Children's and family needs of young women with advanced breast cancer: A review

This article reviews literature about the impact of advanced breast cancer on children and families. It is clear that the adjustment of the family is influenced by disease stage and maternal adjustment, the needs of the particular child relating closely to their developmental stage. Interventions with children and families to promote adjustment when a parent has advanced cancer are also discussed, including implications for clinical practice.

Survey of intensive care nurses' knowledge relating to the pulmonary artery catheter

In 2003 there was an increase in the use of pulmonary artery catheters in Australia from 12, 000 to 16, 000 units in intensive care and peri-operative care. This survey of intensive care nurses in five intensive care units in Queensland addressed knowledge of use, safety and complications of the pulmonary artery catheter, using a previously validated 31 question multiple choice survey. One hundred and thirty-nine questionnaires were completed, a response rate of 46%. The mean score was 13.3, standard deviation +/-4.2 out of a total of 31 (42.8% correct). The range was 4 to 25. Scores were significantly higher in those participants with more ICU experience, higher nursing grade, a higher self-assessed level of knowledge and greater frequency of PAC supervision. There was no significant correlation between total score and hospital- or university-based education, or total score and public or private hospital participants. Fifty-one per cent were unable to correctly identify the significant pressure change as the catheter is advanced from the right ventricle to the pulmonary artery.

Advanced patient monitoring displays: Tools or continuous informing

We reviewed the use of advanced display technologies for monitoring in anesthesia. Researchers are investigating displays that integrate information and that, in some cases, also deliver the results continuously to the anesthesiologist. Integrated visual displays reveal higher-order properties of patient state and speed in responding to events, but their benefits under an intensely timeshared load is unknown. Head-mounted displays seem to shorten the time to respond to changes, but their impact on peripheral awareness and attention is unknown. Continuous auditory displays extending pulse oximetry seem to shorten response times and improve the ability to time-share other tasks, but their integration into the already noisy operative environment still needs to be tested. We reviewed the advantages and disadvantages of the three approaches, drawing on findings from other fields, such as aviation, to suggest outcomes where there are still no results for the anesthesia context. Proving that advanced patient monitoring displays improve patient outcomes is difficult, and a more realistic goal is probably to prove that such displays lead to better situational awareness, earlier responding, and less workload, all of which keep anesthesia practice away from the outer boundaries of safe operation.

Impact of an intensive nursing education course on nurses' knowledge, confidence, attitudes, and perceived skills in the care of patients with cancer

Purpose/Objectives: To evaluate the impact of a cancer nursing education course on RNs. Design: Quasi-experimental, longitudinal, pretest/post-test design, with a follow-up assessment six weeks after the completion of the nursing education course. Setting: Urban, nongovernment, cancer control agency in Australia. Sample: 53 RNs, of whom 93% were female, with a mean age of 44.6 years and a mean of 16.8 years of experience in nursing; 86% of the nurses resided and worked in regional areas outside of the state capital. Methods: Scales included the Intervention With Psychosocial Needs: Perceived Importance and Skill Level Scale, Palliative Care Quiz for Nurses, Breast Cancer Knowledge, Preparedness for Cancer Nursing, and Satisfaction With Learning. Data were analyzed using multiple analysis of variance and paired t tests. Main Research Variables: Cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Findings: Compared to nurses in the control group, nurses who attended the nursing education course improved in their cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Improvements were evident at course completion and were maintained at the six-week follow-up assessment. Conclusions: The nursing education course was effective in improving nurses' scores on all outcome variables. Implications for Nursing: Continuing nursing education courses that use intensive mode timetabling, small group learning, and a mix of teaching methods, including didactic and interactive approaches and clinical placements, are effective and have the potential to improve nursing practice in oncology.

Obesity in pre-school children: Issues and challenges for community based child health nurses

Childhood obesity is becoming a topical issue in both the health literature and the popular media and increasingly child health nurses are observing preschool children who appear to be disproportionately heavy for their height when plotted on standardised growth charts. In this paper literature related to childhood obesity in New Zealand and internationally is explored to identify current issues, and the implications of these issues for nurses in community based child health practice are discussed. Themes that emerged from the literature relate to the measurement of obesity, links between childhood and adult obesity and issues for families. A theme in the literature around maternal perception was of particular interest. Studies that investigated maternal perceptions of childhood obesity found that mothers identified their child as being overweight or obese only when it imposed limitations on physical activity or when the children were teased rather than by referring to individual growth graphs. The implications for nursing in the area of child health practice is discussed as nurses working in this area need an understanding of the complex and often emotive issues surrounding childhood obesity and an awareness of the reality of people's lives when devising health promotion strategies.

