Competency and Capability: Imperative for Nurse Practitioner Education

Objective The objective of this study was to conduct research to inform the development of standards for nurse practitioner education in Australia and New Zealand and to contribute to the international debate on nurse practitioner practice. Setting The research was conducted in all states of Australia where the nurse practitioner is authorised and in New Zealand Subjects The research was informed by multiple data sources including nurse practitioner program curriculae documents from all relevant universities in Australia and New Zealand, interviews with academic convenors of these programs and interviews with nurse practitioners. Primary argument Findings from this research include support for masters level of education as preparation for the nurse practitioner. These programs need to have a strong clinical learning component and in-depth education for the sciences of specialty practice. Additionally an important aspect of education for the nurse practitioner is the centrality of student directed and flexible learning models. This approach is well supported by the literature on capability. Conclusions There is agreement in the literature about the lack of consistent standards in nurse practitioner practice, education and nomenclature. The findings from this research contribute to the international debate in this area and bring research informed standards to nurse practitioner education in Australia and New Zealand

Nurse Practitioner Competency Standards: Findings from Collaborative Australian and New Zealand Research

Background: The title, Nurse Practitioner, is protected in most jurisdictions in Australia and in New Zealand and the number of nurse practitioners is increasing in health services in both countries. Despite this expansion of the role there is scant national or international research to inform development of nurse practitioner competency standards. Objectives: The aim of the study was to research nurse practitioner practice to inform development of generic standards that could be applied for the education, authorisation and practice of nurse practitioners in both countries. Design: The research used a multi-methods approach to capture a range of data sources including research of policies and curricula, and interviews with clinicians. Data were collected from relevant sources in Australia and New Zealand Settings: The research was conducted in New Zealand and the five states and territories in Australia where, at the time of the research, the title of nurse practitioner was legally protected. Participants: The research was conducted with a purposeful sample of nurse practitioners from diverse clinical settings in both countries. Interview and material data were collected from a range of sources and data were analysed within and across these data modalities. Results: Findings included identification of three generic standards for nurse practitioner practice namely, Dynamic Practice, Professional Efficacy and Clinical Leadership. Each of these standards has a number of practice competencies, each of these competencies with their own performance indicators. Conclusions: Generic Standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice

Synthesis of allylic and homoallylic alcohols via organometallic ring-opening of vinylic epoxides and oxetanes

Additions of organometallic reagents to vinylic epoxides have become useful synthetic reactions for preparing allylic alcohols when the regio- and stereochemistry of the product can be controlled. Analogous organometallic processes employing vinylic oxetanes have never been reported in the literature. The results presented in this dissertation are the first observed examples of vinylic oxetanes reacting with organometallic reagents to afford homoallylic alcohols. The scope and limitations of these reactions will be discussed;The reactions of aryl- and vinylpalladium compounds with vinylic oxetanes provide a high yielding route to functionally substituted homoallylic alcohols. The homoallylic alcohols are isolated as mixtures of E- and Z-isomers. The E/Z ratio, however, is generally greater than 80:20. Catalytic amounts of palladium can be employed in the reaction if cupric chloride and oxygen are used to reoxidize the palladium;Vinylic oxetanes have also been observed to react with various nucleophiles in the presence of a catalytic amount of palladium(0) to produce the corresponding di- or trisubstituted homoallylic alcohols. These reactions proceed in high yield and are both regio- and stereoselective. It has also been shown that trisubstituted allylic alcohols can be produced in high yields, via palladium(0)-catalyzed nucleophilic ring-opening of substituted vinylic epoxides. Conditions have been found for this reaction where either the E- or Z-isomer of the trisubstituted allylic alcohol can be formed preferentially;The reactions of vinylic oxetanes with organolithium, -copper and -boron reagents have been explored. The corresponding homoallylic alcohols are isolated as mixtures of stereoisomers in good yields

The temporal dynamic of response inhibition in early childhood: An ERP study of partial and successful inhibition

Event-related potentials were recorded while five-year-old children completed a Go/No-Go task that distinguished between partial inhibition (i.e., response is initiated but cancelled before completion) and successful inhibition (i.e., response is inhibited before it is initiated). Partial inhibition trials were characterized by faster response initiation and later latency of the lateral frontal negativity (LFN) than successful Go and successful inhibition trials. The speed of response initiation was influenced by the response speed on previous trials and influenced the response speed on subsequent trials. Response initiation and action decision dynamically influenced each other, and their temporal interplay determined response inhibition success

Environmental tobacco smoke exposure among non-smoking waiters: measurement of expired carbon monoxide levels

