A montage of the qualities of the registered nurse.

AIM: This study aimed to gain undergraduate nursing students' perceptions of the essential qualities of the professional nurse. BACKGROUND: An essential component of undergraduate nursing programmes is to educate the student to become qualified as a professional/registered nurse. These characteristics will determine curricula and students' perceptions. No qualitative studies of the essential qualities of nurses are evident in recent literature. METHODS: A descriptive survey method was used to gather participants' perceptions of the qualities of a registered nurse over each year of their bachelor of nursing course at the largest programme in Australia. FINDINGS: Six concepts occurred most frequently in the students' responses. Caring was the most common followed by knowledge/understanding, empathy, work, communication and skills. DISCUSSION: A montage was developed with an interlacing of the qualities rather than any one concept predominating any year. Each quality was seen as essential and used to varying degrees as the nurse becomes a professional. These qualities form part of the education of nurses and have implications for nursing and/or health policy. This study has implications in the development of nursing curricula, which should include both the science and art of nursing with an emphasis on technical and communication skills. CONCLUSION: This study has shown that students in Australia hold similar perceptions to their contemporaries in other international western countries. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Caring is emphasized as a critical component of nursing delivery; however, opportunities must be presented to students to integrate skills such as caring, knowledge/understanding, empathy and communication.

A study of matrix metalloproteinase expression and activity in atopic dermatitis using a novel skin wash sampling assay for functional biomarker analysis.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin condition that is characterized by a defective skin barrier. Despite the well-recognized role of proteases in skin barrier maintenance, relatively little is known of the contribution made by matrix metalloproteinases (MMPs) to the inflammatory process in AD. OBJECTIVES: To test a simple, novel ex vivo bioassay technique in an analysis of the MMPs present in wash samples taken from the skin surface of patients with AD. METHODS: Saline wash samples were collected from eczematous and unaffected areas of the skin of patients with AD and from the skin of normal controls. Wash samples were analysed for their MMP content using a functional peptide cleavage assay, gelatin zymography and an antibody array. RESULTS: Using a functional substrate cleavage assay, skin wash samples from AD lesions were shown to contain 10- to 24-fold more MMP activity than those from normal control skin (P < 0.02) and fivefold more than those from unaffected AD skin (P < 0.05); this activity was inhibited by a broad-spectrum MMP inhibitor Ro 31-9790. Gelatin zymography and antibody array analysis revealed substantial levels of MMP-8 (neutrophil collagenase) and MMP-9 (92-kDa gelatinase) in AD skin wash samples as well as lower levels of MMP-10 (stromelysin 2) and tissue inhibitor of metalloproteinases (TIMP)-1 and TIMP-2; low levels of MMP-1 (fibroblast collagenase), MMP-3 (stromelysin 1) and TIMP-4 were also detected. CONCLUSIONS: A simple skin wash technique suitable for the quantitative and functional analysis of biomolecules in AD is described. Using this method we show that MMPs, and in particular MMP-8 and MMP-9, represent an important potential component of the pathology of AD. The method is expected to prove useful in advancing our understanding of AD and in identifying biomarkers for the evaluation of new therapies.

Aunties and Uncles Co-operative Family Project: the experiences of children, volunteers and parents.

BACKGROUND: This paper reports on the experiences of the children (nieces and nephews), volunteers (aunts and uncles) and parents involved in the Aunties and Uncles Co-operative Family Project in Sydney, Australia. The project has run for 30 years as an extended family network of community volunteers and has never been evaluated. METHODS: A survey comprising open-ended and closed questions relating to the service was administered to all stakeholders. Demographic data were collected on all respondents. The text from answers to open-ended questions on the survey was coded for similarities and differences and was categorized. From the categories, the experiences of children, volunteers and parents were written with exemplars from the respondents' text. RESULTS: Three major categories emerged from the text: enjoyment/satisfaction of the experience for volunteers, children and parents; family relationships; and the difference it has made to me (children, parents and volunteers). CONCLUSIONS: The long-term benefits of a supportive 'extended family type' relationship were recognized by all participants. Although the children were the primary focus of the project, parents and volunteers also described the rewards they experienced. The volunteer element was integral to providing the wide-ranging, ongoing supports which would not be possible from a paid staff basis.