Industrial networks of the future:review of research and practice

Academic researchers have followed closely the interest of companies in establishing industrial networks by studying aspects such as social interaction and contractual relationships. But what patterns underlie the emergence of industrial networks and what support should research provide for practitioners? Firstly, it appears that manufacturing is becoming a commodity rather than a unique capability, which accounts especially for low-technology approaches in downstream parts of the network, for example in assembly operations. Secondly, the increased tendency towards specialization has forced other, upstream, parts of industrial networks to introduce advanced manufacturing technologies to supply niche markets. Thirdly, the capital market for investments in capacity, and the trade in manufacturing as a commodity, dominates resource allocation to a larger extent than previously was the case. Fourthly, there is a continuous move towards more loosely connected entities that comprise manufacturing networks. More traditional concepts, such as the “keiretsu” and “chaibol” networks of some Asian economies, do not sufficiently support the demands now being placed on networks. Research should address these four fundamental challenges to prepare for the industrial networks of 2020 and beyond.

Strategy-as-practice:a review and future directions for the field

This review maps and critically evaluates the rapidly growing body of research in the strategy-as-practice field. Following an introduction on the emergence and foundations of strategy-as-practice, the review is structured in three main parts, based on the terminology, issues and research agendas outlined in the field. First, the paper examines the concepts of practitioners and praxis. A typology of nine possible domains for strategy-as-practice research is developed, based on the way that different studies conceptualize the strategy practitioner and the level of strategy praxis that they aim to explain. Second, the paper reviews the concept of practices, which has been adopted widely but inconsistently within the strategy-as-practice literature. While there is no dominant view on practices, the review maps the various concepts of practices that inform the strategy-as-practice field and outlines avenues for future research. The final section attends to the call for strategy-as-practice research to develop and substantiate outcomes that may better explain or inform strategy praxis. Five categories of outcomes are found within existing empirical studies, and an agenda for building upon this evidence is advanced. The paper concludes with a summation of the current state of the field and some recommendations on how to take strategy-aspractice research forward.

Enhancing delivery of health behaviour change interventions in primary care: a meta-synthesis of views and experiences of primary care nurses

Objective To systematically find and synthesise qualitative studies that elicited views and experiences of nurses involved in the delivery of health behaviour change (HBC) interventions in primary care, with a focus on how this can inform enhanced delivery and adherence to a structured approach for HBC interventions. Methods Systematic search of five electronic databases and additional strategies to maximise identification of studies, appraisal of studies and use of meta-synthesis to develop an inductive and interpretative form of knowledge synthesis. Results Nine studies met the inclusion criteria. Synthesis resulted in the development of four inter-linking themes; (a) actively engaging nurses in the process of delivering HBC interventions, (b) clarifying roles and responsibilities of those involved, (c) engaging practice colleagues, (d) communication of aims and potential outcomes of the intervention. Conclusion The synthesis of qualitative evidence resulted in the development of a conceptual framework that remained true to the findings of primary studies. This framework describes factors that should be actively promoted to enhance delivery of and adherence to HBC interventions by nurses working in primary care. Practice implications The findings can be used to inform strategies for researchers, policymakers and healthcare providers to enhance fidelity and support delivery of HBC interventions.

Staying in nursing:what factors determine whether nurses intend to remain employed?

Aim. To test a model of eight thematic determinants of whether nurses intend to remain in nursing roles. Background. Despite the dramatic increase in the supply of nurses in England over the past decade, a combination of the economic downturn, funding constraints and more generally an ageing nursing population means that healthcare organizations are likely to encounter long-term problems in the recruitment and retention of nursing staff. Design. Survey. Method. Data were collected from a large staff survey conducted in the National Health Service in England between September-December 2009. A multi-level model was tested using MPlus statistical software on a sub-sample of 16,707 nurses drawn from 167 healthcare organizations. Results. Findings were generally supportive of the proposed model. Nurses who reported being psychologically engaged with their jobs reported a lower intention to leave their current job. The perceived availability of developmental opportunities, being able to achieve a good work-life balance and whether nurses' encountered work pressures were also influencing factors on their turnover intentions. However, relationships formed with colleagues and patients displayed comparatively small relationships with turnover intentions. Conclusion. The focus at the local level needs to be on promoting employee engagement by equipping staff with the resources (physical and monetary) and control to enable them to perform their tasks to standards they aspire to and creating a work environment where staff are fully involved in the wider running of their organizations, communicating to staff that patient care is important and the top priority of the organization. © 2012 Blackwell Publishing Ltd.

The acquisition of French past tenses by tutored anglophone advanced learners : is aspect enough?

