The intra-aortic balloon pump in heart failure management : implications for nursing practice

Management of acute heart failure is an important consideration in critical care. Mechanical support of the failing heart is crucial for improving health outcomes. The most common Australasian application of intraaortic balloon counterpulsation (IABP) is in the setting of cardiogenic shock. High end users of IABP (>37/annum) demonstrate significantly lower mortality for cardiogenic shock managed with IABP (p <0.001) in contrast to hospitals which employ limited IABP (<4/annum). This underscores the importance of proficiency in managing patient receiving IABP support. Nurses play a crucial role in carding for patients with acute heart failure. This paper summarises care considerations for management of the IABP.

From Sydney and Shanghai : Australian and Chinese women writing modernism

In the 1930s and 1940s, Australian women writers published novels, poems, and short stories that pushed the boundaries of their national literary culture. From their position in the Pacific, they entered into a dialogue with a European modernism that they reworked to invigorate their own writing and to make cross-continental connections. My interest in the work of Australian women prose writers of this period stems from an appreciation of the extent of their engagement with interwar modernism (an engagement that is generally under-acknowledged) and the realization that there are commonalities of approach with the ways in which contemporaneous Chinese authors negotiated this transnational cultural traffic. China and Australia, it has been argued, share an imaginative and literal association of many centuries, and this psychic history produces a situation in which ‘Australians feel drawn towards China: they cannot leave it alone.’1 Equally, Chinese exploration of the great southern land began in the fifteenth century, prior to European contact. In recent times, the intensity of Australia’s cultural and commercial connections with Asia has led to a repositioning of the Australian sense of regionalism in general and, in particular, has activated yet another stage in the history of its relationship with China. In this context, the association of Australian and Chinese writing is instructive because the commonalities of approach and areas of interest between certain authors indicate that Australian writers were not alone in either the content or style of their response to European modernism. This recognition, in turn, advances discussions of modernism in Australia and reveals an alternative way of looking at the world from the Pacific Rim through literature. The intent is to examine selective Australian and Chinese authors who are part of this continuous history and whose writing demonstrates common thematic and stylistic features via the vector of modernism. I focus on the 1930s and 1940s because these are the decades in which Australia and China experienced wideranging conflict in the Pacific, and it is significant that war, both forthcoming and actual, features as an ominous soundtrack in the writing of Chinese and Australian women. I argue that, given the immensity of cultural difference between Australia and China, there is an especially interesting juncture in the ways in which the authors interrogate modernist practices and the challenge of modernism. The process in which writing from the Pacific Rim jointly negotiates the twin desires of engaging with European literary form and representing one’s own culture may be seen as what Jessica Berman identifies as a geomodernism, one of the ‘new possible geographies’ of modernism.2 My discussion centres on the work of the Australian women, to which the Chinese material serves as a point of reference, albeit a critical one. The Chinese writing examined here is restricted to authors who wrote at least some material in English and whose work is available in translation.

Psychometric evaluation of the Chinese version of the diabetes coping measure scale

Purpose: To evaluate the psychometric properties of a Chinese version of the Diabetes Coping Measure (DCM-C) scale.----- Methods: A self-administered questionnaire was completed by 205 people with type 2 diabetes from the endocrine outpatient departments of three hospitals in Taiwan. Confirmatory factor analysis, criterion validity, and internal consistency reliability were conducted to evaluate the psychometric properties of the DCM-C.----- Findings: Confirmatory factor analysis confirmed a four-factor structure (χ2 /df ratio=1.351, GFI=.904, CFI=.902, RMSEA=.041). The DCM-C was significantly associated with HbA1c and diabetes self-care behaviors. Internal consistency reliability of the total DCM-C scale was .74. Cronbach’s alpha coefficients for each subscale of the DCM-C ranged from .37 (tackling spirit) to .66 (diabetes integration).----- Conclusions: The DCM-C demonstrated satisfactory reliability and validity to determine the use of diabetes coping strategies. The tackling spirit dimension needs further refinement when applies this scale to Chinese populations with diabetes.----- Clinical Relevance: Healthcare providers who deal with Chinese people with diabetes can use the DCM-C to implement an early determination of diabetes coping strategies.

