Nurse Education: Graduate Versus Diplomate: Does having a nursing degree make you a better nurse?

In 2013, nurse education in the United Kingdom (UK) moved to a graduate-only approach in the preparation of the future nursing workforce. This research study explores the key drivers for this historic change at a point of transition aiming to:  Explore the impact that the introduction of an all-graduate nursing programme may have on the provision of nursing care from the perspectives of nurses in a particular setting. Currently the NHS is operating within a liminal space in which nurses with degrees and nurses with diplomas work side by side. Interrogating the reality of this situation from the perspective of nurses who are directly impacted by the changes, is a central aspect of this study. It examines issues of power and influence from the inception of the NHS, and considers their impact on the current position of the nursing profession. Factors, which influence the preparation of nurses and implications for the provision of future health care are explored and give rise to the question of whether a degree is needed to be ‘a good nurse’. The thesis examines the various meanings attributed to the idea of ‘being a good nurse’. Drawing on the works of Husserl (1931) and Heidegger (1962), Interpretive Phenomenology is utilised to interrogate the lived experience of the participants and gain further understanding from their perspectives, with the objective of:  Exploring graduate and diplomate nurses own perceptions of the impact that a graduate only qualification may have on nursing care delivery.  Exploring nurses experiences of working with the graduate vs diplomate nurse, to ascertain ways in which they may perceive difference in ability  Identifying the opinions of registered health care staff on the new entry criteria to nurse education, focussing on their inclusiveness or exclusivity  Identifying any overall perceived differences in the nursing abilities of staff that hold a degree vs. diploma qualification in practice, from both nurses and other health care staff.  Exploring participants perceptions of the ‘good nurse’ Data reveals a variety of understandings and experiences of both diplomate and graduate nurses. All participants discussed facing an increasingly challenging healthcare working environment, having to manage day-to-day care provision with diminished staffing levels and increasingly more complex patient requirements. These factors revealed tensions and left nurse participants questioning what sort of implications the introduction of the graduate only approach may have for the delivery of frontline care. The thesis concludes by recognising that there remain questions over the practical application of the graduate only approach to nurse education. Potential similarities and differences in expected performance and expectations of the new workforce were drawn from the research. Participants raised concerns in relation to possible changes to the qualitative nature of healthcare following the introduction of a graduate-only profession. Equity and access to nursing programmes was highlighted as an issue in relation to the supply of caring nurses and the possibility of missing out on potentially good nurses, who would be unable to undertake a graduate training programme for various reasons. Original contribution to knowledge is claimed in that that the nurses themselves provided their own insights which were analysed in detail. The investigation was limited to a specific context, but the approach was sufficiently rigorous to allow for the study to be replicated elsewhere and potentially further contribute to knowledge beyond the original setting

Shall I tell my mentor? Exploring the mentor-student relationship and its impact on students’ raising concerns on clinical placement

Aims To explore student nurses' and nurse mentors' perceptions and experiences of raising concerns on clinical placement and the influence (if any) of their relationship on this process. A secondary aim is to consider the above, from a regulatory perspective in light of current literature and policy developments. Background Raising concerns whilst on clinical placement has been shown to be challenging for student nurses internationally. Registered nurses in the UK (in this case called “nurse mentors”) facilitate learning and assessment in practice. However, limited research exists on the influence of the relationship between the nurse mentor and student nurse on the raising concerns process. Design A qualitative approach was used to undertake secondary thematic analysis of interview data. The primary data set was generated during a PhD study, focusing on the mentor–student dynamic and the possible influence of this relationship on students' raising concerns. Methods 30 individual semi‐structured interviews were subjected to concurrent and thematic analysis. Interviews were undertaken with student nurses (n = 16) and nurse mentors (n = 14) between April 2016–January 2018. The COREQ 32‐item checklist was used during the preparation of this article. Findings The following three interrelated analytical themes were generated from the data, “developing a mentor‐student relationship," “keeping your mentor sweet” and “the mentor role in the raising concerns process.” Conclusion Our analysis of participants' experiences and perceptions offers an original contribution to understanding the factors associated with student nurses raising concerns in practice. Student nurses and most mentors believed that students should be encouraged and supported to raise concerns, but students' decisions were strongly influenced by their perceptions of the immediate interpersonal and educational context. Similar barriers to raising concerns have been shown to exist regardless of geographical boundaries, therefore the findings of this study are nationally and internationally relevant

An updated view of hypothalamic-vascular-pituitary unit function and plasticity

The discoveries of novel functional adaptations of the hypothalamus and anterior pituitary gland for physiological regulation have transformed our understanding of their interaction. The activity of a small proportion of hypothalamic neurons can control complex hormonal signalling, which is disconnected from a simple stimulus and the subsequent hormone secretion relationship and is dependent on physiological status. The interrelationship of the terminals of hypothalamic neurons and pituitary cells with the vasculature has an important role in determining the pattern of neurohormone exposure. Cells in the pituitary gland form networks with distinct organizational motifs that are related to the duration and pattern of output, and modifications of these networks occur in different physiological states, can persist after cessation of demand and result in enhanced function. Consequently, the hypothalamus and pituitary can no longer be considered as having a simple stratified relationship: with the vasculature they form a tripartite system, which must function in concert for appropriate hypothalamic regulation of physiological processes, such as reproduction. An improved understanding of the mechanisms underlying these regulatory features has implications for current and future therapies that correct defects in hypothalamic–pituitary axes. In addition, recapitulating proper network organization will be an important challenge for regenerative stem cell treatment

