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1.  Self-rated health, work characteristics and health related behaviours among nurses in Greece: a cross sectional study 
BMC Nursing  2005;4:8.
Background
Previous studies on self-rated health among nurses have indicated an association of low job satisfaction and stress in relation to poor self-rated health. The relationship between self rated health and the specific work characteristics and health related behaviours of nurses to our knowledge have not been adequately studied.
Objective
To investigate the health profile of nurses working in hospitals in North West Greece and to examine the associations between self rated health (SRH) and health related behaviours and work characteristics in this group of hospital employees.
Methods
A self-administered questionnaire was distributed to a random sample of 443 nurses working in all the hospitals in North West Greece. Regression analysis was used to examine the relationship of health related behaviours and work characteristics with self rated health among the nurses.
Results
A total of 353 responded to the questionnaire (response rate 80%) of which 311 (88%) were female and 42 (12%) male. The mean age (standard deviation) of the respondents was 36 years (5.6) and their mean years of working as nurses were 13.5 years (5.9). Almost half of the nurses' smoked, and about one third were overweight or obese. About 58% (206) of the nurses reported having poor health while 42% (147) reported having good health. Self-rated health was independently associated with gender, effort to avoid fatty foods and physical activity, according to multiple logistic regression analysis.
Conclusion
The population studied presented a relatively poor health profile, and a high proportion of poor SRH. Though female gender and effort to avoid fatty foods were associated with poor SRH, and exercise and white meat consumption with good SRH, specific work characteristics were not associated with SRH.
doi:10.1186/1472-6955-4-8
PMCID: PMC1343556  PMID: 16364183
2.  Recognition of delirium in ICU patients: a diagnostic study of the NEECHAM confusion scale in ICU patients 
BMC Nursing  2005;4:7.
Background
A delirium, is a serious, high-frequency complication in intensive care unit (ICU) patients. The consequences of this complication range from high morbidity and mortality to greater need for nursing care. Despite these, delirium is often not recognized and there for not treated. In this study a nursing screening instrument, the NEECHAM confusion scale, was studied for early recognition of delirium ICU patients. This scale proved valid and reliable in several studies in the general hospital population.
Methods
In this study validity and reliability were tested in a prospective cohort of 105 patients. Gold standard for delirium was an independent DSM-IV diagnosis. User friendliness was tested by structured evaluation of nurses' experiences working with the scale.
Results
The NEECHAM confusion scale showed high internal consistency (Cronbach's alpha 0.88) and an interrater reliability of Cohen's Kappa 0.60. The concurrent validity with the DSM-IVcriteria showed a strong link (chi-square 67.52, p [less than or equal to] 0.001). Sensitivity was high, 97% and specificity was good 83%. ICU nurses completed the NEECHAM confusion rating in 3.69, ± 1.21 minutes average. In general the nurses were positive about the NEECHAM confusion scale. They were able to collect data during regular care, but experienced problems in rating the scale in intubated patients. The items in themselves were clear, the content validity, measured by the language used was rated good.
Conclusion
The psychometric characteristics of the NEECHAM confusion scale of this ICU study are generally consistent with validity research previously reported for the general hospital population. The psychometric characteristics and the ease of use of the NEECHAM confusion scale enables ICU nurses to early recognize delirium. Further study, especially in intubed patients is recommended.
doi:10.1186/1472-6955-4-7
PMCID: PMC1352361  PMID: 16351715
3.  A qualitative study of nursing student experiences of clinical practice 
BMC Nursing  2005;4:6.
Background
Nursing student's experiences of their clinical practice provide greater insight to develop an effective clinical teaching strategy in nursing education. The main objective of this study was to investigate student nurses' experience about their clinical practice.
Methods
Focus groups were used to obtain students' opinion and experiences about their clinical practice. 90 baccalaureate nursing students at Shiraz University of Medical Sciences (Faculty of Nursing and Midwifery) were selected randomly from two hundred students and were arranged in 9 groups of ten students. To analyze the data the method used to code and categories focus group data were adapted from approaches to qualitative data analysis.