Psychological predictors of young adults' use of social networking sites

Young people are increasingly using social networking sites (SNSs), like Myspace and Facebook, to engage with others. The use of SNSs can have both positive and negative effects on the individual; however, few research studies identify the types of people who frequent these Internet sites. This study sought to predict young adults’ use of SNSs and addictive tendency towards the use of SNSs from their personality characteristics and levels of self-esteem. University students (N = 201), aged 17 to 24 years, reported their use of SNSs and addictive tendencies for SNSs use, and completed the NEO Five-Factor Personality Inventory 1 and the Coopersmith Self-Esteem Inventory.2 Multiple regression analyses revealed that, as a group, the personality and self-esteem factors significantly predicted both level of SNS use and addictive tendency but did not explain a large amount of variance in either outcome measure. The findings indicated that extraverted and unconscientious individuals reported higher levels of both SNS use and addictive tendencies. Future research should attempt to identify which other psychosocial characteristics explain young people’s level of use and propensity for addictive tendencies for these popular Internet sites.

Who's talking? Communication and the casual/part-time nurse : a literature review

The rapidly evolving nursing working environment has seen the increased use of flexible non standard employment, including part-time, casual and itinerate workers. Evidence suggests that the nursing workforce has been at the forefront of the flexibility push which has seen the appearance of a dual workforce and marginalization of part- time and casual workers by their full-time peers and managers. The resulting fragmentation has meant that effective communication management has become difficult. Additionally, it is likely that poor organisational communication exacerbated by the increased use of non standard staff, is a factor underlying current discontent in the nursing industry and may impact on both recruitment and retention problems as well as patient outcomes. This literature review explores the relationship between the increasing casualisation of the nursing workforce and, among other things, the communication practices of nurses within healthcare organisations.

How to tell the difference between production and consumption : a case study in Doctor Who fandom

A television series is tagged with the label "cult" by the media, advertisers, and network executives when it is considered edgy or offbeat, when it appeals to nostalgia, or when it is considered emblematic of a particular subculture. By these criteria, almost any series could be described as cult. Yet certain programs exert an uncanny power over their fans, encouraging them to immerse themselves within a fictional world.In Cult Television leading scholars examine such shows as The X-Files; The Avengers; Doctor Who, Babylon Five; Star Trek; Xena, Warrior Princess; and Buffy the Vampire Slayer to determine the defining characteristics of cult television and map the contours of this phenomenon within the larger scope of popular culture.Contributors: Karen Backstein; David A. Black, Seton Hall U; Mary Hammond, Open U; Nathan Hunt, U of Nottingham; Mark Jancovich; Petra Kuppers, Bryant College; Philippe Le Guern, U of Angers, France; Alan McKee; Toby Miller, New York U; Jeffrey Sconce, Northwestern U; Eva ViethSara Gwenllian-Jones is a lecturer in television and digital media at Cardiff University and co-editor of Intensities: The Journal of Cult Media.Roberta E. Pearson is a reader in media and cultural studies at Cardiff University. She is the author of the forthcoming book Small Screen, Big Universe: Star Trek and Television.

Examination of social demographic status, disease status, health behaviours and quality of life in older Australians using the theory of planned behaviour model

The increase of life expectancy worldwide during the last three decades has increased age-related disability leading to the risk of loss of quality of life. How to improve quality of life including physical health and mental health for older people and optimize their life potential has become an important health issue. This study used the Theory of Planned Behaviour Model to examine factors influencing health behaviours, and the relationship with quality of life. A cross-sectional mailed survey of 1300 Australians over 50 years was conducted at the beginning of 2009, with 730 completed questionnaires returned (response rate 63%). Preliminary analysis reveals that physiological changes of old age, especially increasing waist circumference and co morbidity was closely related to health status, especially worse physical health summary score. Physical activity was the least adherent behaviour among the respondents compared to eating healthy food and taking medication regularly as prescribed. Increasing number of older people living alone with co morbidity of disease may be the barriers that influence their attitude and self control toward physical activity. A multidisciplinary and integrated approach including hospital and non hospital care is required to provide appropriate services and facilities toward older people.

