Exploring commitment, professional identity, and support for student nurses

Problems with the recruitment and retention of nurses globally mean that insight into the factors that might increase retention in qualified staff and students is crucial. Despite clear links between work commitment and retention, there is little research exploring commitment in student nurses and midwives. This paper reports the findings of a qualitative study designed to provide insight into commitment using semi-structured interviews conducted with nine pre-registration students and a qualitative survey completed by 171 pre-registration students. Thematic analysis of the data emphasised the impact of placement experiences on commitment via interpersonal relationships. Students typically emphasised their professional identity as the basis for commitment, although many participants also highlighted a lack of acceptance by qualified practitioners, which reduced it. There was evidence that suggested that practitioner workload may impact the student experience due to challenges in making sufficient time to provide support. Implications for retention strategies are discussed

Ethnic differences in skin microvascular function and their relation to cardiac target-organ damage

Background: People of Black African descent have increased risks of vascular target-organ damage not explained by greater blood pressures. Objective: To study ethnic differences in the microvasculature. Design and methods: Flow (flux) in microcirculatory skin vessels was assessed using laser Doppler fluximetry in 181 Afro-Caribbean and European men and women aged 40-65 years from the general population in London, UK. Flux in response to maximal heating (maximal hyperaemic response) was measured and minimum vascular resistance calculated. Peak flux and time to peak after an ischaemic stimulus were also measured. Target-organ damage was assessed using echocardiographic interventricular septal thickness (IVST). Results: In men, maximum hyperaemic response was attenuated in Afro-Caribbeans [109 arbitrary units (au), 25th and 75th percentiles 101, 117] compared with Europeans [165 (155, 179) au; P = 0.008]. Minimum vascular resistance was greater in Afro-Caribbeans, significantly so in men [(1.22 (1.18, 1.28) au/mmHg compared with 0.80 (0.77, 0.83) au/mmHg; P = 0.006]. Peak ischaemic response was attenuated in Afro-Caribbean men and women compared with Europeans (35.6 au compared with 49.5 au; P < 0.001) and time to peak was prolonged (14.1 s compared with 12.5 s; P = 0.07). These ethnic differences could not be accounted for by standard cardiovascular risk factors. IVST was greater in Afro-Caribbeans than in Europeans. Minimum vascular resistance and peak response accounted for a small proportion of this ethnic difference, in addition to conventional factors. Conclusions: Afro-Caribbeans have poorer microvascular structure and function, unexplained by conventional risk factors, which may contribute to greater rates of vascular target-organ damage. © 2005 Lippincott Williams & Wilkins

Ethnic differences in vascular stiffness and relations to hypertensive target organ damage

Objective People of Black African descent have greater risks of hypertensive target organ damage than would be anticipated for given levels of blood pressure. Arterial stiffness may further account for ethnic differences in risk. Design Cross-sectional study. Setting Population based, London, UK. Participants One hundred and three Europeans and 99 African Caribbeans aged 40–64 years. Methods We measured resting and ambulatory blood pressure, and pulse wave velocity (PWV) of elastic and muscular arteries. Echocardiography measured interventricular septal thickness (IVST). Main outcome measures PWV, IVST. Results Carotid–femoral PWV was 12.7 m/s [95% confidence interval (CI) 12.3, 13.1] in African Caribbeans and 11.2 m/s (10.9, 11.6) in Europeans (P< 0.0001). This difference persisted on adjustment for resting and ambulatory blood pressure, 12.4 versus 11.5 m/s (P = 0.003). The greater IVST in African Caribbeans (9.6 mm) compared to Europeans (9.1 mm, P = 0.0005), could only in part be accounted for by differences in carotid–femoral PWV. Stiffness in the muscular carotid–radial segment did not differ by ethnicity, but was positively associated with systolic pressure in Europeans (β regression coefficient 0.033, P = 0.04), and negatively associated in African Caribbeans (−0.036, P = 0.04, and P = 0.02 for interaction). Conclusions Aortic stiffness is increased in African Caribbeans compared to Europeans, even when higher blood pressures are accounted for. It is most closely related to IVST, but contributes little to explaining ethnic differences. Stiffness of the upper limb muscular arteries did not differ by ethnicity, but remained favourable in the presence of hypertension in African Caribbeans, while being increased in Europeans. We suggest that this is due to ethnic differences in vascular remodelling