Results
Four themes emerged from the focus group data. From the students' point of view," initial clinical anxiety", "theory-practice gap"," clinical supervision", professional role", were considered as important factors in clinical experience.
Conclusion
The result of this study showed that nursing students were not satisfied with the clinical component of their education. They experienced anxiety as a result of feeling incompetent and lack of professional nursing skills and knowledge to take care of various patients in the clinical setting.
doi:10.1186/1472-6955-4-6
PMCID: PMC1298307  PMID: 16280087
4.  Are patient falls in the hospital associated with lunar cycles? A retrospective observational study 
BMC Nursing  2005;4:5.
Background
Falls and associated negative outcomes in hospitalized patients are of significant concerns. The etiology of hospital inpatient falls is multifactorial, including both intrinsic and extrinsic factors. Anecdotes from clinical practice exist in which health care professionals express the idea that the number of patient falls increases during times of full moon. The aim of this study was to examine in-hospital patient fall rates and their associations with days of the week, months, seasons and lunar cycles.
Methods
3,842 fall incident reports of adult in-patients who fell while hospitalized in a 300-bed urban public hospital in Zurich, Switzerland were included. Adjusted fall rates per 1'000 patient days were compared with days of the week, months, and 62 complete lunar cycles from 1999 to 2003.
Results
The fall rate per 1000 patient days fluctuated slightly over the entire observation time, ranging from 8.4 falls to 9.7 falls per month (P = 0.757), and from 8.3 falls on Mondays to 9.3 falls on Saturdays (P = 0.587). The fall rate per 1000 patient days within the lunar days ranged from 7.2 falls on lunar day 17 to 10.6 falls on lunar day 20 (P = 0.575).
Conclusion
The inpatient fall rates in this hospital were neither associated with days of the week, months, or seasons nor with lunar cycles such as full moon or new moon. Preventive strategies should be focused on patients' modifiable fall risk factors and the provision of organizational conditions which support a safe hospital environment.
doi:10.1186/1472-6955-4-5
PMCID: PMC1274330  PMID: 16225704
5.  Experiencing neutropenia: Quality of life interviews with adult cancer patients 
BMC Nursing  2005;4:4.
Background
Neutropenia is a common toxicity in chemotherapy but detailed information about how neutropenia is associated with changes in patients' quality of life is not readily available. This prospective study interviewed patients with grade 4 neutropenia to provide qualitative information on patients' experience of developing and coping with grade 4 neutropenia during a cycle of chemotherapy.
Methods
A sample of 34 patients who developed grade 4 neutropenia during the first cycle of chemotherapy completed a total of 100 structured clinical interviews. Interviews were transcribed, and 2 raters inductively developed 5 broad categories comprising 80 specific complaint domains nominated by patients. Thirty-five patient-nominated problems were mentioned in 5% or more of the interviews.
Results
Fatigue was the most common physical symptom. Interference in daily routine, negative self-evaluation, negative emotion, and social isolation were other common complaints associated with neutropenia.
Conclusion
Neutropenia is associated with a number of negative experiences among cancer patients undergoing chemotherapy, and these negative experiences have an adverse effect on the patient's quality of life. Oncology nurses can play a key role in helping patients manage adverse effects to maintain their quality of life.
doi:10.1186/1472-6955-4-4
PMCID: PMC1180832  PMID: 16004611
6.  The relationships between depression and other outcomes of chronic illness caregiving 
BMC Nursing  2005;4:3.
Background
Many caregivers with chronically ill relatives suffer from depression. However, the relationship of depression to other outcomes of chronic caregiving remains unclear. This study tested a hypothesized model which proposed that hours of care, stressful life events, social support, age and gender would predict caregivers' outcomes through perceived caregiver stress. Depression was expected to mediate the relationship between perceived stress and outcomes of chronic caregiving (physical function, self-esteem, and marital satisfaction).
