A practical example of exploratory factor analysis and critical realism.

BACKGROUND: Exploratory factor analysis (EFA) can link the levels of ontology in critical realism together as described in Summers (2020). AIM: To demonstrate how components of the actual can be defined by linking potential factors in the empirical to the theorised generative mechanisms in the real. DISCUSSION: This article describes one part of a three-part sequential mixed-methods study that used EFA to describe how components of the actual were linked using factors in the empirical to the generative mechanisms in the real. The author theorised three generative mechanisms: the perceived impact of continuing professional development (CPD) on patient care, the motivations for undertaking CPD and the perceived barriers to CPD. He used EFA to test factors from the empirical against these generative mechanisms to identify linking components in the actual. CONCLUSION: This article shows how components of the actual can be defined using EFA. These components are multifactorial and many factors in the empirical are influenced by different generative mechanisms. IMPLICATIONS FOR PRACTICE: Being able to articulate and link the different aspects of ontology enables researchers to define theorised generative mechanisms and link theory to practice.

Using exploratory factor analysis to define levels of ontology in critical realism.

BACKGROUND: Critical realism is often used in mixed-methods research. There are three domains of ontology in critical realism: the empirical, the actual and the real. Exploratory factor analysis is a statistical method used to identify patterns in datasets. AIM: To demonstrate how exploratory factor analysis can assist in defining the domains of ontology in critical realism. DISCUSSION: The different elements of exploratory factor analysis enable researchers to define each domain of ontology in critical realism. The data related to the different factors in the exploratory factor analysis equate to the domain of the empirical. The bonds that link these factors in the empirical are their theoretical link to the real. The strength of these links is determined by the exploratory factor analysis and are the pathways in the actual linking the real to the empirical. CONCLUSION: Combining all these elements enables researchers to define a theory, as seen by the experiences and influences on that theory. IMPLICATIONS FOR PRACTICE: Exploring people's experiences and then combining them into a theory using critical realism and exploratory factor analysis enables researchers to determine the strength of the relationship between the theory and the experiences.

Continuing Professional Development in Australia: Barriers and Support.

Mandatory continuing professional development (CPD) requirements for nurses are common throughout the world, with CPD being required in Australia since 2010. Many barriers to CPD have been identified. In Australia, state and territory governments have implemented supports to help nurses overcome these barriers.

Accessory ossicles and sesamoid bones: recognition and treatment.

Accessory ossicles and sesamoid bones are normal variants of bone development. In foot and ankle X-rays these bones can appear similar to, or can obscure, fractures, which makes the X-rays difficult to interpret. This article illustrates and describes some of the more common ossicles and sesamoid bones, and provides a brief description of the management of the patients with foot or ankle pain whose X-rays are inconclusive.

Congenital and acquired umbilical hernias: examination and treatment.

Many adults and children with painful swellings to the abdomen present to emergency departments (EDs) and are diagnosed with umbilical hernia. Some of these patients require urgent surgery because the hernia has become incarcerated or strangulated, while others can be discharged home safely. This article explains what an umbilical hernia is and what causes it, and discusses how the abdomen should be examined. The article also reviews potential management techniques in EDs and how nurse practitioners can explain the condition to the patients concerned.

Gynaecological assessment and history taking.

Nurse practitioners (NPs) rarely undertake gynaecological histories or female genital examinations yet, by doing so, they can broaden their scope of practice. This article discusses what NPs should ask women about their gynaecological histories and how to undertake pelvic examinations, and reviews common gynaecological symptoms. Further articles will cover different aspects of the pelvic examination and potential differential diagnoses.

Assessment and treatment of three common anorectal conditions.

This is the second of two articles about the kinds of anorectal problem with which people can present at emergency departments. The first article concerns common symptoms and anorectal examination, while this one discusses the diagnosis and treatment of three common anorectal problems that can be managed by nurse practitioners: haemorrhoids, anal fissure and pruritus ani. Unexpected diagnoses might be found on examination and nurse practitioners should refer these patients to appropriate specialists.

Anorectal examination in emergency departments.

Many patients present to emergency departments with anorectal problems, such as haemorrhoids, anal fissure and pruritis ani. Often, patients with such problems are embarrassed about them or fearful about their potential diagnoses, so practitioners must approach history taking and examination sensitively. They should also have a good understanding of the anatomy of the anorectal area, and be able to recognise the signs and symptoms of relevant conditions. This article provides an overview of the anatomy and physiology of the anorectal area, explains how to undertake anorectal examinations, and describes the signs and symptoms of some common conditions.

