The contribution of nurses' perceptions and actions in defining scope and stabilising professional boundaries of nursing practice.

This paper reports on the findings of a naturalistic inquiry study that explored the scope and boundaries of nursing practice. Findings from interview and observation data suggest that nurses negotiate and adjust professional boundaries on an individual, case-by-case basis, thereby managing the scope of their practice as they see it in that circumstance. The strategies they used are presented in four major categories: 1) maintaining a comfort zone, 2) expanding into safe territory, 3) moving into the grey zone and 4) stepping over the line. Findings show that nurses' efforts to maintain the comfort zone serve to perpetuate the status quo and may threaten holistic care. Expanding nursing actions to include functional roles such as coordinating care, sharing information, advocating (for patients), collaborating and innovating offers the profession critical building blocks for defining the scope of nursing practice. Clarifying the grey zone (or overlapping territory) is an essential task for the profession in determining the boundaries of nursing practice. The data revealed that, partly due to the ambiguity of the grey zone, nurses may step over the line into medical decision-making and outside the legal sanctions for the professional nursing role. The implications of this study highlight the need for nursing to define its scope of practice and in so doing stabilise professional boundaries.

Exploring nursing knowledge by using digital photography.

Clinical decision making is in part, an interpretation of visual cues manifested by the patient. The colour of a patient's skin, his or her degree of mobility, or the posture adopted by the patient are examples. Clinicians compare presenting cues with previous representations of those cues to determine significant change. Literature suggests that the sources of data for this comparison are; the long term memory of the clinician, verbal interaction with colleagues and patient, and professional documentation. This paper describes findings of a study based on the assertion that contemporary documentation systems fail to provide sufficient information for nurses to make accurate comparisons between currently presenting visual cues and cues from the past. It is argued that interpretation of visual cues is primarily a visual/spatial activity (Gardiner, 1983) and, as current documentation systems rely on language they cater for linguistic rather than the visual/spatial activities. For example, subtle shades of red exhibited by the skin surrounding a surgical wound are reduced to the word "inflamed". Digital photography was explored as a documentation format that addressed this deficit. Forty nine nurse clinicians were asked to assess and plan management for one of four external sternotomy wound. Subjects were given access to a range of documentation formats including sequential daily wound photographs. Findings demonstrated that nurse clinicians are willing to use digital photographs and there is beginning evidence that photographic documentation may decrease the differences between novice and expert when comparing visual cues.

Impact of clinical information systems on nursing practice. Nurses' perspectives.

This article adds to the literature on the impact of computerized clinical information systems by asking nurses important questions about their nursing practices. A research tool was developed from collaborative work with clinicians who have used computers in their daily practice for more than two decades. A statewide study then was conducted on how nurses believed computer technology impacted their practice. This study also examined the different views that computer users and nonusers held. Questions were posed relating to resource consumption, nursing work practices, and professional and patient outcomes. It was found that nurses, whether computer naive or knowledgeable, clearly do not expect the technology to have negative impact on practice. The two groups differed mostly in the strength of their beliefs. One startling outcome, that slow computer response time delayed care, was identified within the computer-user group and direct action was taken as a result.

Assessment of computer learning needs and priorities of registered nurses practicing in hospitals.

The purpose of this study was to identify computer learning needs of practicing nurses at the bedside. Knowles' adult learning theory clearly implies that learners have a role in identifying their learning needs. Expert opinion is the second source of needs identification and complements learner input. This principle served to underpin the conceptual framework of this study. A Delphi technique was used to solicit expert opinions from nurse informaticians about the computer learning needs of practicing nurses. A 75 knowledge/skill item questionnaire was developed from the expert consensus of the Delphi and distributed to 150 registered nurses considered to be computer novices. Novices' responses were compared to the experts' responses to identify content essential for nurses to be able to use computers in their practice. Further, sequence for content delivery was postulated through the comparison of expert and novice opinion relative to the essential/nonessential nature of the content.

Nursing informatics: a Victorian survey.

Interviews of selected personnel from a stratified random sample of Victoria's public and private acute care hospitals provided data about current computer systems implementation in nursing departments. Key informants were asked about their hospitals' present level of computerisation and plans for the future. The study found that stand-alone microcomputers are currently driving systems development in nursing. This strategy limits nurses' ability to access data, diminishes their influence in decision-making and undervalues the contribution of nursing information to interdisciplinary health care.

Experience of MOET with Welsh Black cattle in a group breeding scheme.

The embryo production records of 27 Welsh Black cows in a multiple ovulation and embryo transfer (MOET) program were examined. Significant monthly variations in the number of viable embryos recovered (P=0.07) and in embryo viability (P=0.002) were detected, although ovarian responses did not vary. Embryo recovery was not affected by the type of catheter used or by the side of the uterus flushed.

The digestibility of amino acids in the small intestine of the sheep.

1. The digestibilities of microbial and food proteins in the small intestine were studied in three sheep fitted with re-entrant cannulas in the proximal duodenum and terminal ileum. 2. The quantities of microbial and food proteins at the small intestine were varied by infusion of a microbial isolate or by dietary manipulation and the balance of amino acids along the small intestine was determined. 3. A mean value of 0.69 for the apparent digestibility and 0.86 for the true digestibility of total amino acids was obtained. 4. From the composition of digesta at the duodenum the daily flows of microbial and food proteins were estimated. Their true digestibilities in the small intestine were calculated by regression and found to be: microbial protein 0.87 and food protein 0.82. The mean endogenous loss of amino acids secreted into the small intestine was estimated to be 13.3 g/d.

The absorption of magnesium from the forestomachs, stomach and small intestine of sheep.

The passage of magnesium from the mouth to the proximal duodenum and from the proximal duodenum to the terminal ileum was measured continuously in two rams for 24 and 19 days. The results indicate a net disappearance of 25 per cent and 34 per cent of ingested magnesium from the forestomachs and stomach, and no set absorption from the small intestine.

The effect of glucose infusion on the plasma free amino acids in sheep.

1. Glucose in solution in saline, or saline alone, was administered to a group of twenty ewes during late pregnancy and again after lambing. Sequential blood samples were taken before and after the infusion and the concentration of plasma free amino acids was determined. 2. The effect of glucose was to reduce the concentrations of all amino acids except alanine. The reduction was greatest for tryptophan in the pregnant sheep, but this amino acid showed no significant change in the lactating animals. 3. An attempt to rank the amino acids on the basis of their response to glucose infusion indicated that, with the exception of tryptophan for the preparturient ewes, groups of essential amino acids could not be distinguished from each other. These groups were, for the preparturient sheep, valine, leucine, phenylalanine and isoleucine, and for the postparturient animals, isoleucine, lysine, methionine, valine and phenylalanine.