New Zealand development and trial of mental health nursing clinical indicators - a bicultural study

This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand. ANZCMHN, Greenacres). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. During the national field study, consumer files (n=327) from 11 District Health Boards, and registered nurses (n=422) completed an attitude questionnaire regarding the regularity of specific nursing and service activities. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5–89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.

Nursing care practices following a percutaneous coronary intervention : results of a survey of Australian and New Zealand cardiovascular nurses

Background: Although there is high-level evidence to guide optimal medical care for percutaneous coronary interventions, there are less explicit guidelines to support nurses in providing care. Aim: This study describes the practice standards and priorities of care of cardiovascular nurses in Australia and New Zealand. Method: Item generation for the survey was informed by an integrative literature review and existing clinical guidelines. A 116-item Web-based survey was administered to cardiovascular nurses, via electronic mail lists of professional cardiovascular nursing organizations, using a secure online data collection system. Results: Data were collected from March 2008 to March 2009. A total of 148 respondents attempted the survey, with 110 (74.3%) completing all items. All respondents were registered nurses with an average of 12.3 (SD, 7.61) years of clinical experience in the cardiovascular setting. A range of practice patterns was evident in ambulation time after percutaneous coronary intervention, methods of sheath removal, pain relief, and patient positioning. Respondents consistently rated psychosocial care a lower priority than other tasks and also identified a knowledge deficit in this area. Conclusion: This survey identified diversity of practice patterns and a range of educational needs. Increasing evidence to support evidence-based practice and guideline development is necessary to promote high-quality care and improved patient outcomes.

Embodied dispositions or experience? Identifying new patterns of professional competence

Aim. This paper is a report of a study to explore nurses' competence as revealed during an admission assessment. Background. Studies of nursing competence and of models of competence have become virtually synonymous with the five-stage developmental model applied to nursing by Benner. However, the model has been criticized for its interpretation of intuition and also for the exclusion of the social elements and context of nursing practice. Method. The study was conducted in 2004. This paper draws on data from 12 structured non-participant observations of admission assessments in an orthopaedic ward by four nurses: two with <1 year' experience and two with more than 5 years' experience. Defined variables were observed using instantaneous and event sampling. The analysis was guided theoretically by the assumptions embedded in Benner's competence model and Bourdieu's theory of practice. Findings. Each nurse had unique patterns of practice that did not correspond to the level of competence expected in relation to their length of experience as a nurse. Nurses' competence seems to be situational rather than related to levels in the developmental model: in some observed variables, inexperience nurses acted as experts, while experienced nurses acted as advanced beginners, contrary to the expectations of Benner. Conclusion. The five-stage developmental competence model could not be verified empirically in this study. The findings suggest that further empirical research is needed to clarify the apparent links between situation and competence.

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)

Athapaskan clothing and related objects in the collections of Field Museum of Natural History / James W. VanStone, Curator, North American Archaeology and Ethnology, Dept. of Anthropology, Field Museum of Natural History.

n.s. no.4(1981)

Aleutian islanders; Eskimos of the north Pacific / by George I. Quimby, Curator of Exhibits, Dept. of Anthropology. Drawings by Helen Z. Quimby.

no.35(1944)

The Simms Collection of Plains Cree material culture from southeastern Saskatchewan / James W. VanStone, Curator, North American Archaeology and Ethnology, Dept. of Anthropology, Field Museum of Natural History.

n.s. no.6(1983)