Caring for patients with cancer in non-specialist wards: the nurse experience.

This study aims to describe the experiences of nurses caring for cancer patients in non-specialist wards. The study was conducted in a large (420 beds) and small (32 beds) hospital in an area health service with urban and rural populations in the west of Sydney. A qualitative descriptive approach was utilized to collect data from the nurses. Data were collected using a survey and in-depth interviews of nurses working in non-specialist cancer wards. Transcribed data were managed with Nudist Vivo software and analysed for common themes using process of constant comparison and contrast. Twenty-five surveys were returned and five nurses volunteered to be interviewed. The six major themes that emerged from analysis of data were: emotional nature of care, lack of time, lack of knowledge of cancer treatment, family support, environment not conducive to proper care and dealing with patient's non-acceptance of cancer diagnosis. The nurses in this study wished to provide quality supportive care for cancer patients and their families but the inconducive environment and inadequate relevant training hindered the nurses' efforts. This then presents further need of relevant training for nurses in cancer care and time management, to meet up with these challenges.

The hidden side of nursing: why caring for patients with malignant malodorous wounds is so difficult.

OBJECTIVE: This cross-sectional qualitative study used semi-structured telephone interviews with palliative care nurses working in urban and rural settings in Australia to explore their experiences of dealing with patients with malignant, often malodorous, wounds. METHOD: This paper was the second phase of a research project examining the care of patients with malignant wounds. Of 71 palliative care nurses in New South Wales invited to participate, 26 took part, 17 of them working in community positions. The data from the telephone interviews were transcribed and analysed, using content analysis, and coded for themes relating to the nurses' experiences of caring for this patient group. RESULTS: Nurses working in this setting strove to do the best for patients and their families under circumstances that are emotionally and physically difficult. Some of them suffered personal distress as a consequence. Patient isolation and altered body image are significant challenges for these nurses. CONCLUSION: The nature of the work these nurses do, in particular the fact that they are dealing with cancers, tends to push them into literal and practical silence. But the researchers question whether this is always the best option. They ask if hiding feelings could be bad for nurses and patients alike. In qualitative research it is not appropriate to generalize the results, although lessons can be learnt from the experience of this group.

The safety and tolerability of daily infergen plus ribavirin in the treatment of naíïve chronic hepatitis C patients.

The treatment of chronic hepatitis C patients was enhanced when the combination of interferon alfa-2b and ribavirin was shown to be safe and more effective than interferon monotherapy. To date, no published reports have addressed the use of consensus interferon (CIFN) when combined with ribavirin. We conducted a pilot study to compare the safety and tolerability of daily CIFN plus ribavirin to CIFN monotherapy for the initial treatment of chronic hepatitis C patients. Forty subjects were randomized to two treatment groups; CIFN 9 microg daily, or CIFN 9 microg daily plus ribavirin 1000 or 1200 mg daily. All subjects received 48 weeks of therapy except for nongenotype 1 subjects in the combination treatment group who received only 24 weeks of therapy. The results show that at baseline, age, gender, risk factors, race, RNA titres, and liver histology were not different between the two groups. The proportion of subjects with genotype 1 infection was 50% (10/20) and 55% (11/20) for the monotherapy and combination therapy groups, respectively. Fifty (10/20) and sixty-five (13/20) per cent of subjects in the monotherapy and combination therapy groups exhibited a 2-log or greater decrease in viral titre at week 12 (P = NS). Using intent-to-treat analysis, 20% and 40% of enrolled subjects exhibited a sustained viral response in the monotherapy and combination therapy groups, respectively (P = NS). The proportion of subjects requiring dose reduction was 55% (11/20) and 65% (13/20), respectively. Study discontinuations for any reason were 25% (5/20) and 35% (7/20) for the monotherapy and combination groups, respectively. Discontinuations due to adverse events related to study drug were 20% (4/20) and 25% (5/20), respectively. A total of four serious adverse events occurred, two in each treatment group, only one of which was determined to be study-drug related. It is concluded that the safety and tolerability profiles of the two treatments were similar suggesting that daily dosing of CIFN may be difficult to tolerate resulting in discontinuation of therapy in a significant proportion of patients. The combination regimen resulted in a trend towards a higher viral response rate than monotherapy treatment. These data suggest that CIFN may be safely combined with ribavirin and may enhance the sustained response rate but is not well tolerated in US patients when given in a daily dosing regimen.

