Changing roles of nurse educators employed in acute and chronic care settings : the impact of professional and statutory mandates in Ontario at four sites of one hospital corporation /

The role of the hospital-employed nurse educator is evolving. Factors influencing this change include the introduction of standards for nurse educators by the College of Nurses of Ontario (CNO), a change in the way nurses are educated, the emergence of nursing as a profession, and hospital restructuring as a result of budgetary constraints. Two of these influencing factors: the introduction of the updated Standards of Practice for Registered Nurses and Registered Practical Nurses (1996) and hospital restructuring occurred over the last 7 years at several hospitals in southern Ontario. Current literature as well as the Standards of Practice (1996) were utilized to examine the current roles and responsibilities of nurse educators and subsequently develop a questionnaire to study the impact of these influencing factors on the role of the nurse educator. This questionnaire was piloted and revised before its distribution at 4 hospitals in southern Ontario. Twenty-five of the 41 surveys (61%) distributed were returned for analysis. The data reflected that the Standards of Practice had a positive influence on the role of the nurse educator, while hospital restructuring had a negative impact. In addition, many of the roles and responsibilities identified in the literature were indeed part of the current role of nurse educators, as well as several responsibilities not captured in the literature. The predictions for the future of this role in its current state were not positive given the financial status of the health care system as well as the lack of clarity for the role and the current level ofjob satisfaction among practicing nurse educators. However, a list of recommendations were generated which, if implemented, could add clarity to the role and improve job satisfaction. This could enhance the retention of current nurse educators and the possibility of recruiting competent nurse educators to the role in the future.

The self-management approach of health education in the treatment of chronic illnesses

Health education is essential to the successful treatment of individuals with chronic illnesses. Self-management is a philosophical model of health education that has been shown to be effective in teaching individuals with chronic arthritis to manage their illness as part of their daily lives. Despite the proven results of arthritis self-management programs, some limitations of this form of health education were apparent in the literature. The present study attempted to address the problems of the self-management approach of health education such as reasons for lack of participation in programs and poor course outcomes. In addition, the study served to investigate the relationship between course outcomes and participation in programs with the theory upon which arthritis self-management programs are based, known as self-efficacy theory. Through a combination of qualitative and quantitative methodologies, data collection, and analysis, a deeper understanding of the self-management phenomenon in the treatment of chronic arthritic conditions was established. Findings of the study confirm findings of previous studies that suggest that arthritis self-management programs result in enhanced levels of self-efficacy and are effective in teaching individuals with arthritis to self-manage their health and health care. Findings of the study suggest that there are many factors that determine the choice of participants to participate in programs and the outcomes for the individuals who do choose to participate in programs. Some of the major determinants of enrollment and outcomes of programs include: the participant's personality, beliefs, attitudes and abilities, and the degree of emotional acceptance of the illness. Other determinants of course enrollment and outcomes included class size and length of time, timing of participation, and ongoing support after the program. The results of the study are consistent with the self-management literature and confirm the relationship between the underlying philosophies of adult education and Freire's model of education and self-management.

A phenomenological approach to understanding the psychological response to chronic low back pain

Chronic low back pain (CLBP) is a complex health problem of psychological manifestations not fully understood. Using interpretive phenomenological analysis, 11 semi-structured interviews were conducted to help understand the meaning of the lived experience of CLBP; focusing on the psychological response to pain and the role of depression, catastrophizing, fear-avoidance behavior, anxiety and somatization. Participants characterized CLBP as persistent tolerable low back pain (TLBP) interrupted by periods of intolerable low back pain (ILBP). ILBP contributed to recurring bouts of helplessness, depression, frustration with the medical system and increased fear based on the perceived consequences of anticipated recurrences, all of which were mediated by the uncertainty of such pain. During times of TLBP all participants pursued a permanent pain consciousness as they felt susceptible to experience a recurrence. As CLBP progressed, participants felt they were living with a weakness, became isolated from those without CLBP and integrated pain into their self-concept.

Chronic mild social stress increases neurogenesis in adolescent male rats

Once thought to occur only during specific periods of development, it is now clear that neurogenesis occurs in the rat hippocampus into adulthood. It is wellestablished that stress during adulthood decreases the rate of neurogenesis, but during adolescence, the effects of stress are much less understood. I investigated the effect of short-term or chronic stress during adolescence (daily lhr isolation and change of cage partner from postnatal day (PND) 30-32 or 30-45) on hippocampal neurogenesis. In experiment 1, rats were administered Bromodeoxyuridine (BrdU) daily on PND 30-32, or 46-48, to mark neurogenesis at the beginning of the stressor or after the stressor had ceased, respectively. Neither short-term nor chronic stress had an effect on proliferation or survival (evidenced by BrdU and Doublecortin (Dcx) immunohistochemistry respectively) of cells born at the beginning of the stress procedure. Compared to controls, BrdU-labeling showed chronic stress significantly increased proliferation of cells generated after the stressor had ceased, but survival of new neurons was not supported (Dcx-Iabeling). However, it may be that BrdU injections are inherently stressful. In experiment 2, the stressor (described above) was applied in the absence of BrdU injections. Ki67 (a marker of proliferation) showed that stress transiently increased cell proliferation. Dcx-Iabeling showed that stress also increased neuron survival into adulthood. Labeling with OX.,.42 (a marker of macro phages) suggested that the immune system plays a role in neurogenesis, as stress transiently decreased the number of activated microglia in the hippocampus. It can be concluded that in the adolescent male rat, chronic mild stress increases neurogenesis.

Chronic versus acute ingestion of sodium citrate: a randomized placebo controlled cross-over trial for swimming 200 metres in well-trained swimmers age 13-17

A double-blinded, placebo controlled, cross-over design was used to investigate sodium citrate dihydrate (Na-CIT) supplementation improve 200m swimming performance. Ten well-trained, male swimmers (14.9 ± 0.4y; 63.5 ± 4kg) performed four 200m time trials: acute (ACU) supplementation (0.5g/kg), acute placebo (PLC-A), chronic (CHR) (0.1g/kg for 3 days and 0.3g/kg on the 4th day pre-trial), and chronic placebo (PLC-C). Na-CIT was administered 120min pre-trial in solution with 500mL of flavored water; placebo was flavored water. Blood lactate, base excess (BE), bicarbonate, pH, and PCO2 were analyzed at basal, 100min post-ingestion, and 3min post-trial via finger prick. Time, lactate, and rate of perceived exertion were not different between trials. BE and bicarbonate were significantly higher for the ACU and CHR trials compared to placebo. “Responders” improved by 1.03% (P=0.043) and attained significantly higher post-trial lactate concentrations in the ACU versus PLC-A trials and compared to non-responders in the ACU and CHR trials.