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Issue 199 - 4 Oct 2011

Articles on Kidney Transplants

1. Clinical Consult. Post-Kidney Transplant Rejection and Infection Complications
By Ding, Dadi. Nephrology Nursing Journal, Jul/Aug2010, Vol. 37
Issue 4: p419-426
The article provides an answer to a question of the most common complications of post-kidney transplant rejection and infection and how to manage them.

2. Self-efficacy, self-care behaviours and quality of life of kidney transplant recipients.
By Weng, Li-Chueh et al. Journal of Advanced Nursing, Apr 2010, Vol. 66 Issue 4: p828-838
This paper is a report of an exploration of the effects of self-efficacy and different dimensions of self-management on quality of life among kidney transplant recipients.
Background. Self-efficacy is an important factor influencing self-management. Patients with higher self-efficacy have better self-management and experience better quality of life. Self-efficacy influences the long-term medication-taking behaviour of kidney transplant recipients.
Method. A longitudinal, correlational design was used. Data were collected during 2005–2006 with 150 adult kidney transplant recipients on self-efficacy, self-management and quality of life using a self-efficacy scale, self-management scale and the Medical Outcomes Scale SF-36 (Chinese), respectively. Relationships among variables were analysed by path analysis.
Results. Participants with higher self-efficacy scored significantly higher on the problem-solving ( ß = 0·51), patient–provider partnership ( ß = 0·44) and self-care behaviour ( ß = 0·55) dimensions of self-management. Self-efficacy directly influenced self-care behaviour and indirectly affected the mental health component of quality of life (total effect = 0·14). Problem-solving and partnership did not statistically significantly affect quality of life. Neither self-efficacy nor self-management had any effect on the physical health component of quality of life.
Conclusion. Transplant care teams should incorporate strategies that enhance self-efficacy, as proposed by social cognitive theory, into their care programmes for kidney transplant recipients. Interventions to maintain and improve patients’ self-care behaviour should continue to be emphasized and facilitated. Support to enhance patients’ problem-solving skills and the partnership of patients with health professionals is needed. [ABSTRACT FROM AUTHOR]

3. Perceptions of a Multiple Kidney Transplant Recipient: Understanding A Fragile Life
By Scott, Karen Wilson & Hollingsworth, Guy M. Nephrology Nursing Journal, Mar/Apr2010, Vol. 37 Issue 2: p161-167
This mixed classical and interpretive biographical study investigates the experience of living with a chronic illness as perceived by a wife and mother who is a multiple kidney transplant recipient. This article highlights her efforts to address challenges associated with this illness, and at the same time, improve her individual worth through ongoing, lifelong learning process. [ABSTRACT FROM AUTHOR]

Articles from Journal of Advanced Nursing, Volume 67, Issue 10, October 2011

4. REVIEW PAPER - Medication administration technologies and patient safety: a mixed-method systematic review
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
Healthcare leaders need evidence-based information on nursing medication administration technologies to guide the design of improvements to patient safety.
Aim.  The aim of this study was to evaluate the research evidence on relationships between the use of medication administration technologies and incidence of medication administration incidents and preventable adverse drug events to inform decision-making about existing technology options.
Data sources.  Thirteen electronic databases and seven relevant patient safety websites were searched for the years 1980–2009.
Review methods.  A mixed-method systematic literature review of research on medication administration technologies and associated links to patient safety, operationalized as medication administration incidents and preventable adverse drug events, was conducted.
Results.  Twelve studies (two qualitative, five pre- and postinterventions and five correlational) met the inclusion criteria. All were assessed as medium quality with low generalizability of study findings. Only two studies sampled more than one hospital and none of the studies was driven by an explicit theoretical framework. The studies included in this review are generally positive towards medication administration technologies and their potential benefits, yet the level of evidence overall is equivocal. The majority of studies pointed to the development of workarounds by nurses following medication administration technology implementation that could compromise patient safety.
Conclusion.  More theoretically driven research is needed to determine which medication administration technologies should be implemented in what ways to most effectively reduce medication administration incidents and preventable adverse drug events and minimize the development of potentially unsafe workarounds. Further evidence is required to accurately assess the actual contribution of medication administration technologies for improving patient safety.

