Producing the magnum opus: a metaphor for nephrology nursing expertise acquisition

Aim. This paper elucidates the nature of metaphor and the conditions necessary to its use as an analytic device in qualitative research, and describes how the use of metaphor assisted in the analytic processes of a grounded theory study of nephrology nursing expertise. Background. The use of metaphor is pervasive in everyday thought, language and action. It is an important means for the comprehension and management of everyday life, and makes challenging or problematic concepts easier to explain. Metaphors are also pervasive in quantitative and qualitative research for the same reason. In both everyday life and in research, their use may be implicit or explicit. Methods. The study using grounded theory methodology took place in one renal unit in New South Wales, Australia between 1999 and 2000 and included six non-expert and 11 expert nurses. It involved simultaneous data collection and analysis using participant observation, semi-structured interviews and review of nursing documentation. Findings. A three stage skills-acquisitive process was identified in which an orchestral metaphor was used to explain the relationships between stages and to satisfactorily capture the data coded within each stage. Conclusion. Metaphors create images, clarify and add depth to meanings and, if used appropriately and explicitly in qualitative research, can capture data at highly conceptual levels. Metaphors also assist in explaining the relationship between findings in a clear and coherent manner. © 2005 Blackwell Publishing Ltd

Structure and Electron Transfer Reactions of Blue Copper Proteins

Complete assignments of the electronic spectra of stellacyanin, plastocyanin, and azurin have been made. Bands attributable to d-d transitions have been located in the near-infrared region for the first time, and their positions are consistent with a distorted tetrahedral geometry for the blue copper center. The kinetics of the electron transfer reactions of stellacyanin, azurin, and plastocyanin with Fe(EDTA)^(2-) and Co(phen)_3^(3+) have been studied. Kinetic parameters indicate that reduction of azurin and plastocyanin by Fe(EDTA)^(2-) occurs by long distance transfer to a buried blue copper center. However, the pathway for oxidation involves substantial protein rearrangement, thereby allowing contact of Co(phen)_3^(3+) with the copper ligands. In contrast, the blue copper center of stellacyanin is equally accessible in solution to redox agents

Being a nurse in nursing home for patients on the edge of life

Nurses in nursing homes care for patients with complex health problems that need to be followed up by medical treatment. Most patients benefit from the treatment, but for some the treatment seems only to lengthen their death process. Sometimes questions are raised as to whether life‐sustaining treatment should be withheld/withdrawn. Decisions related to such questions are difficult to make as some patients are ‘on the edge of life’, which is understood as a transition between living and dying with an unpredictable outcome, whether the illness will lead to recovery or dying. The aim of this study was to acquire a deeper understanding of what it is to be a nurse in a nursing home for patients on the edge of life. The research design was qualitative, based on hermeneutic phenomenology. Fourteen nurses at two nursing homes were interviewed twice. The result shows that when facing a patient on the edge of life, the nurses were challenged as professionals and as human beings. Two main themes were identified, which included two sub‐themes each. The first main theme: ‘striving to do right and good for everyone’ included the sub‐themes ‘feeling certain, but accompanied by uncertainty’ and ‘being caught between too much responsibility and too little formal power’. The second main theme: ‘being a vulnerable helper – the prize and the price’, contained the sub‐themes ‘needing emotional protection in professional commitment’ and ‘feeling undervalued in spite of professional pride’. The essence was: ‘being a lonely and enduring struggler between opposite poles’. The findings revealed paradoxes in nurses’ work which might threaten nurses’ professional identity and put heavy demands on their professional performance. There is a need for formal involvement in end‐of‐life decisions from nurses, further education and support to nurses related to patients on the edge of life