Planning and evaluation

Introduction: The core business of public health is to protect and promote health in the population. Public health planning is the means to maximise these aspirations. Health professionals develop plans to address contemporary health priorities as the evidence about changing patterns of mortality and morbidity is presented. Officials are also alert to international trends in patterns of disease that have the potential to affect the health of Australians. Integrated planning and preparation is currently underway involving all emergency health services, hospitals and population health units to ensure Australia's quick and efficient response to any major infectious disease outbreak, such as avian influenza (bird flu). Public health planning for the preparations for the Sydney Olympics and Paralympic Games in 2000 took almost three years. ‘Its major components included increased surveillance of communicable disease; presentations to sentinel emergency departments; medical encounters at Olympic venues; cruise ship surveillance; environmental and food safety inspections; bioterrorism surveillance and global epidemic intelligence’ (Jorm et al 2003, 102). In other words, the public health plan was developed to ensure food safety, hospital capacity, safe crowd control, protection against infectious diseases, and an integrated emergency and disaster plan. We have national and state plans for vaccinating children against infectious diseases in childhood; plans to promote dental health for children in schools; and screening programs for cervical, breast and prostate cancer. An effective public health response to a change in the distribution of morbidity and mortality requires planning. All levels of government plan for the public’s health. Local governments (councils) ensure healthy local environments to protect the public’s health. They plan parks for recreation, construct traffic-calming devices near schools to prevent childhood accidents, build shade structures and walking paths, and even embed drafts/chess squares in tables for people to sit and play. Environmental Health officers ensure food safety in restaurants and measure water quality. These public health measures attempt to promote the quality of life of residents. Australian and state governments produce plans that protect and promote health through various policy and program initiatives and innovations. To be effective, program plans need to be evaluated. However, building an integrated evaluation plan into a program plan is often forgotten, as planning and evaluation are seen as two distinct entities. Consequently, it is virtually impossible to measure, with any confidence, the extent to which a program has achieved its goals and objectives. This chapter introduces you to the concepts of public health program planning and evaluation. Case studies and reflection questions are presented to illustrate key points. As various authors use different terminology to describe the same concepts/actions of planning and evaluation, the glossary at the back of this book will help you to clarify the terms used in this chapter.

Developing a culture of enquiry to sustain evidence-based practice

Evidence-based practice (EBP) is having a significant effect on the health service environment. It constructs a language that bridges the healthcare disciplines and the clinical and managerial components of health services. Most experienced clinicians in nursing, medicine and allied health now recognise that the contemporary healthcare environment calls for our practice to be justified by sound, credible evidence. There is pressure on all clinicians to accommodate innovation, while at the same time ensuring their practice is effective, safe and efficient (Forbes & Griffiths 2002). Consequently, EBP in healthcare is having a profound effect on nursing and the way we think about nursing. There are many available models for research utilisation that are dependent on organisational strategies for change. This chapter describes the relationship between organisation and culture, and explores the notion of cultural change; that is, developing a culture of inquiry that can sustain evidence-based practice. We begin this chapter with a clear conception of what we mean by EBP and what we mean by ‘culture’.

Development and use of clinical guidelines

The purpose of this chapter is to provide an overview of the development and use of clinical guidelines as a tool for decision making in clinical practice. Nurses have always developed and used tools to guide clinical decision making related to interventions in practice. Since Florence Nightingale (Nightingale 1860) gave us ‘notes’ on nursing in the late 1800s, nurses have continued to use tools, such as standards, policies and procedures, protocols, algorithms, clinical pathways and clinical guidelines, to assist them in making appropriate decisions about patient care that eventuate in the best desired patient outcomes. Clinical guidelines have enjoyed growing popularity as a comprehensive tool for synthesising clinical evidence and information into user-friendly recommendations for practice. Historically, clinical guidelines were developed by individual experts or groups of experts by consensus, with no transparent process for the user to determine the validity and reliability of the recommendations. The acceptance of the evidence-based practice (EBP) movement as a paradigm for clinical decision making underscores the imperative for clinical guidelines to be systematically developed and based on the best available research evidence. Clinicians are faced with the dilemma of choosing from an abundance of guidelines of variable quality, or developing new guidelines. Where do you start? How do you find an existing guideline to fit your practice? How do you know if a guideline is evidence-based, valid and reliable? Should you apply an existing guideline in your practice or develop a new guideline? How do you get clinicians to use the guidelines? How do you know if using the guideline will make any difference in care delivery or patient outcomes? Whatever the choice, the challenge lies in choosing or developing a clinical guideline that is credible as a decision-making tool for the delivery of quality, efficient and effective care. This chapter will address the posed questions through an exploration of the ins and outs of clinical guidelines, from development to application to evaluation.