5. Self-care of school-age children with diabetes: an integrative review
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This paper is a report of an integrative review of findings from empirical studies on self-care in school-age children with type 1 diabetes. The purpose is to generate insight into opportunities to develop empowering patient education.
Background.  Managing diabetes is demanding and requires parental involvement in care. Good self-care forms the basis for diabetes management and self-care patterns are established at school age, but how and to what extent school-age children increase their self-care capabilities is unclear.
Data sources.  A search for studies from 1998 to 2010 focusing on self-care in school-age children with diabetes was conducted through electronic databases.
Review methods.  Using integrative methods, quantitative and qualitative papers surveyed were analysed separately, but the themes that arose were combined at the end of the analysis.
Findings.  Self-care is formed in a learning process involving the objectives of normality, being able to cope and independence. The content of self-care is a combination of knowledge and skills. Children have the technical skill, but they need their parents to participate in the care and share responsibility for it. The factors related to self-care comprised the characteristics of the child; the nature of the illness and care; and support from the parents, school environment, peers and healthcare team.
Conclusion.  A balance between diabetes care requirements and a child’s maturity should be found. Nurses must adopt an empowering manner of education and recognize and assess a child’s readiness to learn diabetes care and bear responsibility for it. Nurses must also help parents and other adults to gradually shift the responsibility to the children.

6. Non-direct patient care factors influencing nursing workload: a review of the literature 
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  The aim of this paper was to detect which non-direct patient care factors are related to nursing workload in acute hospital nursing care and to develop a conceptual model to describe the relationship between the non-direct patient care factors and nursing workload.
Background.  Since the 1930s, efforts to measure nursing workload have been undertaken. Still, it remains unclear which of the non-direct patient care elements are essential to the nursing workload.
Data sources.  PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Engineering Village 2, Elin and the British Nursing Index were searched from 1970 up to July 2009.
Review methods.  Studies were included in this integrative review if they described factors that are related to nursing workload or if they presented models that explored the association between potential factors, excluding the factors related to direct patient care.
Results.  Thirty publications were included. The influencing variables were classified in five categories based on their level of impact: the hospital and ward, nursing team, individual nurse, patient and family and meta-characteristics. The variables were also classified, based on their cause–effect relationship. Some factors have a direct impact on the patient-nurse relationship, while others have an effect on the work fluency or on the subjective perception of the nursing workload. A conceptual model was built, based on the interaction between both classifications and derived from the systems theory.
Conclusions.  Nursing workload has a multi-causal aetiology. The influencing factors from this review can be integrated in a workload measurement tool.

Original Research
7. ‘Safe passage’: pregnant Iranian Kurdish women’s choice of childbirth method
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This article is a report of a grounded theory study of the influence of emotions on women’s selection of a method of childbirth.
Background.  There is substantial evidence to indicate that a pregnant woman’s emotions play an important role in the decision-making process of selecting a child delivery method. Despite this, however, there is a notable lack of research about the relationship between pregnant women’s emotions and their choice of a childbirth method in developing countries.
Methods.  A qualitative study using the grounded theory approach was conducted. The data were collected from 22 Iranian Kurdish pregnant women in their third trimester using semi-structured interviews. Concurrent data collection and analysis took place between 2008 and 2009. A cumulative process of theoretical sampling and constant comparison was used to identify concepts and then expand, validate, and clarify them.
Findings.  The substantive grounded theory that was identified from data analysis was ‘safe passage’. ‘Safe passage’ involved five phases that were not mutually exclusive in their occurrence. The five phases of the ‘safe passage’ theory that were identified from the data analysis were: ‘safety of baby’, ‘fear’, ‘previous experience’, ‘social support’ and ‘faith’. The goal of ‘safe passage’ was to achieve a healthy delivery and to ensure the health of the newborn.
Conclusion.  ‘Safe passage’ was a process used to determine how the emotions of pregnant Iranian Kurdish women influenced their choice of the mode of child delivery. More research is needed in this field to develop a body of knowledge beneficial to midwifery education and practice.

8. Examination of the utility of the Promoting Action on Research Implementation in Health Services framework for implementation of evidence based practice in residential aged care settings
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care.
Background.  Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care.
Methods.  This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007–2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities.
Findings.  Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents’ home, staff’s workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged.
Conclusion.  Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change.

9. Readjusting one’s life in the tension inherent in work and motherhood
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This paper is a report on a study undertaken to interpret employed first-time mothers’ experiences of returning to work after maternity leave, in a Norwegian context.
Background.  Despite the increasing rate of employed fertile women and increasing welfare benefits to support the work-life balance, the first years after giving birth are described as being the most demanding on mothers’ health. However, little is known about mothers’ experiences of returning to work after maternity leave.
Methods.  The study included nine Norwegian employees who were individually interviewed during the first months after their return to work following maternity leave. The interviews were conducted during 2009 and interpreted using a method grounded in hermeneutics.
Findings.  Overall, the meaning of returning to work was interpreted as ‘Readjusting one’s life in the tension inherent in work and motherhood’. This comprehensive theme was based on three sub-themes: (a) Striving to manage the workload and taking responsibility for the best interests of the child, (b) Struggling with feelings of not being a good enough mother, and (c) Maintaining a balance between sensitivity and self-confidence.
Conclusion.  Returning to work after maternity leave appears to be a transitional phase that can be critical to the well-being of first-time mothers. To support women during this phase, employers and public health nurses should monitor the work in relation to the women’s capacity and value their competence both as employees and mothers.
10. Learning to live well with chronic fatigue: the personal perspective
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  Persistent fatigue is recognized as an integral and significantly disabling aspect of the experience of living with a long-term health condition. Acute medical care models have limited applicability when seeking to provide health care to meet the needs of those living with chronic fatigue.
Aims.  This article is a report of a study that sought to understand how people can live well in spite of the presence of chronic fatigue.
Methods.  A thematic analysis was conducted on 43 narratives provided by people living with chronic fatigue during 2007 as part of an internet-based study.
Findings.  This report focuses on the two themes that appeared of most relevance to participants: managing energy and redefining self. Two particular approaches to energy management were noted. In the first, the focus is upon moderating and avoiding excess to manage energy. In the second approach, the body was conceptualized as a machine so that energy becomes a limited resource to be managed. Work to redefine the sense of self appeared to be focused upon the desire to seek normality, to see oneself as rational and come to terms with change.
Conclusion.  People can and do find ways to live well with chronic fatigue. Understanding how the person with chronic fatigue has come to conceptualize his/her experiences will be a more fruitful starting point than providing recipes for successful living if nurses are to work effectively with this group of people.
11. Living with severe mental illness: perception of sickness
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This article is a report of a study on how participation in photo groups influenced the perception of the impact of sickness on daily life.
Background.  Living with severe mental illness can have a strong impact on daily life and the experience of self. In combination with self-stigmatization, this can lead to a sense of being no more than a patient.
Method.  A mixed-methods design was used to measure the perception of sickness impact. Consumers of psychiatric services participated in photography groups that aimed at integration of illness and developing new goals in life. These groups were conducted by nurses and data were collected between the years 2005 and 2009. The Sickness Impact Profile (SIP) questionnaires were completed by the respondents before and after intervention. The SIP was used to differentiate between respondents who perceived less impact of illness on their daily lives after following a photogroup and those who did not perceive so or remained the same. A sample of these three groups was used to complement the quantitative findings with in-depth interviews with consumers and mentor nurses.
Results.  Findings indicated absence of important changes in the sickness impact scores except in the domain of mobility. Consumers did, however, show signs of progress in terms of increasing openness, understanding of their feelings and situation and abilities to cope with them.
Conclusion.  Participating in photo groups can help patients get along with their life and make it more bearable. No signs of demoralization and self-stigmatization were found.

12. Relationships between preventive activities, psychosocial factors and recurrence of venous leg ulcers: a prospective study
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  The aim of this study was to identify relationships between preventive activities, psychosocial factors and leg ulcer recurrence in patients with chronic venous leg ulcers.
Background.  Chronic venous leg ulcers are slow to heal and frequently recur, resulting in years of suffering and intensive use of healthcare resources.
Methods.  A prospective longitudinal study was undertaken with a sample of 80 patients with a venous leg ulcer recruited when their ulcer healed. Data were collected from 2006 to 2009 from medical records on demographics, medical history and ulcer history; and from self-report questionnaires on physical activity, nutrition, preventive activities and psychosocial measures. Follow-up data were collected via questionnaires every 3 months for 12 months after healing. Median time to recurrence was calculated using the Kaplan–Meier method. A Cox proportional-hazards regression model was used to adjust for potential confounders and determine effects of preventive strategies and psychosocial factors on recurrence.
Results.  There were 35 recurrences in a sample of 80 participants. Median time to recurrence was 27 weeks. After adjustment for potential confounders, a Cox proportional hazards regression model found that at least an hour/day of leg elevation, 6 or more days/week in Class 2 (20–25 mmHg) or 3 (30–40 mmHg) compression hosiery, higher social support scale scores and higher General Self-Efficacy scores remained significantly associated (P < 0·05) with a lower risk of recurrence, while male gender and a history of deep vein thrombosis remained statistically significant risk factors for recurrence.
Conclusion.  Results indicate that leg elevation, compression hosiery, high levels of self-efficacy and strong social support will help prevent recurrence.

13. Multi-disciplinary perceptions of patient group directions as a replacement for the pro re nata prescribing of antipsychotic medications in acute mental health settings
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  Patient group directions have been used in the NHS for 10 years. Despite high levels of reported use, few studies have examined staff perceptions or evaluated them in practice. In mental health services, pro re nata prescriptions continue to contribute to high doses and polypharmacy of antipsychotics. Replacing pro re nata with patient group directions might improve the quality and safety of care associated with this practice.
Aims.  This study aimed to explore the acceptability of patient group directions in acute mental health services.
Method.  Qualitative methods were used. Data were analysed using thematic content analysis. Twenty-six members of the multi-disciplinary team (doctors, nurses and pharmacists) participated in either focus groups or individual interviews in 2009.
Results.  A broad range of benefits were suggested, including improved safety and access to treatments, and the professional development of nurses. However, concerns also emerged about the need for a culture shift in thinking, and the danger of multiple systems for the supply of medicines.
Conclusion.  Despite the widespread use of patient group directions in clinical settings in the last 10 years, limited research has examined their development and potential. Patient group directions can potentially give a rigorous means of supplying or administering medicines. However, their development requires careful consideration.

14. Perinatal attachment in naturally pregnant and infertility-treated pregnant women in Taiwan
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
This article is a report of a study of the differences in maternal-foetal attachment and maternal-infant attachment among naturally pregnant and infertility-treated pregnant women in Taiwan.
Background.  Studies have shown that infertility treatment is likely to make up an increasing proportion in the coming years. As these experiences are unique, the attachment relationship may be affected.
Method.  The research data were collected from two obstetrics clinics which were located in central Taiwan. In 2008, all participants (n = 125) were asked to fill out the prenatal questionnaires at the beginning of the study and were followed up with postnatal questionnaires that were mailed to them 1–2 months after labour (n = 110). We used chi-square tests for categorical and t- tests for continuous variables. Multivariate analysis of variances was then performed, and changes in the maternal–foetal attachment and maternal–infant attachment Scales were assessed.
Findings.  Women who became pregnant after fertility treatment had higher maternal-foetus and maternal-infant attachment scores, and this result was statistically significant; pregnancy mode and level of education are the main factors that have a significant effect on maternal–foetus attachment; and pregnancy mode and participation in prenatal education have a main effect on maternal–infant attachment.
Conclusion.  Development of a specific support group for mothers, such as a group for prenatal education, and providing useful resources for pregnant women with a lower level of education are involved in the future research studies for therapeutic intervention

15. Do targeted child health promotion services meet the needs of the most disadvantaged? A qualitative study of the views of health visitors working in inner-city and urban areas in England
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
The aim of this study was to explore health visitors’ views on the effects of policy change on the services they offer to preschool children in areas of high health inequalities in England.
Background.  Child health promotion services are offered throughout the world to maintain and improve children’s health. It is not known how the policy shift to a more overtly targeted service, which has occurred in some countries, has affected child health promotion practice in areas of deprivation.
Methods.  An in-depth telephone interview study was conducted between October 2006 and January 2007. All participants (n = 25) were registered health visitors who had taken part in a 2005 National Survey of Child Health Promotion Practice in England and were delivering health promotion services to preschool children in inner-city and urban areas.
Results.  Despite high levels of need, some children who would have benefited from an enhanced health visiting service were offered only the core programme. Local interpretation of national policy is a key factor in determining the level of service offered, and the extent of targeting.
Conclusion.  This study illustrates the importance, in any country, of exploring the effects of national policy change from the perspective of practitioners, to identify unintended outcomes. Reductions in the core child health promotion programme can lead to difficulties in monitoring and improving children’s health outcomes in areas of deprivation.

16. Searching for harmony: parents’ narratives about their child’s genital ambiguity and reconstructive genital surgeries in childhood
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This paper is a report of a narrative study of parents’ experiences of their child’s genital ambiguity and the place reconstructive surgeries have in their lives.
Background.  Increasingly, the use of early reconstructive genital surgery has come under criticism. Few studies have explored parents’ inclusion in the surgical decision-making process, their experiences of their child’s surgeries or of parenting a child born with ambiguous genitalia.
Method.  Narrative interviews about parents’ experiences of having and caring for a child of uncertain gender and their rationale for reconstructive surgeries were conducted with 15 parents between October 2004 and February 2006. Interviews were recorded, transcribed verbatim and analysed in a narrative analysis framework.
Results.  Narrative analysis resulted in three increasingly contextual and conceptual levels of stories. Connections between stories gave the basis for the synthesis of the data; interpretation identified three elements of shock, protection and anxiety, which influenced the parents. The parents identified the need for early and ongoing support from healthcare professionals. The parents expected professionals to be knowledgeable about the dilemmas surround disorders of sex development and have experience in managing care for themselves and their child.
Conclusion.  For the parents seeking a sense of harmony between their child’s genital ambiguity and gender during childhood was important. Searching for this harmony became a dynamic and evolving process, which was built on their knowledge and increasing willingness to engage with professionals, negotiate their social worlds, emotional responses and belief systems.

17. A survey of the practice of nurses’ skills in Wenchuan earthquake disaster sites: implications for disaster training
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
To determine nursing skills most relevant for nurses participating in disaster response medical teams; make recommendations to enhance training of nurses who will be first responders to a disaster site; to improve the capacity of nurses to prepare and respond to severe natural disasters.
Background.  Worldwide, nurses play a key role in disaster response teams at disaster sites. They are often not prepared for the challenges of dealing with mass casualties; little research exists into what basic nursing skills are required by nurses who are first responders to a disaster situation. This study assessed the most relevant disaster nursing skills of first responder nurses at the 2008 Wenchuan earthquake disaster site.
Method.  Data were collected in China in 2008 using a self-designed questionnaire, with 24 participants who had been part of the medical teams that were dispatched to the disaster sites.
Findings.  The top three skills essential for nurses were: intravenous insertion; observation and monitoring; mass casualty triage. The three most frequently used skills were: debridement and dressing; observation and monitoring; intravenous insertion. The three skills performed most proficiently were: intravenous insertion; observation and monitoring; urethral catheterization. The top three ranking skills most important for training were: mass casualty transportation; emergency management; haemostasis, bandaging, fixation, manual handling.
Conclusion.  The core nursing skills for disaster response training are: mass casualty transportation; emergency management; haemostasis, bandaging, fixation, manual handling; observation and monitoring; mass casualty triage; controlling specific infection; psychological crisis intervention; cardiopulmonary resuscitation; debridement and dressing; central venous catheter insertion; patient care recording.

18. Educating for teamwork – nursing students’ coordination in simulated cardiac arrest situations
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
The overarching aim was to explore and describe the communicative modes students employ to coordinate the team in a simulation-based environment designed for resuscitation team training.
Background.  Verbal communication is often considered essential for effective coordination in resuscitation teams and enhancing patient safety. Although simulation is a promising method for improving coordination skills, previous studies have overlooked the necessity of addressing the multifaceted interplay between verbal and non-verbal forms of communication.
Method.  Eighty-one nursing students participated in the study. The data were collected in February and March, 2008. Video recordings from 28 simulated cardiac arrest situations in a nursing programme were analysed. Firstly, all communicative actions were coded and quantified according to content analysis. Secondly, interaction analysis was performed to capture the significance of verbal and non-verbal communication, respectively, in the moment-to-moment coordination of the team.
Findings.  Three phases of coordination in the resuscitation team were identified: Stating unconsciousness, Preparing for resuscitation, Initiating resuscitation. Coordination of joint assessments and actions in these phases involved a broad range of verbal and non-verbal communication modes that were necessary for achieving mutual understandings of how to continue to the next step in the algorithm. This was accomplished through a complex interplay of taking position, pointing and through verbal statements and directives.
Conclusion.  Simulation-based environments offer a promising solution in nursing education for training the coordination necessary in resuscitation teams as they give the opportunity to practice the complex interplay of verbal and non-verbal communication modes that would otherwise not be possible.

19. Linking transformational leadership to nurses’ extra-role performance: the mediating role of self-efficacy and work engagement
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This paper is a report of a social cognitive theory-guided study about the link between supervisors’ transformational leadership and staff nurses’ extra-role performance as mediated by nurse self-efficacy and work engagement.
Background.  Past research has acknowledged the positive influence that transformational leaders have on employee (extra-role) performance. However, less is known about the psychological mechanisms that may explain the links between transformational leaders and extra-role performance, which encompasses behaviours that are not considered formal job requirements, but which facilitate the smooth functioning of the organization as a social system.
Methods.  Seventeen supervisors evaluated nurses’ extra-role performance, the data generating a sample consisting of 280 dyads. The nurses worked in different health services in a large Portuguese hospital and the participation rate was 76·9% for nurses and 100% for supervisors. Data were collected during 2009. A theory-driven model of the relationships between transformation leadership, self-efficacy, work engagement and nurses’ extra-role performance was tested using Structural Equation Modelling.
Results.  Data analysis revealed a full mediation model in which transformational leadership explained extra-role performance through self-efficacy and work engagement. A direct relationship between transformational leadership and work engagement was also found.
Conclusion.  Nurses’ supervisors with a transformational leadership style enhance different ‘extra-role’ performance in nurses and this increases hospital efficacy. They do so by establishing a sense of self-efficacy but also by amplifying their levels of engagement in the workplace.

20. Examining and establishing translational and conceptual equivalence of survey questionnaires for a multi-ethnic, multi-language study
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This paper is a report of techniques used to examine and establish translational and conceptual equivalence of survey questionnaires.
Background.  A major concern arose about standardization of translated survey questionnaires, when preparing to evaluate differences in acute coronary syndrome presentation in European (White), Chinese and South Asian patients.
Methods.  The survey questionnaires were first translated by an accredited translation company. Between July and November 2009, materials were taken to like-speaking healthcare reviewers to ensure that the clinical meaning was appropriate. Like-speaking lay reviewers were then asked to make comment about grammar; meaning and understanding of questions; and any concerns about the suitability of graphics. A key informant from each language group reviewed all comments and worked with the investigators and the translation company to create final sets of survey questionnaires.
Results.  Readability of the questionnaires (too complex or too basic) was the most common concern. A major discrepancy between ethnic groups arose about a graphic of ‘squeezing’ pain. A hand grasping a balloon was considered appropriate for European and South Asian groups, while a picture of a towel being wrung out was identified as more appropriate for the Chinese. There were no negative comments about the graphics. Soliciting key informants who were highly fluent in both English and the language under study was critical to ensure that the participants’ feedback was appropriately reconciled.
Conclusion.  Traditional forward–backward translation of study materials is insufficient. Translation must be accompanied by a process whereby equivalence and acceptability are also established.

21. Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing
Journal of Advanced Nursing, Volume 67, Issue 10, October 2011
  This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role.
Background.  Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians.
Data sources.  International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant.
Discussion.  The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus.
Implications for nursing.  Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support.
Conclusion.  The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

Journals - Table of Contents

22. From American Journal of Nursing, September 2011 - Volume 111 - Issue 9
Disaster Preparedness 10 Years After 9/11
22B. The Case for Specialized Transport Teams
In the News
. Finding Solutions to Advance Rural Health
22D. New Drug for Metastatic Melanoma Increases Survival Rate; HPV vaccine reduces cervical abnormalities in teens
22E. More Data: Transitional Care Reduces Readmissions; NewsCAP: NPs and physician assistants (PAs) deliver care equivalent to that of medical house staff in adult ICUs;NewsCAP: Every two additional hours of daily TV increases the risk of diabetes by 20%  
. Transforming Pain Care: An IOM Report; NewsCAP: Medical specialists more often deny treatment to children with public insurance
AJN Reports
. 9/11 and Nursing, 10 Years On
Drug Watch
. Two New Drugs for Chronic Hepatitis C; New Drug for Type 2 Diabetes; New Drug to Treat HIV Infection; Two Drugs Now Approved to Treat Pancreatic Cancers
Original Research
Blood Transfusion: The Patient's Experience; CE Test 2.4 Hours: Blood Transfusion: The Patient's Experience 
22J. Care of the Suicidal Pediatric Patient in the ED: A Case Study; CE Test 2.6 Hours: Care of the Suicidal Pediatric Patient in the ED: A Case Study
22K. Cultivating Quality: Creating a Unit-Based Resource Nurse Program
22L. Evidence-Based Practice, Step by Step: Sustaining Evidence-Based Practice Through Organizational Policies and an Innovative Model


23. Australasian Society for Psychiatric Research 2011 Conference
This years theme, From Idea to Implementation, will have a strong psychiatry and neurology focus and will appeal to people from a wide range of disciplines including psychiatrists, psychologists, mental health nurses & health professionals.
: 5 to 8 December 2011
Venue: Dunedin, New Zealand 
More information:

News - National

24. Community Pharmacist-led Anticoagulation Monitoring Services (CPAMS)
By Prof John Shaw et al
27 March 2011,%20John2.pdf

25. Working Towards Higher Living Standards for New Zealanders
25 May 2011
Authors: Ben Gleisner, Mary Llewellyn-Fowler & Fiona McAlister
Working Towards Higher Living Standards for New Zealanders describes how Treasury thinks about and works towards its vision of "higher living standards for New Zealanders"
Treasury's understanding of the term living standards goes beyond the narrow material definition - often proxied by GDP - to incorporate a broad range of material and non-material factors such as trust, education, health and environmental quality.  In taking a broad approach to understanding living standards, Treasury is in line with other economic institutions internationally. For example, the Australian Treasury acknowledges that "analyses of economic development or progress that only take income into account neglect other important determinants of wellbeing" and has thus developed its own wellbeing framework, while Stiglitz, Sen and Fitoussi's 2009 report for President Sarkozy's commission into Measuring Social and Economic Progress highlights the gap between "the information contained in aggregate GDP data and what counts for common people's wellbeing".

26. Big pharma loses case to Otara chemist
New Zealand Herald - 3 October 2011
A multinational pharmaceutical giant has been ordered to pay an Otara pharmacy for the costs of recalling a suspected faulty medicine.
Ian Johnson Pharmacy took GlaxoSmithKline to court seeking reasonable payment for expenses it incurred after the Marevan brand of blood-thinning medicine warfarin was recalled in January.

News - International

27. Regular aspirin users at higher risk of sight problems, research suggests
The Telegraph - 3 October 2011

People who take a daily dose of aspirin are twice as likely to suffer blindness in later life, a study suggests.


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