Friendships under strain : the work-personal life integration of middle managers

Middle managers in today\u27s organisations have reported experiencing longer working hours and intensified work regimes. These increased pressures, in turn, have led to growing difficulty in addressing the integration of their work and personal lives. In an exploratory study of the daily workplace experiences of Australian middle managers and the impacts on their personal lives, one of the key themes to emerge was respondents\u27 concerns about the negative effects on their friendships. This paper discusses middle managers\u27 recognition of the value of friendships for their wellbeing, and the resultant anger and sadness reported at the strain on these relationships due to competing time demands. The significant role that friendships play in alleviating some of the stresses of work demands, while concurrently being impeded by these same demands, is an important issue for organisations to consider. These findings indicate the need for middle managers to truly have an ability to engage in activities - and friendships - which will aid them in their working lives. The study also indicates a need for further investigation into the development and maintenance of friendships for both middle managers and other groups of employees. <br /

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants’ systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultraacute prehospital setting. Funding British Heart Foundation

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Ethics on the floor

The work of the 'Human Research Ethics Committee' (HREC) is expanding as the dimensions of ethical practice and research grow in the clinical arena. Over the past five years, the demands on practitioners and ethics committee members have expanded, as the : general public demands accountability on the part of clinical and other researchers. This paper presents a case study of an ethics committee in an Area Health Service in Sydney. It represents the views of the members as to why they see their job as important, what aspects are difficult, how they delineate between ethical/legal and scientific issues, and what are the major stumbling blocks for them in enacting their membership' of a HREC. The data for the case study was collected using interviews wtth nine out of eleven members. The audio taped interviews were transcribed, the text thematically analysed for commonalitiesand contrasts, and a description of the members' perspective on various issues written. Issues emerging include: amount of material members read prior to the committee meeting, the difficulty in educating practitioners (all researchers) to write information sheets that are simple and comprehensible to laypersons, the payment of subjects for their time, the appropriale amount of monitoring to be applied on each project, the difficulty in letting researchers know that the ethics committee is committed to encouraging research and that its questions are intended to ensure the best possible project answering the researchers' questions/aims is conducted, and the slow or no response by researchers to ethics committee questions. The findings imply that reviewing research proposals for their ethical value is individual and members of human research ethics committees need to synthesise these in a committee context to make informed decisions

Developing a research culture with clinical nurses : personal reflections from the field

Imperative to producing research outcomes is developing a research. While this term is used extensively, little research has been conducted to determine its key characteristics. In a survey study with researchers at Australian universities, the key features of an enabling research culture were found to be: an environment characterised by research productivity, positive collegial relationships, inclusivity, non-competitiveness and effective research processes and training [1]. Building on personal experience and reflection, the question explored in this narrative paper is how these characteristics can be promoted in the clinical arena to establish an enabling environment for conducting research and translating research findings. Narrative inquiry gives meaning to the storyteller and people who read the story

Using the Delphi technique in nursing research

The Delphi technique is often used when consensus views of experts are sought in nursing education, management and clinical work. This article discusses the usefulness of the technique for research in nursing, using personal experience, past critiques and examples from contemporary nursing research

Managing family life while studying : single mothers' lived experience of being students in a nursing program

Evidence suggests that single parent families are more likely to be affected by problems associated with poor health and poverty. Single parent families are growing in number and are overwhelmingly headed by women. Despite their increasing number and their level of vulnerability, the lived experiences of single mothers have attracted little attention in the literature. Still little is known about many aspects of life as experienced by single mothers. Nursing is a profession that is dominated by women, and every year a number of single mothers enrol in undergraduate nurse education programs. Currently, there is little information about the experiences of women who are single mothers, undertaking a nursing degree in a university. This paper reports a study that explored the lived experiences of five single mother undergraduate nursing students. Van Manen's phenomenological method informed the design and conduct of the study. Findings were grouped into the following themes: being exhausted all the time; being overwhelmed with worries; and being hopeful of the future. Findings of this study revealed that the single mother's major health concerns were chronic tiredness and overwhelming worries. However, their being in the university was perceived as being health promoting and restoring to their self esteem. Implications for educators, health providers and women's health services are drawn from the findings

Occupational exposure of nurses working in high risk areas : an Australian study

This study aimed to explore the incidence, reporting and management of occupational exposure among nurses working in high risk areas in two major hospitals in the western suburbs of Sydney, Australia. A structured questionnaire with a mixture of open and closed ended questions was developed to survey the nurses. The responses to each question was analysed using either a quantitative approach for closed ended questions, or a qualitative approach that compared frequency of themes for the open-ended questions. Under reporting of exposures, concern following an exposure and dissatisfaction of nurses with the reporting process were identified. This paper emphasises the need for organisations to have user friendly protocols for immediate reporting and management of exposures by knowledgeable assessors

Caring for residents : the effects of education on staff attitude and knowledge in an aged care facility

Providing quality health care to elderly people assumes knowledge and positive attitudes of the people involved. This paper reports the findings of a study aimed to investigate whether education over a 12 month period affected the knowledge and attitudes of staff at an aged care facility towards older people. A pre-post test design was utilised to compare the knowledge and attitudes of a sample of 47 staff at the facility. The results indicate that the staff who provided direct care to residents showed a higher increase in knowledge and attitude than those who did not. While 44 of the 47 attended some form of education, the staff who attended specific aged care education sessions showed more positive attitudes and greater knowledge of older people at the end of the 12 months. These results imply that education of staff in aged care facilities is important and should be directed to topics specifically relevant to aged care

Palliative care at home : stress for nurses in urban and rural New South Wales, Australia

Nurses often experience positive and negative dimensions of caring for dying clients and their families. This project aimed to compare stress experienced by urban and rural community nurses working with palliative-care clients in the home. Participants included five nurses working in rural Australia and seven nurses working in an urban area. Transcribed data from unstructured audio-taped interviews were coded for common and contrasting themes, and a comparison was made of the stress experienced by the two groups of nurses. The major themes were role conflict and definition, family dynamics, time and workload. For both groups of nurses, the impact of family relationships and role conflict within the community impacted significantly to the stress they experienced. Debriefing opportunities for nurses to discuss stress, including educational and support sessions, is an essential component of best practice. Rural nurses had the additional stress of trying to provide a 24 h service over vast distances with a lack of financial resources