Methods
The sample for this secondary data analysis consisted of 236 and 271 subjects from the Americans' Changing Lives, Wave 1, 1986, and Wave 2, 1989, data sets. Measures were constructed from the original study. Structural equation modeling was used to test the hypothesized model, and an exploratory structural modeling method, specification search, was used to develop a data-derived model. Cross-validation was used to verify the paths among variables.
Results
Hours of care, age, and gender predicted caregivers' outcomes directly or through perceived caregiver stress (p < .01). Depression mediated the relationship between perceived stress and psychological outcomes and explained 40% and 11% of the variance in self-esteem and marital satisfaction, respectively.
Conclusion
Depression predicted psychological outcomes. Whether depression predicts physical health outcomes needs to be further explored.
doi:10.1186/1472-6955-4-3
PMCID: PMC554787  PMID: 15725346
7.  The effects of long-term total parenteral nutrition on gut mucosal immunity in children with short bowel syndrome: a systematic review 
BMC Nursing  2005;4:2.
Background
Short bowel syndrome (SBS) is defined as the malabsorptive state that often follows massive resection of the small intestine. Most cases originate in the newborn period and result from congenital anomalies. It is associated with a high morbidity, is potentially lethal and often requires months, sometimes years, in the hospital and home on total parenteral nutrition (TPN). Long-term survival without parenteral nutrition depends upon establishing enteral nutrition and the process of intestinal adaptation through which the remaining small bowel gradually increases its absorptive capacity. The purpose of this article is to perform a descriptive systematic review of the published articles on the effects of TPN on the intestinal immune system investigating whether long-term TPN induces bacterial translocation, decreases secretory immunoglobulin A (S-IgA), impairs intestinal immunity, and changes mucosal architecture in children with SBS.
Methods
The databases of OVID, such as MEDLINE and CINAHL, Cochran Library, and Evidence-Based Medicine were searched for articles published from 1990 to 2001. Search terms were total parenteral nutrition, children, bacterial translocation, small bowel syndrome, short gut syndrome, intestinal immunity, gut permeability, sepsis, hyperglycemia, immunonutrition, glutamine, enteral tube feeding, and systematic reviews. The goal was to include all clinical studies conducted in children directly addressing the effects of TPN on gut immunity.
Results
A total of 13 studies were identified. These 13 studies included a total of 414 infants and children between the ages approximately 4 months to 17 years old, and 16 healthy adults as controls; and they varied in design and were conducted in several disciplines. The results were integrated into common themes. Five themes were identified: 1) sepsis, 2) impaired immune functions: In vitro studies, 3) mortality, 4) villous atrophy, 5) duration of dependency on TPN after bowel resection.
Conclusion
Based on this exhaustive literature review, there is no direct evidence suggesting that TPN promotes bacterial overgrowth, impairs neutrophil functions, inhibits blood's bactericidal effect, causes villous atrophy, or causes to death in human model.
The hypothesis relating negative effects of TPN on gut immunity remains attractive, but unproven. Enteral nutrition is cheaper, but no safer than TPN. Based on the current evidence, TPN seems to be safe and a life saving solution.
doi:10.1186/1472-6955-4-2
PMCID: PMC549542  PMID: 15686591
8.  Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius 
BMC Nursing  2005;4:1.
Background
The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system.
Methods
A force field analysis in terms of the driving forces had shown that there was dissatisfaction with the traditional method of handover which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The restraining forces identified were a fear of accountability, lack of confidence and that this change would lead to more work. A 3 – step planned change model consisting of unfreezing, moving and refreezing was used to guide us through the change process. Resistance to change was managed by creating a climate of open communication where stakeholders were allowed to voice opinions, share concerns, insights, and ideas thereby actively participating in decision making.
Results
An evaluation had shown that this process was successfully implemented to the satisfaction of patients, and staff in general.
Conclusion
This successful change should encourage other nurses to become more proactive in identifying areas for change management in order to improve our health care system.
doi:10.1186/1472-6955-4-1
PMCID: PMC548693  PMID: 15676078

Results 1-8 (8)