In Australia, nurses face a double-barreled challenge to their role. With the rapid adoption of new health care technologies coupled with increasing economic constraints, they find themselves "doing more with less." In this context of continuous change, it is useful to determine what expert nurse clinicians deem the most essential skills, attitudes and knowledge required for practice in complex technological environments. Separate panels of 28 educators and 43 cardiac nurse clinicians participated in a national Delphi study rating the importance to the nursing role of 107 items drawn from the international literature on expert practice and technology. Indicating the importance of each item in both the "real" and "ideal" worlds of practice, educators identified 58 items where they felt actual practice was substantially far from the ideal. For 16 of these items relating to empowerment of patients, nursing research, and technology policy, the educators rated clinical behavior below the median of the real world scale, indicating substandard performance of a role or inadequate assimilation of a concept. The implications for the definition of expert practice and for curricula development are discussed.

Delphi Technique↗

PubMedDate not supplied

Impact of a physical fitness program in a blue-collar workforce.

The purpose of this study was to examine the impact of participation in the Wellness--Paths to Health Physical Fitness Program on selected physiological and personal health variables including blood pressure, pulse, body weight, trunk flexibility, cardiovascular endurance, abdominal strength, percent body fat and a cumulative fitness score. The subjects (N = 129) of this study were divided into four levels of adherence to this exercise-based health program. Data analysis examined relationships between adherence levels and changes in the selected physiological and personal health variables across two measures. In addition, data from high-risk participants were analyzed. The results of the study found statistical significant changes in the selected variables between repeated assessment measures. In addition, statistically significant relationships were found between levels of adherence to the program and six of the dependent variables.

Data Collection↗

PubMedDate not supplied

It's all in a name. When is a 'Delphi study' not a Delphi study?

As nursing researchers we need to fully understand the origins of the methods we are using in research investigations. Without an in-depth understanding, we may find ourselves violating fundamental underpinning assumptions or conventions through ignorance, and the resulting studies are unlikely to stand up to tests of congruence and rigour. This paper is a discussion of some complexities encountered while exploring the literature on the Delphi technique, a research method we had believed to be straightforward. The Delphi method had been used extensively since its development in the 1950s, and its use in nursing research appears to be increasing. Our explorations revealed that, rather than a simple means of obtaining the judgments of experts, modifications and adaptations over the years have dramatically changed 'the' Delphi. Anyone wishing to use the method needs a sound knowledge of complex theoretical issues associated with its implementation.

Consultants↗

PubMedDate not supplied

Changes in transthoracic electrical impedance during endotoxemia in dogs.

Our aim was to investigate the role of hematocrit (H) and respiration in transthoracic electrical impedance during endotoxemia. Transthoracic electrical impedance at end-expiratory apnea (Z0) and at end-inspiration (Zmax), H values, and extravascular lung water level (EVLW), estimated by means of gravimetric analysis and the impedance method, were measured in splenectomized and mechanically ventilated dogs. In endotoxemia, there were increases in Z0, Zmax, H and the respiratory frequency. In the splenectomized dogs, both impedances slightly increased without any significant change in H. In the ventilated dogs, Z0, and Zmax increased similarly, while H increased. In the splenectomized, ventilated dogs, no changes were found in the impedances or H. The EVLW values showed that there was no serious edema in the endotoxemic groups. The results suggest that Z0 increased mainly in association with the increase in H. We conclude that the noninvasive measurements of the changes in impedance can be used for continuous monitoring of the fluid and gas shifts in the thorax.

Animals↗

PubMedDate not supplied

Outcomes, problems and quality of life with the implantable cardioverter defibrillator.

The survey aimed to assess the outcomes, problems and quality of life (QOL) in recipients of the implantable cardioverter defibrillator (ICD). Average QOL was 6.4 (1-10 scale), but lower in those who had received shocks (p < 0.05); 54% of patients had been shocked at least once. Usual daily activities were resumed by 72%, and driving by 76% of patients; 96% would recommend the ICD to others. Primary information sources were the implanting cardiologist and manufacturer's booklet. This study concluded that most ICD recipients have good QOL, but it is reduced in those who have been shocked by the defibrillator. Most eventually know enough about living with the ICD, but desire more education and support at the time of ICD insertion. Nurses could meet this need.

Adult↗

PubMedDate not supplied

Australian clinicians and educators identify gaps in specialist cardiac nursing practice.

Change is endemic in both the health care and higher education sectors in Australia. Consequently professional roles and educational pathways must also evolve and adapt, often catalysed by those in leadership positions. Two national Delphi panels, one of cardiac nurse educators and the other of cardiac nurses, were convened to answer the question 'What knowledge, skills and attitudes are required for an expert nurse practising in the highly technological cardiac care environment?' Respondents indicated on a Likert scale the importance of 107 items to the nurse's role in both the 'real' and 'ideal' worlds of practice. Overall there was very strong agreement between the two panels with results indicating that Australian nurses perform close to their ideal in many areas of practice. For 31 of the items, both panels identified that the reality of practice is quite far from their ideal. Both panels agree that 10 of the behaviours are carried out or valued very little in practice. Reasons why nurses are not carrying out these elements of the role to their satisfaction are discussed and remediation strategies suggested. The findings can inform both curriculum development and clinical practice. In the dynamic health care arena, the nursing profession continues to respond to community and professional needs, seeking to establish sound research-based practice and maintain a high quality of clinical care and nursing management. The development of competencies by the Confederation of Critical Care Nurses (1996) is a good example of professional groups taking the initiative both in defining the practice role and providing tools that assist educational bodies to develop programs appropriate for a practice based discipline. Specialty nursing practice is 'under the microscope' in Australia as the profession seeks the best methods to weight nursing activities, measure nursing outcomes and recruit, retain and justify the use of specialist practitioners.

Attitude of Health Personnel↗