Establishing content validity of a survey research instrument : the older patients in acute care survey - United States

Geriatric nursing competency in the acute care setting is a social mandate for the 21st century. This article reports on the content validation of an Australian research instrument, the Older Patients in Acute Care Survey (OPACS) that examines the attitudes, the knowledge, and the practices of nurses working with acute care patients. The OPACS tool was developed primarily to assist nurse educators to assess attitudes, knowledge, and practices of nursing staff in caring for older patients in the acute care setting; to evaluate the implementation of institution-specific educational interventions; and to improve quality of care given to older patients. An overall content validity index (CVI) for the OPACS was calculated (CVI = .918), revealing high content validity. Opinions (CVI = .92) and practices (CVI = .97) subconstructs revealed high content validity as well. Therefore, results indicate that the OPACS has high content validity in the U.S. acute care setting and could assist nurse educators in establishing and enhancing nurse competency in the care for geriatric patients in the future.

Romancing the Dane : reviving (and revising) Ophelia in contemporary YA fiction

Shakespeare’s Ophelia has been circulated in recent times as a figure of the adolescent woman at risk. Mary Pipher’s best-selling and influential Reviving Ophelia (1994) argued that the “story of Ophelia […] shows the destructive forces that affect young women” (20). Without undermining Pipher’s project, this paper reads two contemporary YA romance novels—Lisa Fiedler’s Dating Hamlet (2002) and Lisa Klein’s Ophelia (2006)—in order to demonstrate that not only can Ophelia be appropriated as a figure of empowerment for young women today, but that such appropriations are, seemingly ironically, most powerfully rendered within the genre of romance; a genre long-maligned by feminists as recuperative of patriarchy.--------- These two novels stage interventions both into narratives of female adolescence as a time of being ‘at risk’ or ‘under threat’, and also into narratives of canonical literary patriarchy. Rather than a suicidal Ophelia, subject to the whims of men, these authors imagine Ophelias who take charge of their own destiny; who dictate their own romance and agency; who refuse to be subject to or subjected by, those scripts of cultural authority and heteronormative romance so often perceived as antithetical to female agency. In doing so, they force us to revise our own notions of the romance genre and the functions of canonical literary tradition in contemporary YA culture.

Kava and St. John's wort : current evidence for use in mood and anxiety disorders

Background: Mood and anxiety disorders pose significant health burdens on the community. Kava and St John’s wort (SJW) are the most commonly used herbal medicines in the treatment of anxiety and depressive disorders, respectively. Objectives: To conduct a comprehensive review of kava and SJW, to review any evidence of efficacy, mode of action, pharmacokinetics, safety and use in Major Depressive Disorder (MDD), Bipolar Disorder (BP), Seasonal Affective Disorder (SAD), Generalized Anxiety Disorder (GAD), Social Phobia (SP), Panic Disorder (PD), Obsessive-Compulsive Disorder (OCD), and Post Traumatic Stress Disorder (PTSD). Methods: A systematic review was conducted using the electronic databases MEDLINE, CINAHL, and The Cochrane Library during late 2008. The search criteria involved mood and anxiety disorder search terms in combination with kava, Piper methysticum, kavalactones, St John’s wort, Hypericum perforatum, hypericin and hyperforin. Additional search criteria for safety, pharmacodynamics , and pharmacokinetics was employed. A subsequent forward search was conducted of the papers using Web of Science cited reference search. Results: Current evidence supports the use of SJW in treating mild-moderate depression, and for kava in treatment of generalized anxiety. In respect to the other disorders, only weak preliminary evidence exists for use of SJW in SAD. Currently there is no published human trial on use of kava in affective disorders, or in OCD, PTSD, PD or SP. These disorders constitute potential applications that warrant exploration. Conclusions: Current evidence for herbal medicines in the treatment of depression and anxiety only supports the use of Hypericum perforatum for depression, and Piper methysticum for generalized anxiety.