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Issue 129 - 26 March 2010


1. Nursing and health policy perspectives.
INR: a global forum for nursing perspectives. International Nursing Review, Volume 57 Issue 1, March 2010: p1-2

History of and changes in the nursing profession over the last 40 years

2. INR is a nursing and health policy journal. International Nursing Review, Volume 57 Issue 1, March 2010: p3
In 2010 INR enters its second decade as a peer-reviewed journal and it seems an appropriate time to review its focus.

3. The potential of women and the burden of inequality. International Nursing Review, Volume 57 Issue 1, March 2010:

It is over 110 years since ICN was founded by the combined efforts of a small group of visionary women. These women recognised the need for nurses to reach out across countries to further the development of our profession through ensuring that it had a strong and coherent voice prepared to tackle the key issues of the day, as well as set direction for the future.

International perspectives
4. Planting ceremony honours nursing's pioneering innovator. International Nursing Review, Volume 57 Issue 1, March
2010: p5-8

His Imperial Majesty the Emperor Akihito and Her Imperial majesty the Empress Michiko of Japan participated in a ceremonial planting of the Florence Nightingale Anniversary Rose in the garden of the imperial palace in Tokyo.

Review articles
5. Patient safety: a literative review on the impact of nursing empowerment, leadership and collaboration.
International Nursing Review, Volume 57 Issue 1, March 2010: p12-21

Nurses are ideally placed to drive the safety and quality agenda within health care because of their unique proximity to patients. There have been some attempts to look at the links between nursing care and quality outcomes, but relatively little on the connection between nursing and patient safety. Therefore, exploring the evidence on this issue was indicated, excluding links to nurse staffing and environment.
Aims: The aim of this study was to identify to what extent and in what way nursing leadership, collaboration and empowerment can have a demonstrable impact on patient safety.
Methods: A search of electronic databases was undertaken from 1998 to 2008. One thousand seven hundred eighty-eight titles and abstracts were retrieved, and the full text of 65 relevant papers was obtained and reviewed. Data extraction was undertaken if papers met the following inclusion criteria: a measure of impact from a study or audit, patient safety and nursing focused, and identified one of the following issues (leadership, advocacy, interdisciplinary working, empowerment and collaboration). Eleven papers were selected and critically reviewed.
Finding: Of the 11 papers, 7 were undertaken in the USA, 2 in Canada, 1 in the UK and 1 in Iceland. Selected papers comprised of one systematic review, one cohort study, four qualitative studies, three cross-sectional studies, one survey and an evaluation. The quality of papers was variable and provided limited evidence of impact or effectiveness in terms of nurses directly influencing patient safety.
Conclusion: Gaps currently exist in relation to knowledge on the extent and nature of the role of nurses in patient safety improvement. Considerable work is required before comprehensive solutions can be further developed. Huge potential exists for improvement through nursing empowerment, leadership and the development of tools to strengthen and support nurses' influential role in the quality and safety movement; therefore, the need for investment into well-designed research studies to address these gaps is obvious, required and timely.

6. Stress and coping in Australian nurses: a systematic review. International Nursing Review, Volume 57 Issue 1, March 2010: p22-31
Aim: To identify factors that contribute to stress in Australian nurses, consider the coping strategies they use and
examine the effects of stressors on nurses' health and well-being.
Background: Stress is a major concern in the nursing profession with work overload, nurse shortages and high turnover rates as the common stressors. Although nursing stress has been studied extensively, there is a lack of  clarity on the nursing situation in Australia.
Methods: A systematic review of the current literature was conducted on stress and coping strategies within the Australian nursing population.
Results: Stressors included work overload, role conflicts and experiences of aggression. Coping strategies included seeking support, problem solving and self-control. The majority of the studies reported detrimental effects on nurses' physical and mental well-being with little consideration given to the spillover effects of nursing work stress to their family and social relationships.
Conclusion: Recommendations included factoring in personal and work stresses, promoting the use of effective coping strategies and maintaining supportive social relationships.