Metabolism and distribution of [2,3-(14)C]acrolein in lactating goats.

The metabolism and distribution of [2,3-(14)C]acrolein were studied in a lactating goat orally administered 0.82 mg/kg of body weight/day for 5 days. Milk, urine, feces, and expired air were collected. The goat was killed 12 h after the last dose, and edible tissues were collected. The nature of the radioactive residues was determined in milk and tissues. All of the identified metabolites were the result of the incorporation of acrolein into the normal, natural products of intermediary metabolism. There was evidence that the three-carbon unit of acrolein was incorporated intact into glucose, and subsequently lactose, and into glycerol. In the case of other natural products, the incorporation of radioactivity appeared to result from the metabolism of acrolein to smaller molecules followed by incorporation of these metabolites into the normal biosynthetic pathways.

Metabolism and distribution of [2,3-(14)C]acrolein in laying hens.

The metabolism and distribution of [2,3-(14)C]-acrolein were studied in 10 laying hens orally administered 1.09 mg/kg of body weight/day for 5 days. Eggs, excreta, and expired air were collected. The hens were killed 12-14 h after the last dose and edible tissues collected. The nature of radioactive residues was determined in tissues and eggs. All of the identified metabolites were the result of the incorporation of acrolein-derived radioactivity into normal natural products of intermediary metabolism in the hen except for 1,3-propanediol, which is a known degradation product of glycerol in bacteria.

Prednisone withdrawal followed by interferon alpha for treatment of chronic hepatitis C infection: results of a randomized controlled trial.

Immunosuppressive therapy increases levels of hepatitis C virus (HCV) RNA, and when combined with interferon, corticosteroids have been reported to variably improve or have no effect on sustained response rates. We conducted a randomized double-blind placebo-controlled trial in 39 patients with biopsy-proven chronic HCV infection and elevated alanine aminotransferase levels. Patients received either 6 weeks of a tapering dose of prednisone (60 ng, 40 mg, and 20 mg in 2-week intervals) or an identical placebo. All patients then received recombinant interferon alpha-2b, 3 million units three times a week for 24 weeks. Patients were then followed for a further 24 weeks. At the end of the study there was no significant difference in the sustained biochemical response rates between the two groups (4/20 vs. 3/19, p value was not significant). Prednisone-treated patients had a significant increase in HCV RNA from baseline during steroid treatment (400 +/- 60% increase vs. -280 +/- 140% decrease; p = 0.005). Two prednisone-treated patients were withdrawn from the study secondary to serious complications related to therapy. Prednisone priming before interferon alpha therapy in patients with chronic HCV infection does not improve the sustained response rate. This therapy was associated with an increase in viral burden and significant morbidity.

Malignant wound management: what dressings do nurses use?

This paper reports on the findings from the first part of a three-phase project that aimed to identify nursing strategies used in the management of malignant wounds. The difficulties relating to the management of these wounds and the significant physical and psychological impact on patients are described. A quantitative postal survey aiming to identify the types of dressing used in the care of malignant wounds was sent to specialist nurses working in oncology and palliative care in New South Wales, Australia. Additional qualitative data showed that the major issues were coping with odour and meeting the financial costs of the dressing products. The long list of products compiled for this research demonstrates the complexities nurses face when selecting dressings for the management of malignant wounds. Furthermore, there are no clear recommendations to guide nursing practice. This study provides a framework for subsequent phases of the project and will hopefully lead to the development of guidelines for best practice in malignant wound management.