Following Andersen's (1986, 1991) study of untutored anglophone learners of Spanish, aspectual features have been at the centre of hypotheses on the development of past verbal morphology in language acquisition. The Primacy of Aspect Hypothesis claims that the association of any verb category (Aktionsart) with any aspect (perfective or imperfective) constitutes the endpoint of acquisition. However, its predictions rely on the observation of a limited number of untutored learners at the early stages of their acquisition, and have yet to be confirmed in other settings. The aim of the present thesis is to evaluate the explanatory power of the PAH in respect of the acquisition of French past tenses, an aspect of the language which constitutes a serious stumbling block for foreign learners, even those at the highest levels of proficiency (Coppieters 1987). The present research applies the PAH to the production of 61 anglophone 'advanced learners' (as defined in Bartning 1997) in a tutored environment. In so doing, it tests concurrent explanations, including the influence of the input, the influence of chunking, and the hypothesis of cyclic development. Finally, it discusses the cotextual and contextual factors that still provoke what Anderson (1991) terms "non-native glitches" at the final stage, as predicted by the PAH. The first part of the thesis provides the theoretical background to the corpus analysis. It opens with a diachronic presentation of the French past tense system focusing on present areas of competition and developments that emphasize the complexity of the system to be acquired. The concepts of time, grammatical aspect and lexical aspect (Aktionsart) are introduced and discussed in the second chapter, and a distinctive formal representation of the French past tenses is offered in the third chapter. The second part of the thesis is devoted to a corpus analysis. The data gathering procedures and the choice of tasks (oral and written film narratives based on Modern Times, cloze tests and acceptability judgement tests) are described and justified in the research methodology chapter. The research design was shaped by previous studies and consequently allows comparison with these. The second chapter is devoted to the narratives analysis and the third to the grammatical tasks. This section closes with a summary of discoveries and a comparison with previous results. The conclusion addresses the initial research questions in the light of both theory and practice. It shows that the PAH fails to account for the complex phenomenon of past tense development in the acquisitional settings under study, as it adopts a local (the verb phrase) and linear (steady progression towards native usage) approach. It is thus suggested that past tense acquisition rather follows a pendular development as learners reformulate their learning hypotheses and become increasingly able to shift from local to global cues and so to integrate the influence of cotext and context in their tense choice.

FASTtrack applied pharmaceutical practice

This revision guide takes the student pharmacist or pharmacy technician through the main stages involved in pharmaceutical dispensing. It gives bullet points of basic information on applied pharmacy practice followed by questions and answers. This reference text accompanies the compulsory dispensing courses found in all undergraduate MPharm programmes and equivalent technical training courses. Changes for the new edition include: * Information on revisions to the community pharmacy contract. * Additional content on new advanced community pharmacy services. * Revised worked examples and student questions. * Updated prescription labelling information, including the use of new cautionary and warning labels. * Updated references and bibliography.

Servitization within manufacturing:exploring the provision of advanced services and their impact on vertical integration

Purpose – The debate about services-led competitive strategies continues to grow, with much interest emerging around the differing practices between production and servitized operations. The purpose of this paper is to contribute to this discussion by investigating the vertical integration practice (in particular the micro-vertical integration, otherwise known as the supply chain position) of manufacturers who are successful in their adoption of servitization. Design/methodology/approach – To achieve this the authors have investigated a cross-section of four companies which are successfully delivering advanced services coupled to their products. Findings – Manufacturers who have embraced the servitization trend tend to retain capabilities in design and production, and do so because this benefits their speed, effectiveness and costs of supporting assets on advanced services contracts. Research limitations/implications – These are preliminary findings from a longer term research programme. Practical implications – Through this research note the authors seek to simultaneously contribute to the debate in the research community and offer guidance to practitioners exploring the consequences of servitization. Originality/value – Successful servitization demands that manufacturers adopt new and alternative practices and technologies to those traditionally associated with production operations. A prevailing challenge is to understand these differences and their underpinning rationale. Therefore, in this research note, the authors report on the practices of four case companies, explore the rationale underpinning these, and propose an hypothesis for the impact on vertical integration of successful servitization.

Data envelopment analysis model for the appraisal and relative performance evaluation of nurses at an intensive care unit

The appraisal and relative performance evaluation of nurses are very important and beneficial for both nurses and employers in an era of clinical governance, increased accountability and high standards of health care services. They enhance and consolidate the knowledge and practical skills of nurses by identification of training and career development plans as well as improvement in health care quality services, increase in job satisfaction and use of cost-effective resources. In this paper, a data envelopment analysis (DEA) model is proposed for the appraisal and relative performance evaluation of nurses. The model is validated on thirty-two nurses working at an Intensive Care Unit (ICU) at one of the most recognized hospitals in Lebanon. The DEA was able to classify nurses into efficient and inefficient ones. The set of efficient nurses was used to establish an internal best practice benchmark to project career development plans for improving the performance of other inefficient nurses. The DEA result confirmed the ranking of some nurses and highlighted injustice in other cases that were produced by the currently practiced appraisal system. Further, the DEA model is shown to be an effective talent management and motivational tool as it can provide clear managerial plans related to promoting, training and development activities from the perspective of nurses, hence increasing their satisfaction, motivation and acceptance of appraisal results. Due to such features, the model is currently being considered for implementation at ICU. Finally, the ratio of the number DEA units to the number of input/output measures is revisited with new suggested values on its upper and lower limits depending on the type of DEA models and the desired number of efficient units from a managerial perspective.