared with those of six normal dogs (N). Systolic function was similarly depressed in both groups of pacing animals [end-systolic elastance (Ees) values of 1.66 +/- 0.47 in CHFs, 1.77 +/- 0.38 in CHF(EX), and 3.05 +/- 0.81 mmHg/ml in N, with no changes in volume axis interceptors of the end-systolic pressure-volume relationship]. The diastolic myocardial stiffness constant, k, was elevated in CHFs and was normalized by exercise training (32 +/- 3 in CHFs, 21 +/- 3 in CHF(EX), 20 +/- 4 in N). Thus daily exercise training preserved in vivo hemodynamics during 4 wk of rapid cardiac pacing and was accompanied by a significant change in diastolic myocardial stiffness in vitro. These findings suggest that changes in heart function may contribute to the overall beneficial hemodynamic effects of exercise training in CHF by a significant effect on diastolic properties.

Characterizing ventricular mechanics and energetics following repeated coronary microembolization.

Myocardial mechanics and energetics were investigated in an animal model of moderate chronic heart failure (CHF) created by repeated coronary microembolizations in six dogs. The final fractional area change was 34 +/- 4%. Hearts of these animals were isolated and cross-perfused, and balloons were placed in the left ventricle (LV). Chamber contractile state was markedly depressed in embolized hearts as assessed by the slope (Ees 2.74 +/- 0.49 vs. 4.00 +/- 1.18 mmHg/ml, P < 0.01) and volume axis intercept (V: 8.7 +/- 5.9 vs. 1.0 +/- 3.2 ml, P < 0.01) of end-systolic pressure-volume relation compared with a group of six normal dogs. The end-diastolic pressure-volume relation of embolized hearts was shifted to the right, indicating a dilation of the LV. However, systolic and diastolic stress strain relationships were similar in the two groups, suggesting that the average myocardial properties of the embolized hearts are similar to those of normal hearts. The relationship between oxygen consumption and pressure-volume area in embolized hearts had smaller intercept (2.98 +/- 0.44 vs 3.92 +/- 0.39 x 10(-2) ml O2.beat-1.100 g LV-1, P < 0.01) compared with the control group, with no change in the slope. These results contrast with previous findings in pacing CHF and serve as an important characterization of ventricular properties in this model of CHF from different etiology.

Effects of levosimendan on myocardial contractility and oxygen consumption.

Levosimendan is hypothesized to be primarily a calcium sensitizer in vitro. Therefore, its inotropic action may be similar in both the normal and the congestive heart failure (CHF) state, and it may be associated with a decreased energetic cost of inotropism in vivo. To test these hypotheses, we gave levosimendan to cross-circulated isolated hearts from normal (n = 11) and CHF (n = 7, 4-week rapid pacing) dogs. Peak isovolumic left ventricular pressure at an end-diastolic pressure of 5 mm Hg (Pmax,5) measured by an intraventricular balloon was 120 +/- 15 mm Hg in normal dogs, and it was increased by approximately 40% in response to approximately 0.63 microM levosimendan. In CHF dogs, base-line Pmax,5 was only 60 +/- 12 mm Hg (P < .01 compared to normals), and approximately 8.4 microM levosimendan (P < .05) was required to increase Pmax,5 by approximately 40%. The inotropic actions were associated with increases in unloaded myocardial oxygen consumption by comparable amounts in normal and falling hearts. The blunted inotropic response in CHF and the energetic cost of inotropism were also comparable to those obtained with isoproterenol. In other studies, there was no significant inotropic action of levosimendan in Langendorff-perfused rat hearts (n = 5), and intracellular calcium concentration, estimated by macroinjected aequorin, in ferret hearts (n = 2) increased dose-dependently. These findings suggest that inotropic actions of levosimendan in vivo may be mediated in part by factors other than calcium sensitization.

Length-dependent activation in intact ferret hearts: study of steady-state Ca(2+)-stress-strain interrelations.

We examined the steady-state stress-strain relationships and the steady-state stress-intracellular calcium concentration ([Ca2+]i) relationship in intact ferret hearts and compared these to previously published analogous relationships in skinned and intact muscle. Langendorff-perfused ferret hearts were treated with ryanodine and tetanized by rapid stimulation to create steady-state conditions. [Ca2+]i was measured concurrently by macroinjected aequorin. Over a range of volumes corresponding to strains between 1.0 and 0.75, steady-state stress decreased by 33% when saturating levels of perfusate calcium were used, indicating the degree to which physical factors contribute to the Frank-Starling relationship. The steady-state stress-[Ca2+]i relationship was sigmoidal with a mean Hill coefficient (nH) of 4.91 +/- 0.29 at a strain of 1.0, and the [Ca2+]i required for half-maximal activation (K1/2) was 0.41 +/- 0.03 microM. K1/2 increased and nH decreased with decreasing strains. These results are similar to those observed in intact muscle but differ quantitatively from results obtained in isolated, skinned preparations. Based on these results, we suggest that whole heart function can be related to average sarcomere function without the need for complex models of ventricular structure.

Mechanisms of the Frank-Starling phenomena studied in intact hearts.

The impact of ventricular volume on the relationship between intracellular calcium and ventricular pressure under steady-state conditions was determined in intact ferret hearts. The results reveal major quantitative differences and minor qualitative differences between these relations and those previously measured in isolated intact and skinned cardiac muscle. The importance of these differences is discussed within the context of developing a comprehensive mechanistic theory to describe load-dependence of the intact ventricle.

Future physicians' attitudes on women's reproductive rights: a survey of medical students in an American university.

The July 1989 US Supreme Court decision in Webster v Reproductive Health Services restricts both women's access to legal abortion and physicians' latitude when performing abortions. We surveyed 197 medical students at the Columbia University College of Physicians and Surgeons regarding their general attitudes toward abortion as well as their specific opinions concerning the Webster decision and the possible restriction of minors' access to abortion represented by three then undecided cases. Of those surveyed, 85.8% were pro-choice by self-description as compared with 14.2% pro-life. The antiabortion group was predominantly male (78.6%) and of Catholic background, while there were no significant gender and/or religious correlates among the pro-choice group. The majority of the respondents (83.2%) disagreed with either one or both stipulated restrictions of Webster and 81.4% did not support limiting minors' access to abortion in any way. Moreover, only 19.8% admitted to a change in general attitude toward abortion during their medical education.

The protein synthesis inhibitor, anisomycin, causes exacerbation of the iminodipropionitrile-induced spasmodic dyskinetic syndrome in rats.

The effects of anisomycin on dyskinetic head movements, circling, and locomotor activity were investigated in the IDPN-induced syndrome. Intracerebroventricular (ICV) injections of anisomycin in conjunction with IDPN caused exacerbation of all aspects of the syndrome, although circling and vertical head dyskinesias (retrocollis) were the most affected. Animals treated with only anisomycin showed persistent retrocollis but not laterocollis or circling. Biochemical studies confirmed the increases in the concentration of serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) previously observed in the striata of IDPN-treated rats two weeks after stopping administration of the drug. Rats treated with anisomycin alone also showed significant increases in striatal 5-HT and 5-HIAA concentrations which were somewhat higher on the side of the ICV infusions. Coadministration of IDPN and anisomycin did not cause any further increases in 5-HT or 5-HIAA. These results suggest that inhibition of protein synthesis by IDPN may be one of the processes involved in the development of the persistent dyskinetic syndrome.

Structure-function relationships in the rat brainstem subnucleus interpolaris: II. Low and high threshold trigeminal primary afferents.

Prior studies indicate that vibrissa, guard hair, hairy skin, mucosa, and nociceptive trigeminal primary afferents give rise to morphologically distinct terminal arbors in the medullary dorsal horn. The present study describes the extent to which similar structure-function relationships exist in the rostrally adjacent subnucleus interpolaris (SpVi). Seventy-three axons were physiologically characterized and visualized by standard intra-axonal HRP labeling techniques. They responded to guard hair (GH) or vibrissa (VIB) deflection; gentle pressure applied to hairy skin (HS), glabrous skin (GS), lingual mucosa (LM), or an incisor (PER); or a noxious pinch of the face (NOX). Response latencies to trigeminal ganglion shocks were equivalent for all categories with low threshold receptive fields (mean = 0.44 ms), and these were significantly shorter than those of fibers with high threshold NOX receptive fields (mean = 0.88 ms). All axons gave off transversely oriented collaterals into SpVi with rostrocaudal discontinuities in their arbors. Collaterals were topographically organized. Axons innervating the rostral mouth and face terminated medially, and those that supplied the caudal face innervated successively more lateral SpVi. The dorsal face was represented in the ventral SpVi, whereas the ventral face and mouth were represented more dorsally. This transverse topography extended largely throughout the rostrocaudal extent of SpVi. VIB, GH, GS, and LM collaterals had similar configurations with circumscribed arbors. HS, PER, and NOX arbors had a "stringy" shape without a clear terminal focus, save for the fact that PER and NOX collaterals often terminated in rostrally displaced substantia gelatinosa at the level of the caudal SpVi. Analysis of variance, considering only those data from mystacial VIB, GH, and HS fibers, indicated significant differences for all of the following measures: number of collaterals, number of boutons per collateral, arbor area, arbor circumference, and arbor circularity (form factor). A similar analysis, considering all fiber types, indicated significant differences for only the following measures: number of collaterals, arbor area, and arbor circumference. Individual group comparisons between the more heavily sampled functional categories indicated that GH afferents had significantly fewer collaterals, fewer boutons per collateral, smaller arbor area, shorter arbor circumference, and more circular arbors than those of HS axons. VIB fibers tended to fall between GH and HS afferents with respect to number of collaterals, arbor area, circumference, and circularity. The remaining functional groups were not as orderly.(ABSTRACT TRUNCATED AT 400 WORDS)