Delineating the practice profile of advanced practice nursing : a cross-sectional survey using the modified strong model of advanced practice

AIMS: To test a model that delineates advanced practice nursing from the practice profile of other nursing roles and titles. BACKGROUND: There is extensive literature on advanced practice reporting the importance of this level of nursing to contemporary health service and patient outcomes. Literature also reports confusion and ambiguity associated with advanced practice nursing. Several countries have regulation and delineation for the nurse practitioner, but there is less clarity in definition and service focus of other advanced practice nursing roles. DESIGN: A statewide survey. METHODS: Using the modified Strong Model of Advanced Practice Role Delineation tool, a survey was conducted in 2009 with a random sample of registered nurses/midwives from government facilities in Queensland, Australia. Analysis of variance compared total and subscale scores across groups according to grade. Linear, stepwise multiple regression analysis examined factors influencing advanced practice nursing activities across all domains. RESULTS: There were important differences according to grade in mean scores for total activities in all domains of advanced practice nursing. Nurses working in advanced practice roles (excluding nurse practitioners) performed more activities across most advanced practice domains. Regression analysis indicated that working in clinical advanced practice nursing roles with higher levels of education were strong predictors of advanced practice activities overall. CONCLUSION: Essential and appropriate use of advanced practice nurses requires clarity in defining roles and practice levels. This research delineated nursing work according to grade and level of practice, further validating the tool for the Queensland context and providing operational information for assigning innovative nursing service.

Exploring empathy as a variable in the evaluation of professional development programmes for palliative care nurses

Research indicates that empathy, a quality regarded as fundamentally important to nursing practice, is a teachable skill. Because empathic nurse-patient relationships are particularly important in the care of the terminally ill, this has direct relevance to the professional development of palliative care nurses. This article discusses the place of empathy as a criterion variable in the evaluation of a professional development program for palliative care nurses introduced at the Centre for Mental Health Nursing Research at Queensland University of Technology, Brisbane, Australia. A modified version of the Staff-Patient Interaction Response Scale (SPIRS) was used as a pre- and postintervention measure to assess the expressed empathy of the participating nurses. The modifications to SPIR and its coding system to make it suitable for palliative care nursing, and the mechanisms for improving and evaluating the reliability of this instrument will be discussed. The full description of this particular modification of SPIRS for palliative care research is provided as an example of how this instrument could be used in projects for which nurses undertake the difficult task of providing compassionate care to the terminally ill.

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 crystal and molecular structure of thiamine hydroiodide /|nWilliam Edward Lee. -- 260 St. Catharines [Ont.] : Dept. of Chemistry, Brock University,

The x-ray crystal structure of thiamine hydroiodide,C1ZH18N40S12' has been determined. The unit cell parameters are a = 13.84 ± 0.03, o b = 7.44 ± 0.01, c = 20.24 ± 0.02 A, 8 = 120.52 ± 0.07°, space group P2/c, z = 4. A total of 1445 reflections having ,2 > 2o(F2), 26 < 40° were collected on a Picker four-circle diffractometer with MoKa radiation by the 26 scan technique. The structure was solved by the heavy atom method. The iodine and sulphur atoms were refined anisotropically; only the positional parameters were refined for the hydrogen atoms. Successive least squares cycles yielded an unweighted R factor of 0.054. The site of protonation of the pyrimidine ring is the nitrogen opposite the amino group. The overall structure conforms very closely to the structures of other related thiamine compounds. The bonding surrounding the iodine atoms is distorted tetrahedral. The iodine atoms make several contacts with surrounding atoms most of them at or near the van der Waal's distances A thiaminium tetrachlorocobaltate salt was produced whose molecular and crystal structure was j~dged to be isomorphous to thiaminium tetrachlorocadmate.