7. A critical review of the nursing shortage in Malaysia. International Nursing Review, Volume 57 Issue 1,
March 2010: p32-39
This paper describes and critically reviews steps taken to address the nursing workforce shortage in Malaysia.
Background: To address the shortage and to build health care capacity, Malaysia has more than doubled its nursing workforce over the past decade, primarily through an increase in the domestic supply of new graduates.
Methods: Government reports, policy documents and ministerial statements were sourced from the Ministry of Health Malaysia website and reviewed and analysed in the context of the scholarly literature published about the health care workforce in Malaysia and more generally about the global nursing shortage.
Results: An escalation in student numbers and the unprecedented number of new graduates entering the workforce has been associated with other impacts that have been responded to symptomatically rather than through workplace reform. Whilst growing the domestic supply of nurses is a critical key strategy to address workforce shortages, steps should also be taken to address structural and other problems of the workplace to support both new graduates and the retention of more experienced staff.
Conclusion: Nursing shortages should not be tackled by increasing the supply of new graduates alone. The creation of a safe and supportive work environment is important to the long-term success of current measures taken to grow the workforce and retain nurses within the Malaysian health care system.

7. Supporting Indian nurses migrating to New Zealand: a literature review. International Nursing Review, Volume 57, Issue 1, March 2010: p40-48

Background: New Zealand, like many other Western countries, is struggling to cope with increasing demands for nursing services. Registered nurses are being actively recruited internationally and New Zealand has become a popular destination for nurses who wish to emigrate, including those from India. These nurses have unique cultural, professional and educational needs yet it is unclear how to best support them as they move to their destination countries.
Aims: The issues around nursing migration and its effects have been discussed in many forums, but there is evidence of a gap in understanding the issues around acculturation and socialization. This selected literature review sought to identify the significant factors that impact on migrating nurses becoming competent and confident registered nurses in the New Zealand practice environment.
Methods: A bibliographical database search was undertaken (Web of Knowledge, Web of Science, CINAHL, Medline, Academic Search Elite, and Ebscohost EJS) along with national and international nursing websites for the period 2002–2009. Search terms included Indian nurse, international nurse, migration, experience, cultural safety, globalization, nurse migration, nurse recruitment, New Zealand and research. The search was limited to texts published in English, with preference given to peer-reviewed research-based articles.
Results: A significant volume of literature was located. The key themes that arose were migration, education, language, nursing skills, competence, cultural safety and reflection on practice. Literature considered to best reflect these main themes, and of most relevance to New Zealand, was selected for this review, with preference given to research reports and official nursing publications.
Conclusion: Strategies such as providing ongoing professional education, ensuring cultural safety and offering mentoring in practice environments will contribute to a safe passage for migrating nurses. Further research is required into the acculturation and socialization of Indian nurses, especially those moving to New Zealand.

8. Bibliometric review of references of nursing research papers during the decade 1994–2003 in Turkey. International
Nursing Review
, Volume 57 Issue 1, March 2010: p49-55
To identify important information on the state of academic nursing and the characteristics of academic nursing publications in Turkey.
Methods: The study consists of retrospective bibliometric research. The selected sample of the research consisted of six Turkish nursing journals published between 1994–2003 from a total population of ten journals. Seventy-four issues of these six journals were included and 825 research papers were analysed. A series of classic bibliometric
indexes were used.
Results: The average number of references per scientific paper is 16.19 [±standard deviation (SD) 8.56]. The changes in the number of references taken from journals over time do not show strong fluctuations but were statistically significant (P < 0.001). The average number of references per paper is 17.71 (±SD 8.09) for research papers, while it is 14.50 (±SD 8.76) for reviews. The Price's index is 23.8% and the insularity index is 31.8%.
Conclusions: The number of references used for papers has been increasing in recent years. The use of journals within references is high while the use of books is low. The Price's index tendency is decreasing. The high insularity index observed in the articles may be considered as a negative indicator of nursing journals in Turkey.

