Hypertension - a contemporary approach to nursing care

The incidence of hypertension is increasing as the number of patients with obesity and diabetes mellitus increases. Hypertension results when the peripheral vascular resistance is increased, the blood viscosity is elevated and/or the flow of blood through the main arteries is impeded. Chronic hypertension results in enlarged heart, myocardial damage and lung and renal abnormalities. While some causative factors such as obesity can be controlled, others for example genetics are more difficult to treat because often there is more than one factor involved. This paper explores how essential and secondary factors contribute to the incidence of hypertension and the physiological changes resulting from raised blood pressure. It proposes that although traditional treatment has some success, nurse-led clinics are having better success not only in controlling raised blood pressure but also in reducing cardiac, pulmonary and renal morbidity. It is more cost-effective, staff is more productive and clients are more compliant with treatment.

The assessment and development of drug calculation skills in nurse education: a critical debate

The drug calculation skill of nurses continues to be a national concern. The continued concern has led to the introduction of mandatory drug calculation skills tests which students must pass in order to go on to the nursing register. However, there is little evidence to demonstrate that nurses are poor at solving drug calculation in practice. This paper argues that nurse educationalists have inadvertently created a problem that arguably does not exist in practice through use of invalid written drug assessment tests and have introduced their own pedagogical practice of solving written drug calculations. This paper will draw on literature across mathematics, philosophy, psychology and nurse education to demonstrate why written drug assessments are invalid, why learning must take place predominantly in the clinical area and why the key focus on numeracy and formal mathematical skills as essential knowledge for nurses is potentially unnecessary.

Increasing research evidence in practice: a possible role for the consultant nurse

Aims: To determine the extent to which clinical nursing practice has adopted research evidence. To identify barriers to the application of research findings in practice and to propose ways of overcoming these barriers. Background: Way back in 1976, nursing and midwifery practice started adopting research evidence. By 1990s, there was some transparency of research evidence in practice, but more could have been done to widen its adoption. Many barriers were identified which could hinder implementation of the evidence in practice, and the effort to remove these remains weak. Evaluation: 25 research articles from across Europe and America were selected, and scrutinized, and recommendations analysed. Findings: Many clinical practitioners report a lack of time, ability and motivation to appraise research reports and adopt findings in practice. The clinical environment was not seen as research friendly as there were a general lack of research activities and facilities locally. There was a clear lack of research leadership in practice. Implication for nursing management: This paper reviewed the research evidence from several published research papers and provides consultant nurses with practical suggestions on how to enhance research evidence application in their practice. It recommends how consultant nurses can make their practice more research transparent by providing the required leadership, creating a research-friendly organization, developing a clear research agenda and facilitating staff develop a local research framework for reading research and implementing research evidence in their practice.

What a performance! Developing nurse teachers lecturing persona and identity: a performing arts perspective

Delivering lectures to large groups of students can provoke high levels of anxiety, particularly for new lecturers (Exley and Dennick, 2009). Further, to provide an informative and engaging lecture requires a teacher who is confident, has a sound knowledge and well developed teaching skills (Bentley-Davies, 2010). Thus, new lecturers often need experience and supervision to develop the tacit knowledge and insight into their own style and persona when teaching in order to feel confident when delivering a lecture (Quinn and Hughes, 2007). Considering this model, therefore, may potentially contribute to a lecturers’ development and performance in the classroom. This paper will present the results of the second phase of a two-stage mixed method study that investigated the similarities between lecturing and acting. Twelve in-depth interviews where undertaken with lecturers within one School of Nursing in The United Kingdom. Findings, established a model of ‘persona adoption’ that represents a series of stages that lecturers may go through to both develop and take on a persona when lecturing. This persona is often different from the way they lecturers present themselves in other parts of their working life. The first stage of this model of persona adoption is when the lecturer is subjected to a range of ‘influencing factors’ that provide not only the basic information about a lecture, but also the perceptual stimuli about giving a lecture on a specific subject, to a particular number of students, at a certain academic level. These influencing factors then inter-play with the ‘facets of the individual’, which represent the lecturer’s self-concept, subject knowledge base and philosophy of teaching. This may result in a cognitive dissonance between these ‘facets’ and the ‘influencing factors’, so affecting the lecturers’ perceptions, thoughts and feelings about having to give that particular lecture. This results in the lecturer undertaking specific ‘back stage preparation’ during which they decide on the content and modes of delivery to prepare in light of that discourse. It may result in delivering the information via single or multiple methods, which during the lecture will require various levels of interaction and participation from the students. Just prior to the lecture, the lecturer builds or ‘puts on their persona’ and gets into role, making their initial impact with the group. They use the ‘elements of acting’ as proposed by Tauber and Mester’s (1994) e.g. animated voice and body, space, props humour and suspense and surprise to portray and maintain their persona. This leads the to lecturer demonstrating either positive or negative ‘persona characteristics’ in terms of appearing confident, knowledgeable, fluent in the technical skills of delivering the lecture, being interesting and engendering interaction with the students, or not. These characteristics, may or may not, potentially heighten student interest, attention and attitudes to learning as suggested by Tauber and Mester (1994). This depends on whether the lecturer has successfully used the persona and if the lecturer has been able to engage students in the lecture, in competition with other factors that may be taking the students’ attention. Although the model suggests a linear process, to a great extent, the elements might be more interdependent and interrelated. This might suggest that depending on the lecturer’s perception of their effectiveness during the lecture, that they may decide to continue or adapt their persona and methods to appear more confident. Furthermore, depending on how successful the lecturer perceived the session to be, both their reflections ‘in’ and ‘on’ practice could influence how they teach in the future (Zwozdiak, 2011). Therefore, these reflections become part of the facets of the individual, via the ‘reflective feedback loop’, in the model, which then in turn influences progression through the model in subsequent lectures. This study concluded that these lecturers went through a process whereby they compare the demands of the lecture with their own knowledge base and skill, this resulted in them undertaking specific preparation in terms of content and delivery style, then they adopted their persona immediately prior to entering the lecture, maintain it throughout the lecture via the use of the elements of acting to achieve an informative interactive lecture. The results of which then feedback into their self-concept as a lecturer and consequently may affect the persona they project in future lectures. If lecturers, therefore, can take a step back to consider how they deliver lectures and the way they can deliberately, yet apparently naturally, use their voices, bodies, space and humour in meaningfully, they engage their students in lecture, it will not just result in them being perceived as a good lecturer, but also be a genuine act of education.

Tied to the job: affective and relational components of nurse retention

Paper investigates whether affective and relational components of nurses' experience of work have a significant impact on their intentions to leave either the job or the nursing profession in models that control for other factors (sociodemographic, work conditions, perceptions of quality of care) that are known to affect career decisions. [Abridged Abstract]