Kisspeptin-GPR54 Signaling in Mouse NO-Synthesizing Neurons Participates in the Hypothalamic Control of Ovulation

International audienceReproduction is controlled in the brain by a neural network that drives the secretion of gonadotropin-releasing hormone (GnRH). Various permissive homeostatic signals must be integrated to achieve ovulation in mammals. However, the neural events controlling the timely activation of GnRH neurons are not completely understood. Here we show that kisspeptin, a potent activator of GnRH neuronal activity, directly communicates with neurons that synthesize the gaseous transmitter nitric oxide (NO) in the preoptic region to coordinate the progression of the ovarian cycle. Using a transgenic Gpr54-null IRES-LacZ knock-in mouse model, we demonstrate that neurons containing neuronal NO synthase (nNOS), which are morphologically associated with kisspeptin fibers, express the kisspeptin receptor GPR54 in the preoptic region, but not in the tuberal region of the hypothalamus. The activation of kisspeptin signaling in preoptic neurons promotes the activation of nNOS through its phosphorylation on serine 1412 via the AKT pathway and mimics the positive feedback effects of estrogens. Finally, we show that while NO release restrains the reproductive axis at stages of the ovarian cycle during which estrogens exert their inhibitory feedback, it is required for the kisspeptin-dependent preovulatory activation of GnRH neurons. Thus, interactions between kisspeptin and nNOS neurons may play a central role in regulating the hypothalamic-pituitary-gonadal axis in vivo

The International Maritime Organization and Oil Pollution in the Mediterranean Sea

Maritime transportation has diametric personalities. The advancement in global maritime transportation of oil products has resulted in commercial advantages. This advancement has simultaneously led to environmental disadvantages, sporadically leaving the marine environment in a detrimental position. “Commercial advantages” and “environmental disadvantages” are apparently two central issues that emanate from maritime transportation. Although the disadvantages cannot concretely outweigh the advantages, the “pollution” aspect has coastal states, environmentalists, marine biologists, and international organizations worrying whether economic gain is worth destroying the pristine environment. However, some environmentalists are optimistic and state that the marine environment has a form of resistance-capacity and time may heal the human-initiated damage leading to the point where nature will reinstate itself to its original status. However, what has changed today is that with the advancement in global maritime transportation, the impacts on the marine environment are no longer small, localized, and reversible. Incidents both accidental and operational in nature have raised serious environmental concerns. The Mediterranean Sea is no exception to this concern. Data reveals that maritime activities in the Mediterranean have increased since the late 1900s and this “increase” will reach a higher plateau by 2018. While no major accidents have been recorded so far, the ubiquity, abundance, and broadness of detected operational spills in the Mediterranean have caught the attention of the International Maritime Organization (IMO). Hence, the Mediterranean Sea is distinguished as a “special area” and the need to control oil transportation has become a dire need in order to save the region from anthropogenic impacts. Similar to many anthropogenic impacts on natural systems, oil pollution is one that, despite widespread recognition of the problem, is still growing and even if stopped immediately will persist in the marine environment for years to come. Scientists have proven that polycyclic aromatic hydrocarbons, a high molecular weight component (compound) of crude oil, are extremely difficult to clean due to its complex structure. The main problem associated with this component is that they cannot be absolutely degraded by bioremediation efforts. Since the rise in the number of maritime transportation is inevitable, to eradicate problems associated with illegal oil discharge, the Mediterranean Sea area has been designated as a “special area.” The question is whether the initiatives of the IMO to establish a “zero discharge policy” are sufficient to control oil pollution in the Mediterranean Sea? This chapter will endeavor to answer that question.https://commons.wmu.se/mer_chapters/1003/thumbnail.jp

Conclusions for Part II: National Case Studies

This book (Part II of a volume on “Oil Pollution in the Mediterranean Sea”) has presented a review of knowledge on oil pollution in the Mediterranean Sea, through a series of national and regional case studies. Those chapters have used a range of data on oil extraction and production activities, oil transportation, satellite technology, aerial surveillance, and in situ monitoring, for example, to present a picture of trends in oil pollution in various areas of the region over many years. A range of legislative measures are in place to protect the marine environment of the region, including the Convention for the Protection of the Mediterranean Sea Against Pollution (Barcelona Convention, 1976) and its Protocols. The Mediterranean Sea and its various regions, such as the Adriatic Sea, have special status for the prevention of pollution by oil from ships under International Convention for the Prevention of Pollution from Ships and its Protocols (MARPOL 73/78 Convention). National Contingency Planning (NCP) and other activities take place under the aegis of the Regional Marine Pollution Emergency Response Centre for the Mediterranean Region (REMPEC), through which countries in the region can work together to cooperate in preventing pollution from ships, for example, and work together to combat pollution in the event of an emergency. NCP and oil pollution preparedness and response activities are discussed within a number of the national case studies. By bringing together the work of scientists, legal and policy experts, academic researchers, and specialists in various fields relating to marine environmental protection, satellite monitoring, oil pollution, and the Mediterranean Sea, these national case studies present a picture of oil pollution from a range of sources (shipping – accidental, operational, and illegal), offshore oil and gas exploration and exploitation, and coastal refineries, to present a picture of the current situation in the Mediterranean Sea