Original articles
9. Voices of internationally educated nurses: policy recommendations for credentialing. International Nursing Review
Volume 57, Issue 1, March 2010: p56-63
Background: The authors advance general policy recommendations for credentialing Internationally Educated Nurses (IENs) who migrate to practice nursing in developed, high-income countries. While examples are drawn primarily from a qualitative study exploring IEN experiences in Canada, the suggestions presented have broader application to any nursing, or midwifery, internationally educated professionals wanting, or needing, to practice outside their home
country of education. Examples of credential processing are drawn from Australia, the European Union, New Zealand, the UK and the USA.
Methods: This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IENs volunteered to participate.
Results: The IENs offered recommendations based on their personal experiences, all of which have policy implications to make transparent, standardize and harmonize the credentialing processes both prior to, and upon arrival in their destination country. Suggestions are offered to make relevant the content of IEN integration programmes.
Conclusions: The authors also suggested that national immigration agencies and nursing regulatory bodies could better coordinate their activities when processing potential IEN migrant applications.

10. Italian–Moldovan international nurse migration: rendering visible the loss of human capital. International Nursing Review, Volume 57, Issue 1, March 2010: p64-69
To describe the process of the migration of Moldovan nurses to Italy.
Background: Formerly a part of the Soviet Union, the Republic of Moldova gained independence in 1991. Currently, there are 25 848 nurses (60.6 per 10 000 inhabitants) working mainly in the public health system. Each year, around 2000 nurses leave the country in search of better working conditions and a better quality of life.
Methods: A longitudinal study design was adopted (2006–2007). In the first phase, we contacted all known nurses living in Moldova and their available colleagues following a snowball sampling strategy. Inclusion criteria were nurses who had decided to migrate to Italy and had already prepared the migration documents and/or were awaiting
their departure. In the second phase, we interviewed the same sample of nurses on arrival in Italy.
Findings: After one year, only 25 nurses out of the 110 initially interviewed (22.7%) had arrived in Italy; none were working as nurses. The cost of the migration process incurred by each nurse was around 3278 euros, and the waiting time from the decision to leave until arrival was around 24 months.
Conclusions: All Moldovan nurses involved in this study, once they arrived in Italy, ceased to exist from an official perspective. Policy and recommendations need to be developed to ensure the integration of Moldovan-educated nurses into the health-care system and to monitor the amount of human capital (in terms of care drain, brain drain and youth drain) that this process risks wasting.

11. Culture, context and community: ethical considerations for global nursing research. International Nursing Review
Volume 57, Issue 1, March 2010: p70-77
High-quality research is essential for the generation of scientific nursing knowledge and the achievement of the Millennium Development Goals. However, the incorporation of Western bioethical principles in the study design may not be suitable, sufficient or relevant to participants in low-income countries and may indeed be harmful and disrespectful. Before engaging in global health studies, nurses must consider carefully the cultural and social context and values of the proposed setting in order to situate the research within the appropriate ethical framework. The purpose of this paper was to examine the ethical principles and considerations that guide health research conducted in international settings using the example of a qualitative study of Ugandan nurses and nurse-midwives by a Canadian researcher. The application of Western bioethical principles with their emphasis on autonomy fails to acknowledge the importance of relevant contextual aspects in the conduct of global research. Because ethics is concerned with how people interact and live together, it is essential that studies conducted across borders be respectful of, and congruent with, the values and needs of the community in which it occurs. The use of a communitarian ethical framework will allow nurse scientists to contribute to the elimination of inequities between those who enjoy prosperity and good health, and those who do not.

12. Taiwanese nurses' cognition and attitudes towards the Magnet Hospitals Recognition Programme. International
Nursing Review
, Volume 57, Issue 1, March 2010: p78-84
To explore the relevance and feasibility of using the Magnet Recognition Programme (MRP) at a Taiwanese hospital.
Background: Since no hospitals in Taiwan have applied for American Nurses Credentialing Center Magnet Recognition, and the American medical system and customs are different from those in Taiwan, this study explores whether or not the MRP is appropriate for Taiwanese hospitals.
Method: This study used a cross-sectional design with data collected from 905 nurses at a 1200-bed Taiwanese military hospital. The authors created the structured questionnaire from a framework based on the 14 Forces of Magnetism. The study used descriptive and inferential statistical analyses to explain the nurses' cognitions and
attitudes towards the MRP and to discover if variations in these concepts occurred across nurses' demographics and their job classification.
Findings: The mean nurses' cognitive score on each item varies from 3.3 to 4.1, and the mean nurses' attitude score on each item varies from 3.0 to 4.0 (both with the highest possible score related to the 14 Forces of Magnetism being 5.0). Using regression analysis, overall cognitive score, working in the operating room, or the sub-critical
Neonatal Care Unit, and part-time hours of work explained 42% of the variance in the total attitude score towards the MRP.
Conclusion: The findings indicate that when nurses have a higher cognition towards MRP, the more positive are their attitudes towards seeking the MRP. Using these findings and information about the nurses, the authors suggest strategies that hospital executives and nursing supervisors can use to improve nurses' cognition and attitudes when preparing to seek recognition through the MRP.