Nurse researcher: always a researcher, sometimes a nurse.

A number of theoretical papers have highlighted the concept of the duality and dichotomy of roles when nurses are carrying out research in the clinical arena. The conflicts that can occur are between the roles of researcher and nurse and in the balance between research integrity and the welfare of the individual. There are various personal accounts in the literature of nurse researchers' experiences of unclear role expectations when doing research. There appears to be no consensus on how nurse researchers should handle these varying expectations. No comparative analysis of the reflections of a collective of nurse researchers on role expectations in different clinical contexts was found in an extensive literature search. This paper attempts to do this by analysing stories of a small group of nurse researchers in different clinical contexts. Data were analysed from written stories and audio-taped interviews with nurse researchers about moving from the researcher to the nurse role in doing clinical research. Thematic analysis indicated that the participants' reactions could be classified as either those of a nurse researcher, always the researcher, or as the nurse researcher, sometimes the nurse. There were no distinct differences in relation to research topic, methodology or context. The study highlights the fact that nurses need better research education, team and management support when conducting research and opportunities to debrief after encountering mixed role expectations in the field. Open debate amongst nurse researchers about role delineation is essential to both novices and experts for them to share their experiences and their solutions.

Stories about breast cancer in Australian women's magazines: information sources for risk, early detection and treatment.

Sixty articles in five Australian women's magazines were analyzed for journalistic qualities, metaphors, narrative features and accuracy of clinical facts related to risk, early detection and treatment of breast cancer. The stories were features, news features or soft news stories. The stories reflected the 'good news' editorial style of women's magazines. A dominant theme in the stories was that early detection of breast cancer is crucial and equals survival. While there were few inaccuracies in the stories, there was little detail of treatment modalities, an emphasis on lifestyle as a risk factor and a prevailing message that a genetic history of breast cancer means you will get it. A major implication of the findings is that nurses, who provide information to women, must be aware of the goals of journalists and the educational power of narrative logic of stories in women's magazines.

Palliative care at home: stress for nurses in urban and rural New South Wales, Australia.

Nurses often experience positive and negative dimensions of caring for dying clients and their families. This project aimed to compare stress experienced by urban and rural community nurses working with palliative-care clients in the home. Participants included five nurses working in rural Australia and seven nurses working in an urban area. Transcribed data from unstructured audio-taped interviews were coded for common and contrasting themes, and a comparison was made of the stress experienced by the two groups of nurses. The major themes were role conflict and definition, family dynamics, time and workload. For both groups of nurses, the impact of family relationships and role conflict within the community impacted significantly to the stress they experienced. Debriefing opportunities for nurses to discuss stress, including educational and support sessions, is an essential component of best practice. Rural nurses had the additional stress of trying to provide a 24 h service over vast distances with a lack of financial resources.

Empowerment through information: supporting rural families of oncology patients in palliative care.

A research project examining the support needs of families caring for a relative in palliative care was conducted in New South Wales in 1997. Data were collected from 19 families and 10 specialist palliative care nurses from eight centres throughout New South Wales using audio-taped interviews. The findings show that information was one of the most important support needs for families to enable them to effectively care for their sick relative. The information provided needed to meet the individual and varying needs of families at different stages of their palliative care journey. Often the families described not knowing what their information needs were until a crisis occurred. Lack of information on a range of areas, from practical resources to providing physical care and managing medications, was problematic. Health professionals need to take responsibility in determining if families are aware of the information available, identify the most appropriate medium for this material and provide it at the pace and time wanted by the individual family.

The future of palliative care nursing research in Australia.

