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Issue 35 - 18 October 2012

2012 issue - Kai Tiaki Nursing Research

The third issue of NZNO’s annual research magazine, Kai Tiaki Nursing Research (KTNR) has been published and it contains five articles of original New Zealand nursing research.
Subjects include: An analysis of the success of an extended Plunket Well Child/Tamariki Ora service for teenage mothers; an examination of the views of internationally qualified nurses and New Zealand-educated nurses in an increasingly multicultural workforce; what nurses see as impediments to the delivery of nursing care; the career commitment of generation Y nurses; and embedding quality improvement change in nursing practice.
Kai Tiaki Nursing Research is edited by nursing academic and educator Elizabeth Niven, RN, PhD. 
To subscribe: 
Phone: 0800 28 38 48

Books Available for Borrowing

1/  Achieving health in a rural community: A case-study of nurse-community partnership
By Merian Litchfield
Published in 2004

2/  Evidence for nursing practice
By Mary Courtney
Published in 2005
This is a unique text providing clear and practical step-by-step guidance on finding, appraising and using appropriate evidence for everyday use in a health care setting. There is an overview of instruments used to measure sensitive outcomes such as quality of life, functional assessment and psych-social aspects of health.

3/  Snakes and ladders: the pursuit of a safety culture in New Zealand public hospitals
By Peter Roberts
Published in 2003

4/  Real-World nursing survival guide: Hemodynamic monitoring
By Rebecca Hodges; Kitty Garrett; Cynthia Chernecky & Lori Schumacher
This book explains complex concepts such as cardiac output, stroke volume, preload, afterload and contractility. There is a complete chapter devoted to clinical applications that includes case studies, clinical interventions and exercises.

Articles - Folic Acid

5. U.S. Provider Reported Folic Acid or Multivitamin Ordering for Non-Pregnant Women of Childbearing Age: NAMCS and NHAMCS, 2005-2006
By Burris, Heather H.; Werler, Martha M. Maternal & Child Health Journal. Mar 2011, Vol. 15 Issue 3: p352-359
Folic acid use started prior to pregnancy confers a decreased risk of neural tube defects, and yet 20-50% of pregnancies are unplanned. We sought to determine whether medical providers order folic acid (FA) or folic acid-containing multivitamins (MVI) for their non-pregnant female patients of childbearing age. This is a cross-sectional study using data from the CDC's National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (2005 and 2006). Among non-pregnant, female patients of childbearing age (15-44), the proportion of preventive visits during which a provider ordered FA/MVI supplements was determined and compared to pregnant patients. Next, the rates of FA/MVI orders were examined according to race/ethnicity, age, insurance status, region of the country, provider type, contraceptive care, income and education. Analyses were conducted using SAS-callable Sudaan to account for survey design and to obtain population estimates. There were 4,634 preventive visits for non-pregnant women of childbearing age, representing 32.1 million visits nationally. Of these visits, 7.2% included provider-ordered FA/MVI. Multivariable logistic regression analyses revealed that provider-ordered FA/MVI was most common for women ages 30-34, who receive Medicaid, and whose race/ethnicity was other than White, Black or Hispanic. Preventive care visits represent an important venue for counseling regarding the benefits of FA for women of childbearing age, but appear to be under-utilized in all women. Our findings suggest that annually there may be over 29 million missed opportunities to recommend folic acid to non-pregnant women seeking preventive care. [ABSTRACT FROM AUTHOR].

6. For an Immune System Boost, Folic Acid Supplements?
Running & Fit News. Jan/Feb2011, Vol. 29 Issue 1: p9-10
: The article focuses on folic acid which is a synthetic form of folate that could improve the immune system. It says that the Recommended Dietary Allowance (RDA) of folate for healthy adults is 400 micrograms (mcg) a day, and the Tolerable Upper Intake Level from supplements or fortified foods is 1,000 mcg a day. Furthermore, it cites a study showing that folic acid supplementation in epileptic pregnant women can prevent congenital malformations in newborn infants..

7. CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects with Folic Acid Fortification
By Cordero, A.; Mulinare, J.; Berry, R. J.; Boyle, C.; Dietz, W.; Johnston Jr., R.; Leighton, J.; Popovic, T. MMWR: Morbidity & Mortality Weekly Report. 8/13/2010, Vol. 59 Issue 31: p980-984
The article discusses opportunities and strategies to prevent neural tube defects (NTDs) through folic acid fortification. The approaches to increase folate or folic acid intake include improving dietary habits, supplementation and food fortification. In the U.S., the mandatory fortification of enriched cereal grain products led to a substantial increase in blood folate concentrations. The disparities in NTD prevalence among racial and ethnic groups in the U.S. and the cost of folic acid food fortification in the U.S. and other countries are tackled..

Articles - Osteoporosis

8. Management and prevention of osteoporosis
By Sutcliffe, Anne. Practice Nurse. 5/11/2012, Vol. 42 Issue 8: p32-34
: The article discusses management and prevention of osteoporosis with the recent addition of secondary prevention of osteoporotic fractures to the Quality and Outcomes Framework (QOF) in April 2012. Practice nurses are advised to consider the incorporation of osteoporosis risk assessment into other areas of chronic disease management. Risk factor assessment may help guide in the assessment of future fracture risk and the need for therapeutic intervention

9. Quality-improvement interventions for osteoporosis: When are the results worth the effort?
By Majumdar, Sumit R. CMAJ: Canadian Medical Association Journal. 2/21/2012, Vol. 184 Issue 3: p279-280
In this article the author focuses on a study conducted by researcher W.D. Leslie and colleagues related to osteoporosis and improving the quality of postfracture care. It states that outcomes of the trial were not fractures but treatment and bone mineral density testing, which makes them get associated with better outcomes as they are linked to clinical trials. It mentions that the trial was noteworthy as outcomes were determined using routinely collected data..

Articles - Journal of Clinical Nursing

10. What factors influence the prevalence and accuracy of nursing diagnoses documentation in clinical practice? A systematic literature review
By Paans, Wolter; Nieweg, Roos MB; van der Schans, Cees P; Sermeus, Walter. Journal of Clinical Nursing. Sep 2011, Vol. 20 Issue 17/18: p2386-2403
. To identify what determinants influence the prevalence and accuracy of nursing diagnosis documentation in clinical practice.
Background. Nursing diagnoses guide and direct nursing care. They are the foundation for goal setting and provide the basis for interventions. The literature mentions several factors that influences nurses' documentation of diagnoses, such as a nurse's level of education, patient's condition and the ward environment.
Design. Systematic review.
Method. MEDLINE and CINAHL databases were searched using the following headings and keywords: nursing diagnosis, nursing documentation, hospitals, influence, utilisation, quality, implementation and accuracy. The search was limited to articles published between 1995-October 2009. Studies were only selected if they were written in English and were primary studies addressing factors that influence nursing diagnosis documentation. Results. In total, 24 studies were included. Four domains of factors that influence the prevalence and accuracy of diagnoses documentation were found: (1) the nurse as a diagnostician, (2) diagnostic education and resources, (3) complexity of a patient's situation and (4) hospital policy and environment.
Conclusion. General factors, which influence decision-making, and nursing documentation and specific factors, which influence the prevalence and accuracy of nursing diagnoses documentation, need to be distinguished. To support nurses in documenting their diagnoses accurately, we recommend taking a comprehensive perspective on factors that influence diagnoses documentation. A conceptual model of determinants that influence nursing diagnoses documentation, as presented in this study, may be helpful as a reference for nurse managers and nurse educators.
Relevance to clinical practice. This review gives hospital management an overview of determinants for possible quality improvements in nursing diagnoses documentation that needs to be undertaken in clinical practice. [ABSTRACT FROM AUTHOR].