13. Job satisfaction amongst Dutch nurse anaesthetists: the influence of emotions on events.  International
Nursing Review:
p 85-91
An ageing population, combined with a shortage of health-care professionals, can result in a decrease in the capacity of health-care systems. Therefore, it is important to explore possible solutions for this problem. By finding methods to increase job satisfaction, it may be possible to retain employees within their profession. In this study, we examined events, their influence on emotions and, consequently, the effect of these emotions on job
satisfaction. We attempted to answer the question: Which events and emotions influence job satisfaction?
Methods:  We collected data on events and emotions, and their effects on job satisfaction, amongst Dutch nurse anaesthetists. Participants (n = 314) were asked to complete two questionnaires about events, emotions and job satisfaction at two different times during an average working day.
Results:  One hundred thirty-two nurse anaesthetists from 24 Dutch hospitals participated. Both positive and negative events were significant in the development of positive and negative emotions at the end of the working day. Positive emotions at the end of the working day contributed significantly to job satisfaction. Negative emotions did not have a significant effect on job satisfaction.
Conclusions:  The mediating role of positive emotions in relation to positive and negative events should be taken into account in managing job satisfaction amongst Dutch nurse anaesthetists. Further research is necessary to determine whether the relationship between events and emotions provides a foundation for developing a more positive working atmosphere, and also to explore how hospitals can trigger positive emotions to increase job satisfaction.

14. Nurses' reported influence on the prescription and use of medication. International  Nursing Review, Volume 57, Issue 1, March 2010: p92-97
To identify the activities senior nurses report undertaking that may influence the prescription and use of medicines.
Background: While much attention has focused on the role of nurse prescribing, little is known about the extent to which non-prescribing nurses influence medication decision making. The pharmaceutical industry recognizes this influence in its marketing strategies, and courts nurses by provision of promotional material and sponsorship of  nursing professional development.
Methods: We undertook parallel web- and paper-based surveys of 100 senior registered nurses employed by government-funded health boards in two distinct New Zealand regions.
Findings: Only 2/96 (2%) of nurses had prescribing rights, yet 74/94 (79%) reported recommending treatments to the prescribing doctor, 74/95 (79%) stated they provided advice to patients about over-the-counter medications and 71/92 (77%) participated in the development of guidelines or policies that include the use of medications. All nurses in this sample reported influencing the prescription of medicines in one way or another.
Discussion: From actually writing prescriptions to providing feedback on treatment outcomes, there are many opportunities for nurses to influence the decision making of medical and other prescribers, which open nurses to exploitation from commercial forces. Policy and education regarding prescriber relationships with the pharmaceutical
industry should also recognize the role of non-prescribing nurses.

15. Registered nurses' medication management of the elderly in aged care facilities. International Nursing Review, Volume 57, Issue 1, March 2010: p98-106
Data on adverse drug reactions (ADRs) showed a rising trend in the elderly over 65 years using multiple medications.
Aim: To identify registered nurses' (RNs) knowledge of medication management and ADRs in the elderly in aged care facilities; evaluate an education programme to increase pharmacology knowledge and prevent ADRs in the elderly; and develop a learning programme with a view to extending provision, if successful.
Method: This exploratory study used a non-randomized pre- and post-test one group quasi-experimental design without comparators. It comprised a 23-item knowledge-based test questionnaire, one-hour teaching session and a self-directed learning package. The volunteer sample was RNs from residential aged care facilities, involved in
medication management. Participants sat a pre-test immediately before the education, and post-test 4 weeks later (same questionnaire). Participants' perceptions obtained.
Findings: Pre-test sample n = 58, post-test n = 40, attrition rate of 31%. Using Microsoft Excel 2000, descriptive statistical data analysis of overall pre- and post-test incorrect responses showed: pre-test proportion of incorrect responses = 0.40; post-test proportion of incorrect responses = 0.27; Z-test comparing pre- and post-tests
scores of incorrect responses = 6.55 and one-sided P-value = 2.8E-11 (P < 0.001).
Conclusion and implications: Pre-test showed knowledge deficits in medication management and ADRs in the elderly; post-test showed statistically significant improvement in RNs' knowledge. It highlighted a need for continuing professional education. Further studies are required on a larger sample of RNs in other aged care facilities, and
on the clinical impact of education by investigating nursing practice and elderly residents' outcomes.

