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Issue 36 - 25 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.
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. Aftermath: How the lives of fifteen ordinary New Zealanders have been affected by workplace injury and illness
Department of Labour, 2002

2. Asthma and how to live with it
by Dr Shaun Holt; Robyn Ingleton and Kim van Griensven
Massey University, 2006

3. The unfortunate experiment: the full story behind the inquiry into cervical cancer treatment
By Sandra Coney, 1988

4. Work safe healthy business: A safeguard guide to health & safety in the workplace
Consulting editor Louisa Clery, 2006

Articles - Hypertension

5. Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults -- United States, 2003-2010
By Valderrama, Amy L.; Gillespie, Cathleen; King, Sallyann Coleman; George, Mary G.; Hong, Yuling; Gregg, Edward. MMWR: Morbidity & Mortality Weekly Report. 9/7/2012
  Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. This report uses data from the National Health and Nutrition Examination Survey (NHANES) to examine awareness and pharmacologic treatment of uncontrolled hypertension among U.S. adults with hypertension and focuses on three groups: those who are unaware of their hypertension, those who are aware but not treated with medication, and those who are aware and pharmacologically treated with medication but still have uncontrolled hypertension.
Methods: CDC analyzed data from the NHANES 2003-2010 to estimate the prevalence of hypertension awareness and treatment among adults with uncontrolled hypertension. Hypertension was defined as an average systolic blood pressure (SBP) =140 mmHg or an average diastolic blood pressure (DBP) =90 mmHg, or currently using blood pressure (BP)-lowering medication. Uncontrolled hypertension was defined as an average SBP =140 mmHg or an average DBP =90 mmHg, among those with hypertension.
Results: The overall prevalence of hypertension among U.S. adults aged =18 years in 2003-2010 was 30.4% or an estimated 66.9 million. Among those with hypertension, an estimated 35.8 million (53.5%) did not have their hypertension controlled. Among these, an estimated 14.1 million (39.4%) were not aware of their hypertension, an estimated 5.7 million (15.8%) were aware of their hypertension but were not receiving pharmacologic treatment, and an estimated 16.0 million (44.8%) were aware of their hypertension and were being treated with medication. Of the 35.8 million U.S. adults with uncontrolled hypertension, 89.4% reported having a usual source of health care, and 85.2% reported having health insurance.
Implications for Public Health Practice: Nearly 90% of U.S. adults with uncontrolled hypertension have a usual source of health care and insurance, representing a missed opportunity for hypertension control. Improved hypertension control will require an expanded effort and an increased focus on BP from health-care systems, clinicians, and individuals. [ABSTRACT FROM AUTHOR].

6. Hypertension for the practice nurse
By Lowth, Mary. Practice Nurse. 9/21/2012, Vol. 42 Issue 14: p12-16
The article discusses the British National Institute for Health and Clinical Excellence's (NICE) guideline on the treatment of hypertension. Information is provided for practice nurses on issues such as measuring blood pressure, performing home blood pressure and ambulatory monitoring, and determining blood pressure targets. The symptoms and diagnosis of hypertension and when to refer patients to specialist care are addressed. Hypertension treatment options are also discussed..

7. Diagnostic puzzler: Hypertension in teen
By Barna, Michael; Wilson, Kevin; Chiaruttini, Robert; Muchowski, Karen. Journal of Family Practice. Sep 2012,
Vol. 61 Issue 9: p536-539
The article discusses the medical case of a 17-year-old male who was admitted to the hospital due to drainage and incision of a left forearm abscess near a previous fracture and subsequent fixation surgery. It states that patient was diagnosed with Cushing's syndrome as revealed by the initial cortisol and adenocorticotropic hormone (ACTH) laboratory work. It also differentiates the two types of Cushing's syndrome, the ACTH-independent and the ACTH-dependent..

8. A new epoprostenol formulation for the treatment of pulmonary arterial hypertension
By Fuentes, Amaris; Coralic, Aida; Dawson, Kyle L. American Journal of Health-System Pharmacy. 8/15/2012, Vol. 69 Issue 16: p1389-1393
 The pharmacology and pharmacokinetics of a novel formulation of epoprostenol for the treatment of pulmonary arterial hypertension (PAH) are reviewed, with guidance on addressing a number of important safety considerations.
Summary. Epoprostenol is a direct vasodilator of the pulmonary and systemic vasculature indicated for improving exercise capacity in patients with PAH. Veletri, a recently approved formulation of epoprostenol for continuous i.v. infusion, offers increased stability relative to other available epoprostenol products. Therefore, the use of Veletri can lessen the therapy burden associated with the other available formulation of the drug by allowing for the advance preparation of infusion pump cassettes (at certain concentrations) and administration at room temperature without the need for cooling with ice packs. Sterility, however, is of concern with outpatient preparation of epoprostenol-containing cassettes stored for the maximum duration according to stability guidelines. All epoprostenol infusions are classified as high-risk therapies due to complex dosing, the drug's short half-life, and the potential for life-threatening rebound PAH with abrupt discontinuation. Adverse effects reported in =10% of participants in clinical trials of Veletri included flushing (58%), headache (49%), nausea or vomiting (32%), hypotension (16%), chest pain (11%), and anxiety, nervousness, or agitation (11%). As with other epoprostenol formulations, the use of Veletri requires an evaluation of health-system medication-use practices to ensure patient safety.
Conclusion. Veletri provides an epoprostenol therapy option that reduces some of the inconveniences of the other formulation. Drug stability is dependent on cassette concentrations, which may be limited by sterility concerns with outpatient preparation. Use of this new agent within the health system requires an evaluation of practices to ensure patient safety. [ABSTRACT FROM AUTHOR].

9. Effects of dark chocolate on blood pressure in patients with hypertension
By Haber, Stacy L.; Gallus, Karen. American Journal of Health-System Pharmacy. 8/1/2012, Vol. 69 Issue 15: p1287-1293
: The article presents an overview of the different clinical trials that have been conducted to determine the impacts of dark chocolate on blood pressure in patients suffering from hypertension. The study conducted by Taubert and colleagues in 2003 for around thirteen patients proved that dark chocolate favorably affect blood pressure in hypertension patients. However, additional factors need to be considered in further studies for better results..

Articles - Health Expectations [Journal]

10. Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making
By Charise, Andrea; Witteman, Holly; Whyte, Sarah; Sutton, Erica J.; Bender, Jacqueline L.; Massimi, Michael; Stephens, Lindsay; Evans, Joshua; Logie, Carmen; Mirza, Raza M.; Elf, Marie. Health Expectations. Jun 2011, Vol. 14 Issue 2, p115-132
: To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. Decision-making processes and outcomes may be shaped by a range of non-medical or 'contextual' factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide-ranging research for health decision-making purposes. To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. We present an exploratory tool consisting of questions organized into four thematic domains - Bodies, Technologies, Place and Work (BTPW) - articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasses health-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health-related research. [ABSTRACT FROM AUTHOR].

11. Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making.
By Caldon, Lisa J.M.; Collins, Karen A.; Reed, Malcolm W.; Sivell, Stephanie; Austoker, Joan; Clements, Alison M.; Patnick, Julietta; Elwyn, Glyn. Health Expectations. Jun 2011, Vol. 14 Issue 2: p133-146
There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice. [ABSTRACT FROM AUTHOR].

12. Dying cancer patients talk about physician and patient roles in DNR decision making
By Eliott, Jaklin A.; Olver, Ian. Health Expectations. Jun 2011, Vol. 14 Issue 2: p147-158
Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. [ABSTRACT FROM AUTHOR].

13. Service user involvement in cancer care: the impact on service users
By Cotterell, Phil; Harlow, Gwen; Morris, Carolyn; Beresford, Peter; Hanley, Bec; Sargeant, Anita; Sitzia, John; Staley, Kristina. Health Expectations. Jun 2011, Vol. 14 Issue 2, p159-169
Service user involvement is embedded in the United Kingdom's National Health Service, but knowledge about the impact of involvement on service users, such as the benefits and challenges of involvement, is scant. Our research addresses this gap. To explore the personal impact of involvement on the lives of service users affected by cancer. We conducted eight focus groups with user groups supplemented by nine face-to-face interviews with involved individuals active at a local, regional and national level. Thematic analysis was conducted both independently and collectively. Sixty-four participants, engaged in involvement activities in cancer services, palliative care and research, were recruited across Great Britain. We identified three main themes: (i) 'Expectations and motivations for involvement'- the desire to improve services and the need for user groups to have a clear purpose, (ii) 'Positive aspects of involvement'- support provided by user groups and assistance to live well with cancer and (iii) 'Challenging aspects of involvement'- insensitivities and undervaluing of involvement by staff. This study identified that involvement has the capacity to produce varied and significant personal impacts for involved people. Involvement can be planned and implemented in ways that increase these impacts and that mediates challenges for those involved. Key aspects to increase positive impact for service users include the value service providers attach to involvement activities, the centrality with which involvement is embedded in providers' activities, and the capacity of involvement to influence policy, planning, service delivery, research and/or practice. [ABSTRACT FROM AUTHOR].

14. How sharp can a screening tool be? A qualitative study of patients' experience of completing a bowel cancer screening questionnaire
By Pugh, Wendy; Porter, Alison M. Health Expectations. Jun 2011, Vol. 14 Issue 2, p170-177
There is evidence to suggest that the Patient Consultation Questionnaire (PCQ) is a reliable tool to predict symptomatic left-sided colorectal cancer. While previous research has examined the sensitivity and specificity of the PCQ as a tool, it has not addressed patients' perspectives. To examine qualitatively patients' perspectives on ease of use of the PCQ, and their attitude to completing it. The target population were patients in North Wales between 55 and 85 years with colorectal symptoms who had completed the PCQ. A sample of six was randomly selected. The approach was qualitative, using semi-structured, in-depth cognitive interviews, which were recorded and transcribed before content and thematic analysis. The study found some areas of concern in relation to the PCQ's design and presentation, concerning such issues as the use of medical jargon or ambiguous wording, and the use of questions to which patients may not have an answer. It also found that patients responded to the form as something more than a screening tool, treating it variously as way of speeding up diagnosis and treatment, an opportunity to 'play the system', and a way of bypassing embarrassing encounters. Although major problems were not identified, the minor issues observed in the PCQ's design and presentation may reduce accuracy and patient satisfaction. A greater understanding of patients' perception of the role and function of the PCQ may help clinicians to interpret responses to the form more accurately. [ABSTRACT FROM AUTHOR].

15. Philosophy, health services and research: the importance of keeping conversations open
By Entwistle, Vikki A; Cribb, Alan. Health Expectations. Jun 2011, Vol. 14 Issue 2: p178-181
: The article discusses various reports published within the issue including one by Susan Sherwin and Meghan Winsby on autonomy in contemporary healthcare, one by Richard Ashcroft on financial incentives in health care and health promotion and one by Alan Cribb and Vikki Entwistle on shared decision making in medicine..

16. A relational perspective on autonomy for older adults residing in nursing homes
By Sherwin, Susan; Winsby, Meghan. Health Expectations. Jun 2011, Vol. 14 Issue 2: p182-190
: To review critically the traditional concept of autonomy, propose an alternative relational interpretation of autonomy, and discuss how this would operate in identifying and addressing ethical issues that arise in the context of nursing home care for older adults. Respect for patient autonomy has been the cornerstone of clinical bioethics for several decades. Important though this principle is, there is debate on how to interpret the core concept of autonomy. We review the appeal of the traditional approach to autonomy in health care and then identify some of the difficulties with this conception. We use philosophical methods to explain and discuss the traditional and relational conceptions of autonomy and we illuminate our discussion with examples of various contextual applications. We support the relational conception of autonomy as offering a richer, more contextualized understanding of autonomy which attends to the social, political and economic conditions that serve as background to an agent's deliberations. To illuminate these ideas, we discuss the situation of frail older adults who frequently find their autonomy limited not only by their medical conditions but also by cultural prejudices against the aged and by the conditions commonly found within the nursing homes in which many reside. We propose ways of improving the relational autonomy of this population. [ABSTRACT FROM AUTHOR].

Conferences, Workshops and Training Opportunities

17. 8th Biennial Joanna Briggs International Colloquium
Channelling the Rivers of Knowledge to Improve Global Policy and Practice
November 12th - 14th, 2012
Venue: The Empress Hotel, Chiang Mai, Thailand

18. Workshop on Determinants of Health
Topic:  Equity, Rights and the Determinants of Health
Wednesday 21st November, 2012
Location: Wellington 
Venue: To be Confirmed
Further information: Emma Frost (09) 531 5504 or

Journal - Table of Contents

19. From Nursing Times, 16-22 October 2012, Vol 108 no 42
Its time to change the culture of the NHS
The Nursing Week
Cuts pose risk to infection control
Clinical Digest
. Only intense exercise cuts cardio risks; Dementia toolkit aids communication; Guidance for Crohn's disease published; Typhoid vaccine is recalled by supplier; New antibiotic treats tough skin infections; Bone cancer mistaken for growing pains
19D. Nurse leadership training scheme aims to inspire next generation; NHS could be paperless in three years; Calculator shows safe staff levels per ward
. Researchers to see if birth blood can be refused; Boost patient outcomes by giving nurses the time to care
Nursing Practice
. Understanding the  Liverpool Care Pathway is essential; Calculation of drug dosage is a critical stage
Review - Drug Calculations
How to ensure patient safety in drug dose calculation
Audit - Nasogastric Tubes
How accurate are X-Rays to check NG tube positioning
Guidance in brief - Gastrostomy
New guidance on the insertion of balloon gastrostomy
Practice Educator - Nutrition
PEG feeding tube placement and aftercare
Evidence in Brief - Stroke Care
. Dehydration in stroke patients admitted to hospital
Using rapid spread to improve hospital nutrition
19M. 60 seconds with Michele Allott [Director of nursing and patients safety at Norfolk and Suffolk Foundation]
Role model
Looks good enough to eat [Picture menus to help people with cognitive and physical problems choose the food they wanted]
The Leadership Academy
Maximise your chances to hit the jackpot [Ensure your meetings are  good use of time, not a waste of it]

News - National

20. Severe obesity still growing problem for Americans
TVNZ - Friday October 19, 2012

The number of US residents who are severely obese shot up by 70% in the past decade or so, though the increase has slowed in more recent years, according to a US study. Between 2000 and 2010, the proportion of US residents who were severely obese - at least 45kg overweight - rose from 4% to almost 7%, said researchers, whose findings appeared in the International Journal of Obesity

21. Energy drinks under review
ODT - 25 Oct 2012

A spate of deaths in the United States linked to a highly caffeinated energy drink will be examined as part of a transtasman review that could mean caffeine levels in such drinks are lowered here. Two nutrition experts have called for the review to be hastened, with one calling energy drinks "dangerous stuff".
The US Food and Drug Administration launched an inquiry into the safety of the highly caffeinated Monster Energy drinks after reports of five deaths.

News - International

22. Benefits encourage problem families, says Iain Duncan Smith
The Telegraph - 24 Oct 2012

The welfare system is “promoting destructive behaviour” by encouraging poorer families to have more children and denying them the incentive to get a job, the Work and Pensions Secretary Iain Duncan Smith will warn.

23. Faulty medical implants investigation: Patients failed by poor implant regulation, say surgeons
The Telegraph - 24 Oct 2012

Patients are being “failed” by the poor regulation of artificial hips and other medical devices, which is potentially allowing dangerous products to be used in Britain, the Royal College of Surgeons warns.

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