11. Do nurses have a different physical health profile? A systematic review of experimental and observational studies on nurses' physical health
By Fronteira, Inês; Ferrinho, Paulo. Journal of Clinical Nursing. Sep 2011, Vol. 20 Issue 17/18: p2404-2424
- To review the evidence on nurses' health systematically. Background. Nurses are one of the most important resources of a health system. They are subjected to biological, socio-economic, cultural and health system factors that determine their health. Although mental and physical health problems seem to prevail among nurses, literature is often contradictory. The literature on health styles, health behaviours and self perceived health of nurses is also unclear.
Design. Systematic review of experimental and observational studies on nurses' health. Methods. Forty-three databases searched. 2692 references identified as of potential interest; 187 studies included. Only the results from studies on physical health are presented. No meta-analysis was possible. The Scottish Intercollegiate Guidelines Network system was used to rate evidence.
Results. Nurses were at greater risk of musculoskeletal injuries and more prone to blood-borne pathogens infections than other health care workers. They were at greater risk of breast cancer than other female health care workers. Nurses in hospitals were more at risk of tuberculosis. They did not have excess risk of cancer in general, Hodgkin's disease, stomach, colon, rectum, pancreatic, ovary, kidney, brain or thyroid cancer or of lymphosarcoma. They have a higher prevalence of occupational allergies than clerical workers.
Discussion. Nurses suffer more from musculoskeletal disorders which is consistent with the nature of nursing work. They are at greater risk of acquiring tuberculosis, particularly if they work in pulmonary, medicine or Human Immunodeficiency Virus wards which might be due to repeated contact with infected patients. Nurses are also more prone to blood-borne pathogens infections which might be explained by exposure while working. The proneness to occupational allergies can be explained by exposure to a series of chemical agents.
Relevance to clinical practice. Without sound knowledge on nurses' health and it is not possible to develop specific occupational health programmes. [ABSTRACT FROM AUTHOR].

12. Registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study
By Fossum, Mariann; Alexander, Gregory L; Göransson, Katarina E; Ehnfors, Margareta; Ehrenberg, Anna. Journal of Clinical Nursing. Sep 2011, Vol. 20 Issue 17/18: p2425-2435
The aim of this study was to explore the thinking strategies and clinical reasoning processes registered nurses use during simulated care planning for malnutrition and pressure ulcers in nursing home care.
Background. Clinical reasoning is an essential component of nursing practice. Registered nurses' thinking strategies and clinical reasoning have received limited attention in nursing science. Further research is needed to understand registered nurses' clinical reasoning, especially for prevention of malnutrition and pressure ulcers as they are important quality indicators of resident care in nursing homes.
Design. A qualitative explorative design was used with a think-aloud interview technique. Methods. The transcribed verbalisations were analysed with qualitative deductive content analysis. Data were collected during six months in 2007-2008 from 30 registered nurses at nine nursing homes in Norway. Results. The registered nurses used a variety of thinking strategies, but there were differences in the frequency of use of the different strategies. The three most commonly used thinking strategies were 'making choices', 'forming relationships' and 'drawing conclusions'. None of the nurses performed a structured risk assessment of malnutrition or pressure ulcers. Registered nurses started with assessing data from the scenarios, but after a short and elementary assessment they moved directly to planning.
Conclusion. Many different thinking strategies were used in registered nurses' clinical reasoning for prevention of malnutrition and pressure ulcers. The thinking strategy 'making choices' was most commonly used and registered nurses' main focus in their reasoning was on planning nursing interventions. Relevance to clinical practice. This study showed that most of the registered nurses go directly to planning when reasoning clinically about residents in nursing homes. A lack of systematic risk assessments was identified. The insight gained from this study can be used to recommend improvements in tools designed for nursing homes to support the registered nurses. [ABSTRACT FROM AUTHOR].

13. Research utilisation and critical thinking among newly graduated nurses: predictors for research use. A quantitative cross-sectional study
By Wangensteen, Sigrid; Johansson, Inger S; Björkström, Monica E; Nordström, Gun. Journal of Clinical Nursing. Sep 2011, Vol. 20 Issue 17/18: p2436-2447

Aim. The aim was to describe research utilisation among newly graduated nurses and to explore critical thinking dispositions and other individual and contextual factors as possible predictors for research use. Background. Nurses are expected to be research users, and variations in research utilisation are explained by individual and contextual factors. To our knowledge, critical thinking dispositions have not earlier been explored as predictors for research use.
Design. A cross-sectional design was chosen. Methods. Data collection was carried out from October 2006 to April 2007 using the Research Utilization Questionnaire (RUQ) and the California Critical Thinking Disposition Inventory (CCTDI). The response rate was 33% ( n = 617). Pearson's chi-square test and regression analyses were used for statistical calculations. Results. The respondents reported a positive attitude towards research, but only 24% ( n = 148) were defined as research users. A significantly higher proportion of research users reported high critical thinking scores. Critical thinking explained 20% of the variance in attitude towards research and 11% of the variance in research use. Availability and support to implement research findings was the second strongest predictor for research use. Conclusions. Critical thinking, a significant predictor for attitude towards research and for the use of research, should be recognised and strengthened in nursing education and clinical practice. Contextual factors seem to be important for newly graduated nurses' use of research. Relevance to clinical practice. Nurse leaders play an important role in nurturing newly graduated nurses' critical thinking and assisting them in transferring their positive attitude towards research into research use. Nurse educators play a significant role in supporting, challenging and supervising nursing students to be critical thinkers and strong believers in research utilisation. [ABSTRACT FROM AUTHOR].

14. Sudden informal caregivers: the lived experience of informal caregivers after an unexpected event
By Pereira, Helder Rocha; Rebelo Botelho, Maria Antónia. Journal of Clinical Nursing. Sep 2011, Vol. 20 Issue 17/18: p2448-2457
Aim - The purpose of this qualitative study was to understand the lived experience of individuals taking on the role of informal adult caregivers after an unexpected event involving a relative.
Background. The literature on the development of the role of informal caregivers widely recognises that protecting and promoting the quality of life of caregivers should be a priority for health professionals. However, knowledge about how individuals develop as sudden caregivers is scarce, with existing knowledge centring mainly on the physical aspects of caregiving. What it means to become a caregiver or to experience role redefinition remains largely unclear.
Design. Hermeneutic phenomenology provided the framework that guided this study. Methods. Unstructured interviews were used for collecting data. We used Van Manen's approach to analyse data and to reveal themes. Reflexivity and collaborative analysis were used to address rigour.
Results. From caregivers' interviews ( n = 14), four main themes were identified: losing control over time, feeling alone, failing expectations and taking over someone else's life. Conclusions. The caregiving experience is characterised as a transition process or a period of ongoing focussing and de-focussing. The extent to which caregivers feel connected with others, redefine their personal use of time and feel comfortable with their new responsibilities indicates how they are managing this transition and how well they are achieving balance in their new role, i.e. from feeling 'exclusively' a caregiver to being 'also' a caregiver. Relevance to clinical practice. Facilitating successful transitions is within the scope of the role of professional nurses. Information about the meaning that caregivers attribute to their experience - relationships, options and strategies - is crucial, as it will help nurses to plan, assess and design adequate nursing interventions to support informal caregivers, especially in unexpected situations. [ABSTRACT FROM AUTHOR].

Conferences & Workshops 

15. AFRICA BUILD 1st International Conference
Call for Abstracts & Posters - Deadline 3 November 2012
The Institute of Tropical Medicine (Antwerp, Belgium), institutional member in the ISfTeH

AFRICA BUILD ( ) is a Coordination Action aiming to support and develop advanced Centres of Excellence in health care, education and research in the African countries, through Information Technologies.
Date: 2 Dec 2012
Venue: Cairo
The topics of interest for this conference include but are not limited to:
    • Biomedical Informatics tools for Health Research in Developing Countries
    • e-Learning
    • e-Health
    • Collaborative platforms for virtual health research
    • Mobile Technologies & Applications
    • Sustainability of training and biomedical Web applications in developing countries
More information:

16. Workshop: Guidelines for Mindful & Meaningful Nursing
with Kala Dostal & Ecie Hursthouse
Inspired by a seventh-century Tibetan text, the 16 Guidelines are a contemporary presentation of ancient wisdom. The 16 Guidelines are actually 16 values that are appreciated by people of any faith or no religion, and promote mindfulness and wisdom in schools, with youth, in healthcare, prisons, the workplace and the home. Launched in 2006, the 16 Guidelines are already in action in 22 countries worldwide, and growing.
This workshop provides a simple yet robust framework that can transform our minds and attitudes towards life. By exploring
the 16 Guidelines we will reflect more deeply on the way we think, act, relate to others and find meaning in the nursing profession. This workshop is also ideal for Continuing Professional Development (10hrs CPD) – certificates provided. The latest research carried out by neuroscientists suggests that each of us has the potential to continue developing and transforming our minds. The 16 Guidelines show us how to do this in a way that will benefit and nourish both ourselves and our patients.
Venue: Amitabha Hospice. 44 Powell St. Avondale.
Dates:  Tuesday 13 November: How we think
        Tuesday 20 November: How we act
        Tuesday 27 November: How we relate to others
        Tuesday 4 December: How we find meaning
Time: From 6.30 to 9.00pm
Cost: $ 200 for General Public (includes book + materials)
$ 100 for Amitabha Hospice Volunteers
1.  Participants need to agree to attend all 4 sessions in order for registration to be accepted.
2.  For bookings call 828-3321 or send an email to:

Journal - Table of Contents

17. From Nursing Standard, Volume 27, No. 5,  October 3-9  2012
. RCN will offer mentor support to nurses facing misconduct charges
17B. Nurses to lose salary increases for missing appraisals or training; Double-Sole socks help to stop falls
17C. Having the views of BME nurses is vital to improve patient care
Nurses support is  most effective follow-up for heart failure patients; Study findings support case for rotavirus vaccinations in high income countries; Inhaled pain relief is more efficient and safer in early stage of labour; Hormonal changes in pregnancy may influence cancer tumour growth; Patients taking certain psychotropic medications should be advised not to drive
17E. Unequal opportunities [Some black and minority ethnic nurses face more career hurdles than others, finds Jennifer Trueland]
17F. Empower yourself [There are simple steps that nurses can take to pursue their chosen career]
17G. Mental scars of racism
. Anatomy and physiology of the senses
17I. Raising awareness of patient dignity
Acute pyelonephritis: risk factors, diagnosis and treatment
Caring for frail patients
Looking for answers [Clinical lead Wendy Turton believes more nurses should be following her lead and getting into research work - and helping to change practice for the better]
17M. Broaden your cultural base [Make the most of every encounter with people from a different ethnicity to your own, says Nicola Davies]

News - National

18. Huge regional health board shake-up
The Wellington region's three health boards will undergo major changes to gradually integrate - including sharing senior management and services, Radio New Zealand has reported.
Resident Doctors Association spokeswoman Deborah Powell confirmed this morning that Wairarapa, Hutt Valley, and Capital & Coast health boards were working on closer ties. Wairarapa and Hutt Valley boards would amalgamate senior management teams and share a chief executive by the middle of next year.
They would also increase links with Wellington's Capital & Coast District Health Board. While each would have their own elected boards, there were many overlaps in memberships between the three boards

19. Rugby World Cup sex 'risky' for men - study
TVNZ - 16 October 2012
Alcohol and low condom use fuelled an increased rate of sexually transmitted infections amongst men who had sex during the Rugby World Cup, a new study has shown. The University of Otago findings have revealed the findings of men and women who attended sexual health clinics in the aftermath of last year's Rugby World Cup. They found more men than women attended clinics after RWC-related sex, with men having an increased risk of STI diagnoses. Men had twice the risk of chlamydia, and five times the risk of gonorrhoea.

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