Journals - Table of Contents

16. From the Journal of Advanced Nursing, Volume 66, Number 3, March 2010
16A. Literature searching and locating qualitative data and studies
16B. Nurses' experiences with telephone triage and advice: a meta-ethnography (p 482-494)
16C. Electronic retrieval of health information by healthcare providers to improve practice and patient care; First-line drugs for hypertension
; Heparin for the prevention of venous thromboembolism in general medical patients (excluding stroke and myocardial infarction); Interventions for post-stroke fatigue (p 495-499)
RESEARCH PAPERS - Original Research
16D. Huntington disease: families' experiences of healthcare services (p 500-510)
16E. Making sense of patients' use of analgesics following day case surgery (p 511-521)
16F. Implementing nurse prescribing: a case study in diabetes (p522-531)
16G. Nursing students administering medication: appreciating and seeking appropriate supervision (p 532-541)
16H. The nurse practitioner role in pain management in long-term care (p 542-551)
16I. Keeping Vigil over the Patient: a grounded theory of nurse anaesthesia practice (p 552-561)
16J. Protocols for pressure ulcer prevention: are they evidence-based? (p 562-572)
16K. Is nurse–patient agreement of importance to cancer nurses' satisfaction with care? (p 573-582)
16L. Efficacy beliefs predict collaborative practice among intensive care unit nurses (p 583-594)
16M. Predictors of fear and anxiety nine years after coronary artery bypass grafting (p 595-606)
16N. Rehabilitation programme after stem cell transplantation: randomized controlled trial (p 607-615)
16O. Leaving the organization or the profession – a multilevel analysis of nurses' intentions (p 616-626)
16P. Occupational stress among hospital nurses: cross-sectional survey (p 627-634)
16Q. A curriculum for nurses in Germany undertaking medically-delegated tasks in primary care (p 635-644)
Research Methodology
16R. Evaluation of five search strategies in retrieving qualitative patient-reported electronic data on the impact of pressure ulcers on quality of life (p 645-652)
16S. Psychometric testing of the Health Quotient questionnaire: a measure of self-reported holistic health (p 653-663)
16T. The Disaster Preparedness Evaluation Tool©: psychometric testing of the Classical Arabic version (p 664-672)
16U. Development of a tool to assess fidelity to a psycho-educational intervention (p 673-682)
16V. Trust in Nurses Scale: construct validity and internal reliability evaluation (p 683-689)
16W. Accidental falls in hospital inpatients: evaluation of sensitivity and specificity of two risk assessment tools (p 690-696)
16X. Models of disability: their influence in nursing and potential role in challenging discrimination (p 697-707)

Conferences, Training, Seminars

17. Midwifery Today International Conference
Birth is a human rights issue - Every mother and baby has the right to be treated with reverence and respect during
the birth process during pregnancy and beyond.

Date: 29 September - 3 October 2010
Venue: Strasbourg, France
More information:

News – National

18. Relaxed minds remember better - study
TVNZ - 26 March 2010
Stronger and more lasting memories are likely to be formed when a person is relaxed and the memory-related neurons in the brain fire in sync with certain brain waves, scientists said on Thursday. Researchers from the United States said their findings could help develop new therapies for people with learning disabilities and some types of dementia

News - International

19. No new health policies to sell
Sydney Morning Herald - March 22, 2010
Voters won't hear any new policy details on health and hospitals from the government or the coalition during Tuesday's leaders' debate. Prime Minister Kevin Rudd and Opposition Leader Tony Abbott are set to go head-to-head on the key election issue during a nationally televised debate.



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