Nursing research in palliative care is becoming more important as cost effectiveness and evidence-based practice are becoming mandatory. Fifty-nine published and unpublished projects relating to nursing research on palliative care in Australia between 1990 and 1996 were reviewed. Findings indicated that nurses working in palliative care in Australia are interested in researching a range of topics using varied methods. The nurses' primary interests appear to be their own professional issues and management of the patient's pain. Little research on families/carers of palliative care patients was evident. There is a need for future research to focus on projects that justify the nurse's role in the palliative care team, show that nursing interventions for symptom control affect patient outcomes and prove nurses are integral to the psychosocial and spiritual wellbeing of the patient and family during the palliative care journey.

How do patients perceive support from nurses?

Patients found support in the clinical friendship of nurses. The nurses instilled a sense of normality into their activities, creating a supportive atmosphere. Patients expressed a need for reciprocity in their relationship with the nurses. This relationship should be balanced and sustainable.

Concept mapping: promoting science learning in BN learners in Australia.

BACKGROUND: We reviewed the process of using concept mapping as a methodology to teach science to RNs in a bachelor degree of nursing program in Australia. METHOD: The technique was used for two classes of students in the science unit during 1995 with work packages and independent student learning being the focus of the unit. RESULTS: Both instructors and students found the experience mainly positive. It helped the students become more independent learners, have a greater confidence in their knowledge of science, and allowed their understanding of science in their practice to become more meaningful and personalized. For the instructors it allowed them to concentrate on students with learning difficulties because they had less face-to-face teaching hours. Major issues arising from the process related to how to balance science content and the techniques of concept mapping and how to more effectively assess the learning outcomes of the students. CONCLUSION: Concept mapping is a useful technique to link science and nursing practice. Not only can it be used in academic programs to teach the science underlying practice, it can be used in the clinical area to teach patients. As a technique it works well in staff development and continuing education where the focus is on elucidating the rationale for inuring practice and providing evidence for the value of this practice.

Supportive care for women with breast cancer: Australian nurses' perspective.

A research project was undertaken to describe how the support needs of women who have had treatment for breast cancer were being met in New South Wales, Australia. Data were collected from both the women and the nurses who cared for them. The findings from the first part of the study examined the nurses' perceptions of the women's needs and how they as health professionals, fulfilled these needs. Analysis was both qualitative and quantitative. Seventy-eight nurses responded to a questionnaire and 15 were interviewed. The findings indicated that the nurses perceived information on disease process and physical aspects of the disease as essential to supporting the women with breast cancer. While they saw providing emotional support to the women as important the nurses themselves often lacked the time and skills to provide it.

The specialist breast care nurse: an evolving role.

The role of the specialist breast care nurse has not previously been described in the Australian context. A study was undertaken, utilising the Delphi technique and focus group interviews to determine the key elements of the role and to describe how these role elements are enacted by the nurses incumbent in these positions in six Australian states. Three rounds of questionnaires to 16 expert nurses established a consensus view as to the essential elements of the specialist breast care nurse's role. The 11 role elements that became significant during analysis of these data were: specialist nurse, supporter, educator, counsellor, adviser, team member, resource person, caregiver, public advocate, manager and researcher. Focus groups were held with nurses from each state and the findings allowed enhancement of the data from the questionnaires. Analysis of the interview data allowed a fuller description of how the nurses actualised their role. This data showed that the specialist breast care nurse co-ordinated the care of the woman and her family during the breast cancer journey. Integral to the role was the support for the woman and her family. It is concluded that in order to perform successfully in the role nurses require specialist education in supportive care, counselling, pathology and treatment of breast cancer, a broad knowledge of oncology nursing, management, research and teaching techniques.

Metropolitan researchers undertaking rural research: benefits and pitfalls.

Can or should metropolitan residents research their rural counterparts and if they do are there inherent pitfalls or benefits? Throughout the history of social and anthropological research there has been debate on the insider-outsider/native-stranger controversy as to who should carry out the field work. This discourse will explore the author's personal experiences in the context of planning a rural health project, entering the field, accessing the informants, interviewing the informants and leaving the field.