CONTEXT: Exposure to environmental tobacco smoke is a health risk that is of concern to patrons and of particular concern to employees of restaurants and bars. OBJECTIVE: To assess environmental tobacco smoke exposure (using expired carbon monoxide levels) in non-smoking waiters before and after a normal day's shift and to compare pre-exposure levels with non-smoking medical students. DESIGN: An observational study. SETTING: Restaurants with more than 50 tables or 100 places in São Paulo. SUBJECTS: 100 non-smoking restaurant waiters and 100 non-smoking medical students in São Paulo, Brazil. MAIN MEASUREMENTS: Levels of expired carbon monoxide, measured with a Smokerlyser (Bedfont EC 50 Scientific), before and after a normal day's work. RESULTS: Waiters' pre-exposure expired carbon monoxide levels were similar to those of medical students, but after a mean of 9 hours exposure in the workplace, median levels more than doubled (2.0 ppm vs. 5.0 ppm, P <0.001). Post-exposure carbon monoxide levels were correlated with the number of tables available for smokers (Kendall's tau = 0.2, P <0.0001). CONCLUSIONS: Exposure to environmental tobacco smoke is the most likely explanation for the increase in carbon monoxide levels among these non-smoking waiters. These findings can be used to inform the ongoing public health debate on passive smoking.CONTEXTO: O ambiente exposto à fumaça do cigarro traz graves riscos à saúde e preocupa tanto os empregadores quanto empregados de restaurantes e bares. No entanto, os fumantes passivos correm riscos elevados de desenvolverem doenças cancerígenas, pulmonares e cardíacas. Baseados nestes parâmetros e na experiência de países que sancionaram leis que proíbem fumar ou restringem o fumar em áreas restritas e, antes de sancionar leis municipais na cidade de São Paulo, dá-se a importância de realizar este estudo. OBJETIVO: Avaliar a exposição à fumaça de cigarro no ambiente de trabalho (através da medida do nível de monóxido de carbono) em garçons não fumantes, antes e depois do expediente de trabalho, e comparar os níveis pré-exposição com os de estudantes universitários não fumantes. TIPO DE ESTUDO: Estudo observacional LOCAL: Restaurantes com mais de 50 mesas ou 100 assentos, todos localizados em São Paulo. PARTICIPANTES: A amostra é constituída por 100 garçons não fumantes e 100 estudantes não fumantes. VARIÁVEIS ESTUDADAS: O nível de monóxido de carbono expirado foi medido com um aparelho Smokerlyser (Bedfont EC 50 Scientific), antes e depois do expediente de cada garçom. RESULTADOS: Os níveis pré-exposição de monóxido de carbono expirado foram semelhantes entre os garçons e os estudantes, mas após uma média de 9 horas no local de trabalho, o nível mediano entre os garçons foi mais que o dobro (de 2,0 ppm para 5,0 ppm, P < 0,001). Os níveis pós-exposição de monóxido de carbono correlacionaram com o número de mesas disponíveis para fumantes (Kendall's tau = 0,2, P < 0,0001). CONCLUSÃO: A exposição à fumaça de cigarro no ambiente de trabalho é a explicação mais provável para este aumento no nível de monóxido de carbono expirado entre os garçons. Estes achados podem ser utilizados para direcionar o debate sobre fumo passivo e a saúde pública.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina UNIAD - Alcohol and drugs research unitUNIFESP, EPM, UNIAD - Alcohol and drugs research unitSciEL

Nurses' attitudes towards alcoholism: factor analysis of three commonly used scales

OBJECTIVE: To investigate the psychometric properties of three scales commonly used to measure attitudes and beliefs about alcoholism. DESIGN: Cross-sectional study using a systematic sample. SETTING: Hospital São Paulo (a public general tertiary hospital) and the adjoining Federal University of São Paulo, Brazil. PARTICIPANTS: 310 nurses and nursing teachers. INSTRUMENTS: The Marcus Alcoholism Questionnaire, The Seaman Mannello Nurses' Attitudes Towards Alcohol and Alcoholism Scale and The Tolor-Tamarin Attitudes Towards Alcoholism Scale, which were combined into one self-administered questionnaire. ANALYSIS: The scales were re-grouped into their original formats and each underwent a principal components analysis with orthogonal rotation of factors. RESULTS: Each scale was found to consist of three main factors. There was some degree of overlap in the nature of the factors that the scales measured but each scale also measured something unique. COCLUSION: The results of this comparative analysis could be used as a basis for developing a new scale covering all the important attitudinal groups identified by this study.OBJETIVO: A investigação das propriedades psicométricas de três escalas mais usadas para medir atitudes e crenças sobre alcoolismo. DESENHO: Estudo transversal numa amostra sistemática. LOCAL: Hospital São Paulo (Hospital Geral Terciário) e na Universidade Federal de São Paulo (UNIFESP), Brasil. PARTICIPANTES: 310 Enfermeiras e Docentes de Enfermagem. INSTRUMENTOS: The Marcus Alcoholism Questionnaire, The Seaman Mannello Nurses' Attitudes Towards Alcohol and Alcoholism Scale e The Tolor-Tamarin Attitudes Towards Alcoholism Scale, as quais foram criadas um questionário. ANÁLISES: As escalas foram re-agrupadas em seu formato original e de cada escala sobresaiu uma análise do componente principal com rotação ortogonal dos fatores. RESULTADOS: Cada escala consistia de três fatores principais. Houve algum grau de interseção na natureza dos fatores que a escala média, mas cada escala também mediu algo único. CONCLUÃO: Os resultados desta análise comparativa poderá ser usada como base no desenvolvimento de novas escalas abrangendo toda a importância dos grupos de atitudes identificada neste estudo.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL