Forging links between academe and practice through research.
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Education, Nursing, Continuing↗
Biomedical subjects
S Bond
Publications and source records attributed to S Bond.
The effect of epigastric vessel ligation on the vascular territories of the pig rectus muscle.
In a pig model, unilateral ligation of the inferior epigastric vessels caused an initial decrease in normal vascularity, followed by an increase toward normal vascularity, in the inferior portion of the rectus muscle over 42 days. Ligation appeared to dilate the choke vessels between the superior and inferior arterial territories. The results indicate that by ligation of the inferior epigastric vessels, the vascular territory, which is normally tenuous, can undergo a transposition without vascular compromise.
Animals↗
Measuring patients' satisfaction with nursing: 1990-1994.
Assessing patients' satisfaction with the care they receive is assuming greater importance in the new-style National Health Service. This paper reviews recent developments in the measurement of patients' satisfaction with nursing, including new approaches and taking into account increased interest in users' opinions. Studies published since 1990 generally demonstrate lack of clarity with regard to the purpose and intent of the study, as well as a lack of conceptual rigour and methodological investment. However, several new approaches were found upon which future nursing research could build.
Humans↗
Newcastle satisfaction with nursing scales: an instrument for quality assessments of nursing care.
OBJECTIVES: To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response. DESIGN: Sample survey. SETTING: 20 wards in five hospitals in the north east of England. PATIENTS: 2078 patients in general medical and surgical wards. MAIN MEASURES: Experiences of and satisfaction with nursing care. RESULTS: 75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home. CONCLUSION: Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate.
Data Collection↗
A novel mechanism for cyclosporine: inhibition of myocardial ischemia and reperfusion injury in a heterotopic rabbit heart transplant model.
BACKGROUND: Advances in myocardial preservation techniques and immunosuppressive drug therapy have resulted in heart transplantation as an acceptable treatment for end-stage heart failure. However, excessive periods of global myocardial ischemia followed by reperfusion can progress to irreversible graft injury. It has been reported that cyclosporine A (in addition to its well-characterized immunosuppressive actions) can blunt certain features of ischemia and reperfusion injury. This study was performed to examine the ability of cyclosporine A to attenuate such injury in a model of heart transplantation. METHODS: Twenty rabbit heterotopic transplants were divided into four study groups: (1) 30-minute ischemic control hearts; (2) 30-minute ischemic cyclosporine A-treated hearts; (3) 4-hour ischemic control hearts; and (4) 4-hour ischemic cyclosporine A-treated hearts. A single dose of cyclosporine A (10 mg/kg intravenously) or vehicle was administered to both the donor and recipient rabbits 45 minutes before heart explantation and heart transplantation, respectively. RESULTS: After transplantation and 30 minutes of reperfusion, the 4-hour ischemic control hearts showed a significant (p < 0.01) leftward shift in the left ventricular end-diastolic pressure versus left ventricular volume curve compared with the 30-minute ischemic control hearts. This finding represents higher end-diastolic pressures and incomplete diastolic relaxation caused by ischemia and reperfusion. Cyclosporine A administration to the donor and recipient rabbits resulted in a significant improvement (p < 0.01) in diastolic relaxation (shift in the left ventricular end-diastolic pressure versus left ventricular volume curve back to the right) compared with 4-hour ischemic control hearts. Cyclosporine A-treated hearts also showed significant improvements in the rate of diastolic pressure fall (p < 0.05) and tau (the isovolumetric pressure decay constant) (p < 0.01) compared with ischemic control hearts. CONCLUSIONS: These results indicate that single doses of cyclosporine A to both the donor and recipient inhibit the dysfunction in extent and rate of left ventricular relaxation caused by prolonged global ischemia and reperfusion. Possible mechanisms for cyclosporine A's myocardial protective actions are presented in the discussion.
Animals↗
Mental health audit. Telling it like it is.
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Focus Groups↗
Development and validation of scales to measure organisational features of acute hospital wards.
In order to make comparisons between wards and explain variations in outcomes of nursing care, there is a growing need in nursing research for reliable and valid measures of the organisational features of acute hospital wards. This research developed The Ward Organisational Features Scales (WOFS); each set of six scales comprising 14 subscales which measure discrete dimensions of acute hospital wards. A study of a nationally representative sample of 825 nurses working in 119 acute wards in 17 hospitals, drawn from seven Regional Health Authorities in England provides evidence for the structure, reliability and validity of this comprehensive set of measures related to: the physical environment of the ward, professional nursing practice, ward leadership, professional working relationships, nurses' influence and job satisfaction. Implications for further research are discussed.
Factor Analysis, Statistical↗
Obtaining patients' views of nursing care to inform the development of a patient satisfaction scale.
Patient satisfaction is increasingly being measured as an indication of the effectiveness of nursing care. At present, however, there are no validated UK scales available specifically addressed to nursing. The aim of the present study was to develop a sensitive, valid and reliable measure of patient satisfaction. This paper describes the first phase of the study, the development of a multidimensional concept of satisfaction from the patients' perspective. Using qualitative methods, patients were interviewed both in hospital and following discharge. Eleven main concepts were identified: nurses' manner, attentiveness, availability, reassurance, individual treatment, openness/informality, information, professionalism, ward organization, nurses' knowledge and ward environment. Beginning with customer-defined values has provided the starting point for the development of a scale to measure patients' satisfaction with nursing using concepts important to patients, rather than hospital personnel or research teams.
Communication↗
Involving clients in clinical audits of mental health services.
Involving clients in service audits is never straightforward. In developing a new audit system for use in mental health settings a review of the literature demonstrated that the concept of satisfaction, like quality, is problematic because it is multidimensional, it is affected by expectations, and may be defined differently by professionals and clients. Furthermore, it fails to address the notion of empowerment. However, the literature provided some clear methodological guidance about involving clients in clinical audit. Clients must be involved in defining audit topics, and the most appropriate techniques of data-collection are open-ended and qualitative. Clients can also be involved in the process of audit, particularly through conducting audits in collaboration with professionals. Evidence from the literature persuaded the authors to abandon the idea of developing an audit module on patient satisfaction, and instead to develop one with a clear focus on clients' perspectives, entitled "Clients' Appraisal of Care" as part of the Newcastle Audit System, with clients involved throughout.
Data Collection↗
Nurse involvement in cardiac rehabilitation prior to hospital discharge.
Interviews were undertaken with 202 men admitted to five hospitals in northeast England following an uncomplicated first myocardial infarction. The likelihood of patients speaking to a nurse about recovery or seeing a physiotherapist, dietician or specialist rehabilitation nurse, varied considerably between hospitals. Whilst virtually all patients received written information concerning some aspect of life-style change or cardiac rehabilitation, the quality and range of information, particularly with regard to information about stress or anxiety, was frequently limited. Instructions about seeing a general practitioner following discharge were often vague; formal rehabilitation programmes, where they existed, excluded some patients. The study suggests that much patient education is dependent on the provision of written information alone, and that further evaluation of the effectiveness of self-help material supported by nursing input is desirable.
Humans↗
The effectiveness of nursing: a review.
This paper describes the findings of a literature review of the effectiveness of nursing. Three journals were selected in which this type of study was most likely to be published. A diversity of attempts to measure nursing effectiveness with various types of patient was found. Generally, however, there was a lack of rigour in study design and sample sizes were too small to be able to draw conclusions. No studies were found which undertook a cost-effectiveness analysis of nursing interventions. Suggestions for the way forward in measuring nursing effectiveness are given, together with questions to be addressed by nursing research.
Humans↗
Measuring patients' satisfaction with nursing care.
Assessing patients' satisfaction with the care they receive is assuming greater importance and satisfaction with nursing is no exception. The kinds of study in which patient satisfaction has been used as an outcome are considered and show the range of conceptualizations and the general lack of rigour in its measurement. It is argued that research methods are often flawed by using inappropriate measures and greater care is warranted in their selection. Where appropriate measures do not exist, only then is the costly process of developing new assessments warranted. Some of the necessary steps in arriving at reliable and valid measures of patient satisfaction are discussed in the context of asking particular research questions.
Humans↗
The contribution of charge to affinity at functional (M3) muscarinic receptors in guinea-pig ileum assessed from the effects of the carbon analogue of 4-DAMP methiodide.
1. 4-Diphenylacetoxy-1:1-dimethyl cyclohexane (carbo-4-DAMP) is the carbon analogue of 4-diphenylacetoxy-N-methylpiperidine (4-DAMP) methiodide. The compounds differ only in that the quaternary nitrogen atom in 4-DAMP methiodide is replaced by a quaternary carbon atom, which is uncharged. 2. Carbo-4-DAMP appears to act competitively at functional (M3) muscarinic receptors in guinea-pig ileum. Estimates of log affinity constant are 6.0 at 30 degrees C and 5.9 at 37 degrees C, i.e. the compound has 0.1% of the affinity of 4-DAMP methobromide. 3. The absence of charge makes little difference to the conformation as determined by X-ray crystallography. The bond lengths and angles are very similar, though the bonds in the cyclohexane ring of carbo-4-DAMP are consistently slightly longer than those in the piperidinium ring of 4-DAMP methiodide, and the presence of the charge slightly reduces the space between molecules. 4. The difference between the affinities of 4-DAMP methobromide and carbo-4-DAMP indicates that the contribution of coulombic forces to the binding between 4-DAMP methiodide and muscarinic (M3) receptors is at least 17 kJ mol-1 (4.1 kcal mol-1) at 37 degrees C. How much this is an underestimate depends upon how much hydrophobic binding is greater with the uncharged compound.
Animals↗
Increased resting energy expenditure in childhood asthma: does this contribute towards growth failure?
In order to determine whether or not there was a relationship between disorders of growth in children suffering from asthma and either increased resting energy expenditure or inadequate energy intake, a group of 34 children suffering from perennial symptoms were studied. A control group matched with the asthmatic children for sex and fat free mass were similarly studied. The children kept seven day records of weighed food intake. Basal metabolic rate was measured on one occasion in the fasted state by means of indirect calorimetry using the ventilated hood technique. The asthmatic children kept a 28 day record of peak expiratory flow rates, asthma symptoms, and medication usage. The asthmatic children expended significantly more energy at rest than their matched controls in absolute terms (14%). There was no correlation between height or height SD score and any parameter of energy balance. The causes of these finding are as yet speculative.
Asthma↗
Patients with suspected myocardial infarction: effect of mode of referral on admission time to a coronary care unit.
The aim of this prospective study was to determine the delay between the onset of symptoms and arrival in the coronary care unit of patients with suspected acute myocardial infarction, and the relative contribution to the total delay of patient delay, method of referral (self referral or general practitioner referral) and delay in the hospital before reaching the coronary care unit. All patients admitted with chest pain to the coronary care unit at Dudley Road Hospital, Birmingham, over the six month period April-September 1989 were included in the study. Ninety five patients were referred by their general practitioner and 107 patients attended the accident and emergency department directly or arrived by ambulance without contacting their general practitioner. The proportion of self referred and general practitioner referred patients with acute myocardial infarction, angina and non-cardiac chest pain were not significantly different. The total delay was significantly longer for patients who had been referred by their general practitioner (median 5.3 hours) than for self referrals (3.2 hours, P less than 0.001), with a significantly higher proportion of self referrals arriving at the coronary care unit within six hours of the onset of symptoms (77% versus 54%, P less than 0.01). Among general practitioner referrals, initial patient delay accounted for a median of 2.5 hours and the general practitioner's response time for a median of 1.1 hours. The delay in hospital was similar for both groups of patients. In inner city areas, self referral may result in considerably less delay than general practitioner referral allowing a greater proportion of patients to receive effective thrombolytic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Coronary Care Units↗
Nurses' assessment of elderly patients in hospital.
Nurses' assessment of patients' mobility in hospital provided the focus for an inductive qualitative study which examined how an everyday aspect of nursing practice was carried out. The study described assessment practices in both long-term care and acute care wards for elderly patients as a situated activity. Interviews with nurses, as well as observation of their activities and records, resulted in explanations of their behaviour as deriving from their conceptions of ward functions. These conceptions arose from their adoption of the values of cure and discharge and so, in the different types of ward, assessment held different meanings and was carried out in different ways. The findings have implications for nursing practice in different settings but also for the care of elderly and chronically ill patients, where cure is an inappropriate end goal of care. This example of developing explanatory theory inductively also has implications for the development of mid-range nursing theory and suggestions are made for its extension.
Geriatric Nursing↗
Outcomes of nursing care: the case of primary nursing.
Using primary nursing as a 'case study', this paper reviews research literature which attempts to measure the effectiveness of a mode of nursing using outcome measures. Previous research, it is argued, is hampered by a lack of conceptualization of structure and process and inadequate research design, with consequent uncertain findings. A shift in emphasis is suggested from an evaluation of global concepts, such as primary nursing, to an identification of the features of structures and processes of nursing care which interrelate with patient and nurse outcomes. For this purpose, multivariate research design and investment in methodological research are recommended.
Humans↗
Experience and preparation of community nursing staff for work associated with HIV infection and AIDS.
Some of the findings from a national survey of 3754 community nursing staff in England regarding their experience of and preparation for working with HIV infection and AIDS are reported. The current absence of confidence to deal with HIV infection is explained and suggestions made regarding the content of educational developments.
Acquired Immunodeficiency Syndrome↗