Treating cement burns in the emergency department.

Use of cement is widespread in the UK and warnings about burns caused by contact with the material are usually printed on bags and delivery dockets. Nevertheless, about 2 per cent of people admitted to burns units have injuries, many serious, caused by prolonged contact with wet cement. This article explores the pathophysiology of cement burns, and outlines the best forms of treatment and prevention.

Managing auricular haematoma to prevent 'cauliflower ear'.

This article describes the typical signs of auricular haematoma, how people who have the condition should be treated in emergency departments and the problems that can arise if they are managed inappropriately.

Emergency management of hyperemesis gravidarum.

Most pregnant women experience morning sickness during the first 20 weeks of pregnancy. Often, the symptoms are mild, but recurring, nausea and vomiting; but the condition can also lead to dehydration, weight loss, electrolyte imbalance and blood volume depletion, and many women with more severe forms of the condition present to emergency departments. This article describes the presenting symptoms, causes of hyperemesis gravidarum, the associated clinical signs and complications, and the most common treatments offered.

Managing mastitis in the emergency department.

Mastitis is a common clinical condition and, although not exclusive to lactating mothers, most patients with the condition seen by clinical staff fall into this group. Between 3 and 33 per cent of lactating mothers experience an episode of mastitis (Academy of Breastfeeding Medicine 2008, Jahanfar et al 2009). Most of these mothers receive treatment from their midwives or GPs, but some attend EDs and require treatment for, and education about, the condition from emergency care staff, including nurse practitioners (NPs). This article describes mastitis and the various treatment measures, and aims to improve NPs' ability and confidence in recognising and treating the condition.

Use of digital nerve blocks to provide anaesthetic relief.

This article discusses the various techniques that nurses can use to perform digital nerve blocks, which are some of the most common procedures undertaken by emergency practitioners treating patients with finger injuries. In covering the advantages and disadvantages of each technique, it focuses primarily on the digits of the hand, but the techniques can also be performed on toes.

Treating burns caused by hydrofluoric acid.

Hydrofluoric acid is an ingredient of many common household and industrial solutions. Even seemingly minor burns caused by this acid can have catastrophic effects if they are treated inappropriately or late. This article describes the signs and symptoms, the pathophysiology and the emergency management of hydrofluoric acid burns.

Identifying non-viral gynaecological conditions.

The role of emergency nurse practitioners (ENPs) is constantly changing as their caseloads expand, from comprising patients with minor injuries and ailments to comprising those with more complex medical and surgical conditions. This article discusses three common gynaecological infections with which women may present to emergency departments: vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis. Knowledge of these conditions, and of how to obtain accurate histories and conduct brief patient examinations, is needed if ENPs are to diagnose and provide treatment for them.

Emergency management of alveolar osteitis.

Patients with urgent dental problems who present to emergency departments (EDs) during weekday office hours are usually referred to their dentists, often after being provided with analgesia. Outside these hours, however, ED professionals may have to provide treatment before referral. One dental emergency with which patients may present but of which ED staff are unlikely to have experience is alveolar osteitis, a painful condition that occurs usually after tooth extraction. This article defines alveolar osteitis and describes management in an ED.

Diagnosis and treatment of meralgia paresthetica.

Many patients present to emergency departments with lower back pain, for which there are several differential diagnoses. One of these is meralgia paresthetica, an obscure and benign condition first described in the late 19th century. Nurse practitioners should familiarise themselves with the symptoms of meralgia paresthetica so that they can make differential diagnoses and offer the relevant management. This article describes the condition, its causes and some conservative management techniques.

Diagnosis and treatment of Morton's neuroma.

Morton's neuroma is a benign foot condition that occurs more often in women than men, and particularly in those who wear narrow, high-heeled shoes. This article presents a case study of the condition, discusses its symptoms and diagnosis, and provides information about the range of treatments on offer.

Manubriosternal dislocation in children.

The use of trampolines at home has increased during the past ten years, and consequently there has been a dramatic increase in the number of children presenting with injuries associated with their use. The case study in this article highlights an unusual injury that was related to a child jumping on a trampoline.

Gingivitis: diagnosis and treatment.

Most emergency nurses have little education on dental conditions yet some new attendances to emergency departments are for dental problems. This article describes the signs and symptoms of three common gingival conditions, and briefly outlines treatment.