"Having attitude" : nurses' perceptions of the qualities and skills needed to successfully nurse the 10-24 year old client : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University

This thesis presents a grounded theory study following Glaser's methodological stance. It explores nursing of the 10-24 year old client through interviews with thirteen registered nurses. The participants worked in a variety of clinical settings including community, hospital and specific adolescent services. From the analysis of the data emerged the complexity of the nurses' work with the chosen age group. The study identifies that the quality of the nurse/client encounter may enable the young person to feel accepted and to be empowered to make their own health choices. This thesis identifies how 'Having Attitude' is seen by the nurse participants as critical in the care of the young person. 'Having Attitude' is about the nurse balancing the dependence/independence needs of the young person with their family and peers, and about being acceptable to the client. This results from the work of the nurse which is characterised by the nurse 'being competent' and 'being supportive' whilst taking into account all of the socio-political factors that effect the nurse's working situation. The socio-political context impacts upon the young person's life in terms of the types of health issues they have, and the availability and affordability of appropriate health services. It also impacts on the environment in which the nurse works, in terms of the complexity of the concerns with which young people present, current health reforms and funding issues. The nurse needs to have a broad knowledge base and ability to work within a complex situation. Nurses believe they can make a difference to the young person's health experience when they are supportive, competent and 'have attitude'

Disentangling complexity: a visualisation-led tool for healthcare associated infection training

Training in infection prevention and control (IPC) measures is crucial to minimise the incidence of healthcare-associated infections (HAIs), a growing cause of patient illness and death in hospital. This paper describes a participative approach to developing a prototype tablet-based digital training tool using dynamic visualisation-led techniques to raise awareness and understanding of IPC and HAIs for hospital-based staff. An evidence-based and iterative visualisation prototyping process was used to engage staff and invite contributions from across a number of roles within the NHS, a typically hierarchical sector. Findings suggest the visualisation-led approach was helpful in articulating the behaviours of pathogens and staff and their interactions within the complex setting and service ecology of the NHS and in making IPC training materials clearer and more engaging

Changes in vitamin biomarkers during a 2-year intervention trial involving increased fruit and vegetable consumption by free-living volunteers

Peer reviewedPublisher PD

Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure

BACKGROUND: Those with advanced heart failure (HF) experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care.METHODS: Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30), carers (n = 20), and professionals (n = 65). Data analysed using Normalisation Process Theory (NPT) as the underpinning conceptual framework.FINDINGS: Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom.CONCLUSIONS: Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences could be improved to a large extent by simple organisational rather than complex clinical mechanisms

Shock Layer Radiation Measurements for Planetary Probes

Shock layer radiation to a planetary probe's heat shield has been investigated since the 1960's, using ground tests, flight tests, and theoretical modelling. Radiometers and a spectrometer were embedded in the TPS of NASA's earlier Project FIRE II, Apollo 4 and 6, as well as PAET. PAET is particularly relevant to planetary probes since it successfully demonstrated detecting the atmospheric composition using shock-layer radiometry. The NASA Orion program and Mars 2020 include and propose for future use embedded small scale, low-mass radiometers and mini-spectrometers. Recent work used a specific COTS fiber-optic mini-spectrometer, selected for wide wavelength range for testing flexibility. In proof of concept tests, these mini-spectrometers detected the strongest Na and K spectral lines in both Arcjet test and Laser tests, with thermal radiation. Characterization and tests of the radiometer and spectrometer devices components is described

Seeing red over black and white: popular and media representations of inter-racial relationships as precursors to racial violence

The recent murder in the UK of Anthony Walker attests to the lingering antipathy, indeed hostility, toward intimate inter-racial relationships, especially those involving black men and white women. Seventeen year-old Walker was brutally beaten then fatally assaulted with an axe to his head - the 'provocation' for the attack was this young black man’s relationship with his white girl friend. This paper assesses the historical and contemporary images and mythologies that continue to stigmatize inter-racial relationships. Specifically, we look at the representations disseminated through varied popular media forms. The paper suggests that these mediated constructs condition an environment that facilitates, if not encourages, violence against those in inter-racial relationships

In vivo model for microbial invasion of tooth root dentinal tubules

ABSTRACT Objective Bacterial penetration of dentinal tubules via exposed dentine can lead to root caries and promote infections of the pulp and root canal system. The aim of this work was to develop a new experimental model for studying bacterial invasion of dentinal tubules within the human oral cavity. Material and Methods Sections of human root dentine were mounted into lower oral appliances that were worn by four human subjects for 15 d. Roots were then fixed, sectioned, stained and examined microscopically for evidence of bacterial invasion. Levels of invasion were expressed as Tubule Invasion Factor (TIF). DNA was extracted from root samples, subjected to polymerase chain reaction amplification of 16S rRNA genes, and invading bacteria were identified by comparison of sequences with GenBank database. Results All root dentine samples with patent tubules showed evidence of bacterial cell invasion (TIF value range from 5.7 to 9.0) to depths of 200 mm or more. A spectrum of Gram-positive and Gram-negative cell morphotypes were visualized, and molecular typing identified species of Granulicatella, Streptococcus, Klebsiella, Enterobacter, Acinetobacter, and Pseudomonas as dentinal tubule residents. Conclusion A novel in vivo model is described, which provides for human root dentine to be efficiently infected by oral microorganisms. A range of bacteria were able to initially invade dentinal tubules within exposed dentine. The model will be useful for testing the effectiveness of antiseptics, irrigants, and potential tubule occluding agents in preventing bacterial invasion of dentine

Coming down from the trees: is terrestrial activity in Bornean orangutans natural or disturbance driven?

The orangutan is the world's largest arboreal mammal, and images of the red ape moving through the tropical forest canopy symbolise its typical arboreal behaviour. Records of terrestrial behaviour are scarce and often associated with habitat disturbance. We conducted a large-scale species-level analysis of ground-based camera-trapping data to evaluate the extent to which Bornean orangutans Pongo pygmaeus come down from the trees to travel terrestrially, and whether they are indeed forced to the ground primarily by anthropogenic forest disturbances. Although the degree of forest disturbance and canopy gap size influenced terrestriality, orangutans were recorded on the ground as frequently in heavily degraded habitats as in primary forests. Furthermore, all age-sex classes were recorded on the ground (flanged males more often). This suggests that terrestrial locomotion is part of the Bornean orangutan's natural behavioural repertoire to a much greater extent than previously thought, and is only modified by habitat disturbance. The capacity of orangutans to come down from the trees may increase their ability to cope with at least smaller-scale forest fragmentation, and to cross moderately open spaces in mosaic landscapes, although the extent of this versatility remains to be investigated