An investigation of the effect of prolonged glove wearing on the hand skin health of dental healthcare workers.

OBJECTIVES: Glove wearing during patient treatment has been central to dental surgery infection control for over 15 years. However, little is known about the cutaneous effects of glove wearing on the hands of dental healthcare workers (DHCWs). The objective of this project was to assess the hand skin health of DHCWs before and after wearing gloves of two types and to compare this with a control group of non-DHCWs. METHODS: Following a mailing to all dentists in the West of Scotland, 50 DHCWs who wore gloves during dental treatment procedures for a minimum of 8h daily for at least 4 days per week were invited to participate in the project. The control group comprised 25 subjects who did not routinely use surgical or examination gloves. Hands were assessed by clinical examination and by transepidermal water loss at baseline, 1 month and 3 months. RESULTS: Of the 50 DHCWs, 26 wore a non-powdered latex glove (Microtouch Powder-free: Johnson and Johnson, Arligton, TX, US), and 24 wore a nitrile glove (Hartalega SDN BHD, Malaysia) from the time of the baseline examination until the 3-month examination. No differences were observed in hand skin health between the control group and the DHCWs at baseline, nor between those wearing the latex or nitrile gloves during the 3 month period of the study. CONCLUSION: It is concluded that the hand skin health of the DHCWs examined were no different from those of a control group of non-DHCWs, and that the wearing of the two types of gloves used in the 3 month study had no significant effect.

End-of-life care in the intensive care unit: a challenge for nurses.

Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.

Interaction in graduate nursing Web-based instruction.

This article describes interaction and communication methods and issues in the context of two Web-based graduate nursing courses, a theory course and a research course. A conceptual model for graduate nursing Web-based instruction is presented in which learner-centered pedagogic philosophies and interaction techniques are combined to produce active learning at each phase of the Web-based courses. The focus is on asynchronous communication techniques because these represent the dominant communication form in the two courses. Asynchronous communication is interaction in which teacher and student activities are not occurring at the same time and/or place (Berge, 1999). Outcomes of the courses are examined briefly. J Prof Nurs 17:128-134, 2001.

Managers' leadership and critical care nurses' intent to stay.

BACKGROUND: Cyclical fluctuations in turnover of critical care nurses are a large and complex problem. Managers' leadership characteristics may be a determinant of critical care nurses' intent to stay in the job. OBJECTIVE: To examine the direct and indirect effects of nurse-managers' characteristics of power, influence, and leadership style on critical care nurses' intent to stay in the nurses' employment positions. METHODS: The sample was 255 staff nurses in intensive care units at 4 urban hospitals. Established instruments with sound reliability and validity were used to assess the predictor, intervening, and outcome variables. Path analysis was used to examine the relationships in a conceptual model of intent to stay. RESULTS: The model explained 52% of the variance in intent to stay, and managers' characteristics were significant at each stage. Managers' position power and influence over work coordination had a direct link to intent to stay; structuring expectations and consideration contributed indirectly through the variables of instrumental communication, autonomy, and group cohesion. Instrumental communication, autonomy, and group cohesion decreased job stress and thus increased job satisfaction. Job satisfaction was directly linked with intent to stay. CONCLUSIONS: Inclusion of nurse-managers' characteristics explained more variance in intent to stay than did previous models. Managers with leadership styles that seek and value contributions from staff, promote a climate in which information is shared effectively, promote decision making at the staff nurse level, exert position power, and influence coordination of work to provide a milieu that maintains a stable cadre of nurses.

Manager leadership and retention of hospital staff nurses.

This study used causal modeling to trace the effects of manager leadership characteristics on staff registered nurse (RN) retention in 4 urban hospitals. Unique to the study were the all-RN sample, using Leavitt's (1958) model of behavior within an organization to group variables, manager characteristics and unit structure variables as predictors, and focus on the work unit rather than the hospital. Effects of manager characteristics were traced to retention through work characteristics, job stress, job satisfaction, commitment, and intent to stay. Theoretical variables explained 22% of the retention variance. Manager consideration of staff and RN intent to remain directly affected retention; other variable effects passed through intent to stay. Different predictors were important to retention, unit separation, and turnover.

Socialization of new graduate nurses in critical care.

OBJECTIVE: To examine the modified contingency theory of role socialization with new graduate nurses in critical care. DESIGN: Descriptive comparative. SETTING: Six midwestern hospitals with 12 types of critical care units. SAMPLE: Fifty new graduate nurses and 89 experienced registered nurses in critical care. OUTCOME MEASUREMENTS: The socialization variables of precepting, support systems, assignment congruence, role conception, self-confidence, affective responses, commitment, job satisfaction, confronting reality, mutual influence, resolution of outside life conflicts, and resolution of conflicting demands at work were measured. New graduates responded to questionnaires about socialization at 1 to 2 weeks, 3 months, and 6 months of employment. Experienced nurses completed a questionnaire about socialization once, simultaneously with the 1- to 2-week data collection for new graduates. RESULTS: At initial employment new graduates differed from experienced nurses in role conception, self-confidence, and commitment to profession. After 6 months of employment new graduates differed from experienced nurses in self-confidence and mutual influence. For new graduates, positive precepting experiences, support systems, and assignment congruence were related to high self-confidence, low anxiety, high commitment, high job satisfaction, and low role conflict and ambiguity. These variables were also associated with the development of role conception. CONCLUSIONS: The study results lend considerable support to the modified contingency theory of role socialization. Positive precepting experiences, support systems, and assignment congruence contributed to successful socialization for the new graduates in this study.

Service use by elders with heart disease.

The study purpose was to determine the impact of demographic, social, environmental, and health indicators on utilization of health services among elders with heart disease. Existing data from a regional Area Agency on Aging were used and the sample (N = 1,167) included vulnerable groups, men, blacks, low income, and rural residents. Services most frequently used were case management, congregate meal, home delivered meal, outreach, and recreation. Multiple linear and logistic regression indicated that race, marital status, living arrangements, payment source, residence, transportation capability, health conditions, sensory impairment, and function were predictors of service use.

Nurse manager personal traits and leadership characteristics.

A portion of an Organizational Dynamics Paradigm provided the framework for examining urban hospital nurse managers' personality and staff nurses' perceptions of their leadership. Nurse managers' personality traits were comparable to American women in general. On motivation to manage they scored lower than business and health services managers and higher than female public school administrators. Staff nurses rated managers favorably on leadership style, power, and influence. Personality was linked modestly to motivation to manage and selected aspects of leadership.