The Role of MicroRNA Regulation of Cardiac Ion Channel in Arrhythmia

La fibrillation auriculaire (FA) est le trouble du rythme le plus fréquemment observé en pratique clinique. Elle constitue un risque important de morbi-mortalité. Le traitement de la FA reste un défi majeur en lien avec les nombreux effets secondaires associés aux approches thérapeutiques actuelles. Dans ce contexte, une meilleure compréhension des mécanismes sous-jacents à la FA est essentielle pour le développement de nouvelles thérapies offrant un meilleur rapport bénéfice/risque pour les patients. La FA est caractérisée par i) un remodelage électrique délétère associé le plus souvent ii) à un remodelage structurel du myocarde favorisant la récurrence et le maintien de l’arythmie. La diminution de la période réfractaire effective au sein du tissu auriculaire est un élément clef du remodelage électrique. Le remodelage structurel, quant à lui, se manifeste principalement par une fibrose tissulaire qui altère la propagation de l’influx électrique dans les oreillettes. Les mécanismes moléculaires impliqués dans la mise en place de ces deux substrats restent mal connus. Récemment, le rôle des microARNs (miARNs) a été pointé du doigt dans de nombreuses pathologies notamment cardiaques. Dans ce contexte les objectifs principaux de ce travail ont été i) d'acquérir une compréhension approfondie du rôle des miARNs dans la régulation de l’expression des canaux ioniques et ii) de mieux comprendre le rôle de ces molécules dans l’installation d’un substrat favorable a la FA. Nous avons, dans un premier temps, effectué une analyse bio-informatique combinée à des approches expérimentales spécifiques afin d’identifier clairement les miARNs démontrant un fort potentiel de régulation des gènes codant pour l’expression des canaux ioniques cardiaques humains. Nous avons identifié un nombre limité de miARNs cardiaques qui possédaient ces propriétés. Sur la base de ces résultats, nous avons démontré que l’altération de l'expression des canaux ioniques, observée dans diverse maladies cardiaques (par exemple, les cardiomyopathies, l’ischémie myocardique, et la fibrillation auriculaire), peut être soumise à ces miARNs suggérant leur implication dans l’arythmogénèse. La régulation du courant potassique IK1 est un facteur déterminant du remodelage électrique auriculaire associée à la FA. Les mécanismes moléculaires sous-jacents sont peu connus. Nous avons émis l’hypothèse que l'altération de l’expression des miARNs soit corrélée à l’augmentation de l’expression d’IK1 dans la FA. Nous avons constaté que l’expression de miR-26 est réduite dans la FA et qu’elle régule IK1 en modulant l’expression de sa sous-unité Kir2.1. Nous avons démontré que miR-26 est sous la répression transcriptionnelle du facteur nucléaire des lymphocytes T activés (NFAT) et que l’activité accrue de NFATc3/c4, aboutit à une expression réduite de miR-26. En conséquence IK1 augmente lors de la FA. Nous avons enfin démontré que l’interférence in vivo de miR-26 influence la susceptibilité à la FA en régulant IK1, confirmant le rôle prépondérant de miR-26 dans le remodelage auriculaire électrique. La fibrose auriculaire est un constituant majeur du remodelage structurel associé à la FA, impliquant l'activation des fibroblastes et l’influx cellulaire du Ca2 +. Nous avons cherché à déterminer i) si le canal perméable au Ca2+, TRPC3, jouait un rôle dans la fibrose auriculaire en favorisant l'activation des fibroblastes et ii) étudié le rôle potentiel des miARNs dans ce contexte. Nous avons démontré que les canaux TRPC3 favorisent l’influx du Ca2 +, activant la signalisation Ca2 +-dépendante ERK et en conséquence activent la prolifération des fibroblastes. Nous avons également démontré que l’expression du TRPC3 est augmentée dans la FA et que le blocage in vivo de TRPC3 empêche le développement de substrats reliés à la FA. Nous avons par ailleurs validé que miR-26 régule les canaux TRPC3 en diminuant leur expression dans les fibroblastes. Enfin, nous avons montré que l'expression réduite du miR-26 est également due à l’activité augmentée de NFATc3/c4 dans les fibroblastes, expliquant ainsi l’augmentation de TRPC3 lors de la FA, confirmant la contribution de miR-26 dans le processus de remodelage structurel lié à la FA. En conclusion, nos résultats mettent en évidence l'importance des miARNs dans la régulation des canaux ioniques cardiaques. Notamment, miR-26 joue un rôle important dans le remodelage électrique et structurel associé à la FA et ce, en régulant IK1 et l’expression du canal TRPC3. Notre étude démasque ainsi un mécanisme moléculaire de contrôle de la FA innovateur associant des miARNs. miR-26 en particulier représente apres ces travaux une nouvelle cible thérapeutique prometteuse pour traiter la FA.

