Defibrillation beliefs of rural nurses: focus group discussions guided by the Theory of Planned Behaviour.

INTRODUCTION: The endorsement of the chain of survival concept and early defibrillation has challenged health professionals to reconsider their beliefs about how they respond to in-hospital resuscitation. In the rural context, where 24 hour coverage is not available nurse-initiated defibrillation is expected. Despite literature and policy change in Australia to allow nurses to initiate defibrillation, there is no current research that uses a systemic theoretical approach to investigate the specific beliefs of nurses and their use of defibrillators. The purpose of this study was to elicit a beginning understanding of the defibrillation beliefs of rural nurses. METHODS: This research used focus groups within the framework of the Theory of Planned Behavior to describe the defibrillation beliefs of rural registered nurses. The sites selected for this study were two acute care hospitals in rural Australia (RRMA Classification). Each of these hospitals was in located 'other rural areas' (RRMA Classification) in separate towns and had 25 and 30 beds. The study sample consisted of 10 females and two males. Focus group questions were designed to elicit salient beliefs within the theoretical framework. Three constructs of behavioral, normative and control beliefs guided the development of the question and analysis of the discussions. In accordance with the authors of the theoretical framework, content analysis was used to analyse the data from the study. RESULTS: Two behavioral beliefs, four control beliefs and four normative belief categories were elicited. Two behavioral beliefs categories emerged from the open-ended question: 'What, if any are the advantages of you being able to use a defibrillator?' Participants were congruent when discussing the advantages of nurses initiating defibrillation. The two categories were 'quicker response times' (15 responses) and 'increased success with resuscitation' (8 responses). Participants were asked to identify any events that might influence their decision to use or not use a defibrillator if there was a cardiac arrest on their ward on that day. The categories of control beliefs elicited were 'rhythm recognition' (22 responses), 'litigation' (15 responses), 'fear of harm to patient or self' (11 responses), and 'roles' (4 responses). To identify the normative referents, participants were asked to identify who would approve or not approve of them being responsible for the use of defibrillators in their clinical area. Four normative beliefs represent 100% of the responses, these were: patients; nurses; doctors; and the nursing registration body, the Queensland Nursing Council. CONCLUSIONS: The central issues for these participating nurses were related to the consequences for the patient, support and confidence with rhythm recognition. Understanding rural nurses beliefs as they pertain to nurse-initiated defibrillation may provide educators with some insight as to what changes are needed to increase nurse-initiated defibrillation.

Lunotriquetral arthrodesis using cancellous bone graft.

Previous reports of lunotriquetral arthrodesis suggest relatively low rates of primary fusion without the use of permanent fixation and/or prolonged immobilization. We performed 26 lunotriquetral arthrodeses in 24 patients with a technique using cancellous bone graft to fill a biconcave space created in the adjoining bones with parallel K-wire fixation. The indications included symptomatic lunotriquetral instability and degenerative arthritis. All patients received conservative treatment before surgery. Primary fusion was achieved in all wrists in an average of 50 days. Postoperative wrist flexion/extension averaged 77%/80% of unaffected sides. Radial/ulnar deviation averaged 95%/91% of unaffected sides. Pain relief was good or very good in 83%. Eight-eight percent returned to the workforce. This study shows reliable, effective results with a technique that adheres to the principles of intercarpal arthrodesis and avoids permanent internal fixation.