Association between sleep quality and quality of life in nursing professionals working rotating shifts

Objective: To analyze the association between sleep quality and quality of life of nursing professionals according to their work schedules. Methods: A prospective, cross-sectional, observational study was conducted between January and December 2010, with 264 nursing professionals, drawn from 989 subjects at Botucatu General Hospital and stratified by professional category. The Pittsburg Sleep Quality Index and the WHOQOL-bref were administered to evaluate sleep quality and quality of life, respectively. Self-reported demographic data were collected with a standard form. Continuous variables were reported as means and standard deviations, and categorical variables were expressed as proportions. Associations were evaluated using Spearman's correlation coefficient. The association of night-shift work and gender with sleep disturbance was evaluated by logistic regression analysis using a model adjusted for age and considering sleep disturbance the dependent variable. The level of significance was p < 0.05. Results: Night-shift work was associated with severe worsening of at least one component of sleep quality in the model adjusted for age (OR = 1.91; 95% CI 1.04; 3.50; p = 0.036). Female gender was associated with sleep disturbance (OR = 3.40; 95% CI 1.37; 8.40; p = 0.008). Quality of life and quality of sleep were closely correlated (R = -0.56; p < 0.001). Conclusions: Characteristics of the nursing profession affect sleep quality and quality of life, and these two variables are associated.

Variation of Environmental Regulation Stringency Among the Top Ten U.S. Hog Producing States

The U.S. hog industry, once primarily made up of small owner-operated crop-hog farms, has become dominated by large specialized operations characterized by low costs and improved technologies in livestock management. Such changes have triggered concerns over the dangers large Hog Feeding Operations (HFOs) are likely to pose to the environment. In 2007, the top ten states accounted for more than 85 percent of total U.S. hog production (Iowa (IA), North Carolina (NC), Minnesota (MN), Illinois (IL), Nebraska (NE), Indiana (IN), Missouri (MO), Oklahoma (OK), Ohio (OH), and Kansas (KS)). With such domination on production, these states are often the subject of environmental debate relating to hog production. When farmers are required to incorporate environmental measures in hog production, their costs of production increase. Metcalfe (2001) found that small HFOs have found it difficult to cope with such costs and many have exited the industry, while large operations have not been affected at the same level. Due to the variation of environmental regulations among states, other operations moved to states with lax regulations (e.g. NC prior to the late 1990s). Such regulations appear to have played a major role in shaping the structure of the hog industry.

The effects of professional factors on the quality of life of family health team nurses

The objective of this study was to identify the professional factors affecting the quality of life of nurses working in the family health teams in the Macro Health Region, referred to as the South Triangle, in the State of Minas Gerais. This is a descriptive, cross-sectional study. The participants were 90 nurses, who answered a questionnaire containing the professional variables and the Quality of Life assessment instrument - WHOQOL-100. The results showed a negative impact regarding the number of jobs, unstable jobs, excessive workload and job dissatisfaction in the nurses' Quality of Life domains. There is a need to (re)define the public policies that control the working conditions of these professionals. Actions that contribute towards improving nurses' Quality of Life are important, considering their strong influence on the quality of the healthcare that is delivered.

Cultural models of healing and health: An ethnography of professional nurses and healers

Cultural models of the domains healing and health are important in how people understand health and their behavior regarding it. The biomedicine model has been predominant in Western society. Recent popularity of holistic health and alternative healing modalities contrasts with the biomedical model and the assumptions upon which that model has been practiced. The holistic health movement characterizes an effort by health care providers and others such as nurses to expand the biomedical model and has often incorporated alternative modalities. This research described and compared the cultural models of healing of professional nurses and alternative healers. A group of nursing faculty who promote a holistic model were compared to a group of healers using healing touch. Ethnographic methods of participant observation, free listing and pile sort were used. Theoretical sampling in the free listings reached saturation at 18 in the group of nurses and 21 in the group of healers. Categories consistent for both groups emerged from the data. These were: physical, mental, attitude, relationships, spiritual, self management, and health seeking including biomedical and alternative resources. The healers had little differentiation between the concepts health and healing. The nurses, however, had more elements in self management for health and in health seeking for healing. This reflects the nurse's role in facilitating the shift in locus of responsibility between health and healing. The healers provided more specific information regarding alternative resources. The healer's conceptualization of health was embedded in a spiritual belief system and contrasted dramatically with that of biomedicine. The healer's models also contrasted with holistic health in the areas of holism, locus of responsibility, and dealing with uncertainty. The similarity between the groups and their dissimilarity to biomedicine suggest a larger cultural shift in beliefs regarding health care. ^

Mies van der Rohe's Illinois Institute of Technology: Analysis and History of a Compositive Development = El IIT de Mies van der Rohe: análisis e historia de un proceso compositivo

The Illinois Institute of Technology (iit) campus, Chicago, by architect Ludwig Mies van der Rohe, is often considered as a transitional work, usually acknowledged as significant for the reorientation of his professional career after he emigrated to the United States. Moreover, its favorable recognition today is somehow indicative of its relevance as a model for urban intervention in the contemporary American city and for contemporary city planning in general, not to mention the profound impact that it had on the cityscape of Chicago. However, today we know it was rather the result of a close collaboration between he and Ludwig Hilberseimer —later on, to be completed with Alfred Caldwell— who merged their personal ideas and expertise in the design for the first time. In addition to this, when one tries to locate the design within its own historical context and evaluate the sources of its approach to it, some contradictions arise. The major impact of the images produced by Mies to promote its realization —widely disseminated in most contemporary architectural periodicals— probably outshined the particular circumstances in which the design was conceived. In fact, it would never be materialized as originally presented, but it was, instead, continuously reworked according to land availability in the site —a circumstance often ignored by subsequent architectural critic, that enthusiastically praised the design even before it was fully completed. One of the main consequences of looking at iit from such a standpoint is that, when historically contextualized, one can appreciate that, due to the urban scale of its implementation process, the design had to face a complex reality very different to that initially planned by the architect, often far from his actual possibilities of intervention. Such approach is in contradiction with the common description of the design as a ‘tabula rasa’ that allegedly would have been formulated on the basis of a full denial of its context. On the contrary, the ever-changing circumstances of the design motivated a necessary re-interpretation of the relation between its executed fragments, in order to keep the original identity of the whole in an ever-changing context. This situation implied a continuous transformation of the design by means of a steady re-composition of its elements: as the number of completed buildings increased in its successive stages, their relation to their site-specific context changed, in a very particular process that these lines try to delineate. Requiring decades to be erected, neither of its authors would ever see the design finished as planned, partially because of the difficulties in acquiring the extension of land that it required. Considering the study of this process as able to provide a valuable gateway to understand the urban discourse that the architects entailed, the aim of these lines is to analyze the problems that the iit campus design had to face. As a starting point, a relationship between practice and theory in the activity of the authors implied in iit campus design has been assumed. Far from being interrupted during World War ii, strong historical evidence can be found to infer that both were developed in parallel. Consequently, the historical sequence of the preserved testimonies has been put into context, as well as their transformation while Mies remained in charge for the campus Master Plan. Notably, when seen from this perspective, some ideas already expressed during his previous European practice were still present during the design process. Particularly, Mies's particular understanding of certain architectural concepts — such as those of ‘order’ and ‘structure’—can be traced paralleling the theories about urban planning from his collaborators, a fact that possibly facilitated the campus successful development. The study of the way these ideas were actually redeveloped and modified in the American urban context, added to the specific process of the implementation of iit campus design, sheds a new light for a critical interpretation of the reasons that made it possible, and of the actual responsibility of Mies's collaborators in its overall development and final completion. RESUMEN El campus del Illinois Institute of Technology (iit) de Chicago, obra del arquitecto Ludwig Mies van der Rohe, es a menudo considerado como una obra de transición que, por lo general, ha venido siendo reconocida como relevante para la reorientación de su carrera profesional posterior a su exilio en los Estados Unidos. El reconocimiento del que goza el proyecto es indicativo, de algún modo, de su importancia como modelo para la intervención urbana en la ciudad norteamericana contemporánea y el planeamiento de la ciudad contemporánea en general, sin olvidar el profundo impacto que ha tenido sobre el paisaje urbano de Chicago. Sin embargo, hoy sabemos que el resultado se benefició de su estrecha colaboración con Ludwig Hilberseimer y se completaría más tarde con la de Alfred Caldwell, quienes unieron sus ideas y experiencia profesional en el proyecto por primera vez. Asimismo, cuando se intenta ubicar el proyecto dentro de su propio contexto histórico y evaluar los criterios de su manera de abordarlo, surgen algunas contradicciones. El considerable impacto de las imágenes producidas por Mies para impulsar su ejecución —ampliamente difundidas en la mayoría de publicaciones de arquitectura de la época— probablemente eclipsó las particulares circunstancias en las que el proyecto fue concebido. De hecho, nunca llegó a materializarse tal y como fue inicialmente presentado. Por contra, fue reelaborado de manera continua, de acuerdo a la disponibilidad de suelo en el emplazamiento; una circunstancia a menudo ignorada por la crítica posterior, que elogió con entusiasmo el proyecto antes siquiera de que fuese terminado. Una de las principales consecuencias de contemplar el iit desde semejante punto de vista es que, una vez contextualizada históricamente su puesta en obra, se puede apreciar que el arquitecto tuvo que enfrentarse a una compleja realidad urbana muy diferente a la inicialmente prevista —probablemente debido a la escala del proyecto— a menudo lejos de sus posibilidades reales de intervención. Este enfoque contradice la descripción habitual del proyecto como una ‘tabula rasa’, que supuestamente se habría formulado sobre la base de una negación completa de su contexto. Por el contrario, las circunstancias cambiantes del proyecto obligaron una necesaria reinterpretación de la relación entre sus frag mentos ejecutados, con el fin de mantener la identidad original del conjunto en un contexto en constante cambio. Esta situación implicó una continua transformación del proyecto por medio de una permanente re-composición de sus elementos: según se incrementaba el número de edificios construidos en las etapas sucesivas de desarrollo del conjunto, variaba su relación con el contexto específico en que se emplazaban, en un proceso muy particular que estas líneas tratan de perfilar. Al necesitar décadas para ser levantado, ninguno de sus autores vería el conjunto terminado según lo planificado, en parte debido a las dificultades para la adquisición de la extensión de suelo que demandaba. Asumiendo que el estudio de este proceso es capaz de proporcionar una valiosa puerta de entrada para elucidar el discurso urbano asumido por los Mies, el objetivo de estas líneas es analizar los problemas a los que el proyecto del campus del iit tuvo que enfrentarse. Como punto de partida, se ha supuesto una relación entre la práctica y la teoría en la actividad de los autores implicados en el proyecto del campus del iit. Lejos de interrumpirse durante la Segunda Guerra Mundial, existen evidencias históricas sólidas para deducir que ambas vertientes se desarrollaron en paralelo. En consecuencia, se ha contextualizado la secuencia histórica de los testimonios conservados, así como su transformación durante el periodo en que Mies estuvo a cargo del Plan General del campus. Significativamente, al ser contempladas bajo esta perspectiva, algunas ideas ya expresadas durante su práctica europea anterior resultan aún presentes durante la redacción del proyecto. En concreto, se puede trazar un paralelismo entre la comprensión particular de Mies de ciertos conceptos arquitectónicos —como los de ‘orden’ y ‘estructura’— y las teorías sobre el urbanismo de sus colaboradores, hecho que posiblemente facilitó el exitoso desarrollo del proyecto. El estudio de la manera en que estas ideas fueron reelaboradas y modificadas en el contexto urbano estadounidense, sumado al proceso específico de su aplicación en el proyecto del campus del iit, arroja una nueva luz para una interpretación crítica tanto de las razones que lo hicieron posible, como del papel real que los colaboradores de Mies tuvieron en su desarrollo y ejecución final.

Coffee / by B. E. Dahlgren, Chief Curator, Dept. of Botany.

no.22(1938)

An early archaeological example of tattooing from northwestern Alaska / James W. VanStone, Curator, North American Archaeology and Ethnology, Field Museum of Natural History, and Charles V. Lucier, Alaska Dept. of Fish and Game.

v.66:no.1(1974)

A forest of the coal age / by B. E. Dahlgren, Acting Curator, Dept. of Botany.

no.14(1933)

Crocodile hunting in Central America / by Karl P. Schmidt, Chief Curator, Dept. of Zoology.

no.15(1952)