Care concept in medical and nursing students' descriptions: philosophical approach and implications for medical education

Introduction. Care is seen as something that is peculiar to the medical sciences but its meaning and status for physicians and nurses differs. Objectives. The aim of this research was to learn how nursing and medical students understand and define care, and how their definition and views on their practice of caring change as they advance through their studies. Material and methods. The study was conducted among two groups of students: before and after their first practicum (n=102). Analysis of the students' answers was carried out using Colaizzi's phenomenological descriptive methodology, which means that a qualitative approach was used. Results. The qualitative analysis shows that the medical and nursing students define care in the same way, using 9 main categories: compassion, commitment, competence, confidence, conscience, communication, patience, courage and support. The nursing students viewed their caring to be within both practical and emotional dimensions and this was a core feature of their identity as nurses. Medical students, on the other hand, viewed the practical dimension of care as an additional activity. All the students in the study underlined the importance of having time to care and showed that, for them, 'time' in this context has a moral meaning. What was interesting to the research team centered on the initial attitudes to 'caring' from both medical and nursing students. Conclusions. We found that students of both nursing and medicine do not begin their studies with different attitudes and concepts of care. However, after their initial exposure to practical placements a process begins which forges different identities around the concept of care. This implies trends in the division of professional roles during their initial education

Choice and perception of the nursing profession from the perspective of Polish nursing students: a focus group study.

BACKGROUND: Although previous quantitative studies provide important information on the factors which influence the choice of nursing as a career, qualitative analysis makes it possible to study the subject more thoroughly. The purpose of this study was to conduct an in-depth analysis of the reasons why Polish students choose nursing as a profession and their later perception of the job based on experiences acquired during the nursing course. METHODS: A qualitative descriptive study was designed. We organized 8 focus group discussions with third-year nursing students. A total of 76 students participated in the study. RESULTS: Several reasons why students had chosen the nursing profession were identified: desire to help others, family tradition, desire to work abroad, failure to get into another course, pure chance, and low admission requirements (relative to medical studies). The participants\u27 views of the nursing profession were based on their own personal experiences or observations of nurses at work. Often these observations were superficial, concerning only selected fragments of nursing work. The participants also identified reasons for there being low regard for the nursing profession. CONCLUSION: The decision about choosing nursing is mainly determined by practical aspects, e.g., the opportunity for employment. Although young people are aware of the low prestige of the nursing profession in Poland, they believe it is possible to improve its image and enhance its prestige

Assessment of differences in psychosocial resources and state of health of rural and urban residents : based on studies carried out on students during examination stress

Introduction. Civilization changes of the environment shaping the psychosocial resources from rural to urban influence human health. Aim. The study aimed to identify the differences due to the place of residence (rural, urban) as far as health resources are concerned (social support, sense of coherence, dehydroepiandrosterone sulfate concentration in plasma) and health in examination stress situations. The study also determined the concentration of dehydroepiandrosterone sulfate (health resource) and cortisol (stress indicator). Material and methods. The psychosocial variables were assessed using the scales: ISEL-48v. Coll., SOC-29, SF-36v.2™ oand analogue scale (perception of examination stress). The study included, based on a stratified sampling (year of study) and purposive sampling (written examination, major), 731 students representing the six universities in Lublin, south-east Poland. Among the respondents, 130 students were rural residents. Results. Health resources of students living in rural and urban areas generally differ statistically significantly in social support and the subscales of availability of tangible support, availability of appreciative support, the availability of cognitive-evaluative support and a sense of resourcefulness. The study recorded a sstatistically significantly larger network of family ties among students living in rural areas. The demonstrated diversity of resources did not substantially affect the perceived health, with the exception of pain sensation. Examination stress assessed by subjective opinion of the respondents and plasma cortisol levels vary relative to the place of residence. Students residing in rural areas showed significantly lower cortisol levels values, but subjectively perceived the situation of examation as more stressful. Conclusions. Differences in health resources and their mechanism of impact on health, to a limited extent, were conditioned by the place of residence, but they are so important in the light of human choices that they require further analysis

Wczesne wyniki leczenia skolioz idiopatycznych z zastosowaniem gorsetu dynamicznego SpineCor

Wstęp: Skolioza idiopatyczna to trójpłaszczyznowa deformacja kręgosłupa. Leczenie uzależnione jest od wielu czynników, spośród których wielkość skrzywienia i stopień dojrzałości kostnej wydają się być najbardziej istotne. W przypadku progresujących skrzywień o kącie <40° zalecane jest stosowanie gorsetu. Dostępnych jest wiele rodzajów gorsetów, najczęściej o sztywnej konstrukcji. Gorset dynamiczny SpineCor to system elastycznych taśm, które po założeniu bezpośrednio korygują deformację kręgosłupa nieograniczając jego ruchomości. Cel pracy: Celem pracy jest przedstawienie wczesnych wyników leczenia skolioz idiopatycznych z zastosowaniem gorsetu dynamicznego SpineCor. Materiał i metodyka: Kryterium rozpoczęcia leczenia gorsetem była obecność progresującego skrzywienia kręgosłupa u chorych z dojrzałością kostną według Rissera 0-3. Aplikacja gorsetu odbywało się według założeń metody. Badaną grupę stanowiło 42 chorych, 36 dziewcząt i 6 chłopców. Wiek w chwili rozpoczęcia leczenia wynosił średnio 11,9 lat. Okres obserwacji wynosił średnio 11 miesięcy. Wyjściowy kąt skrzywienia w odcinku piersiowym wynosił średnio 33,1°, zaś w odcinku lędźwiowym 29,4°. Badana grupa została podzielona na podgrupy na podstawie: wielkości wyjściowego skrzywienia, lokalizacji skrzywienia, płci. Wyniki oceniano jako korekcję (zmniejszenie kąta o >=5°), stabilizację (zmiana kąta +/- 5°) lub progresję (zwiększenie kąta o >=5°). Wyniki: Wielkość kąta skrzywienia w ostatniej kontroli w odcinku piersiowym wyniosła średnio 29,7°, zaś w odcinku lędźwiowym 25,5°. U 21 chorych skrzywienie uległo korekcji (50%), 14 osiągnęło stabilizację (33,3%) a 7 progresję (16,6%). Najlepsze wyniki osiągnięto w grupie chorych z wyjściowym kątem <25° (p < 0,05) - 60% chorych z korekcją. Przeciwnie w grupie chorych z wyjściowym kątem >45° tylko 37,5% osiągnęło korekcję. Nie zanotowano znaczących różnic w wynikach leczenia w zależności od płci. Wnioski: Gorset SpineCor stanowi dobrą alternatywę dla sztywnych gorsetów, zwłaszcza w przypadkach małych skrzywień. Pozwala on na zachowanie ruchomości kręgosłupa. Tego typu gorset jest dobrze akceptowalny przez młodych chorych. Niezbędne są dalsze długofalowe obserwacje celem ostatecznych wniosków.Introdcution: Idiopathic scoliosis is a three-dimensional deformation of the spine. Treatment of this condition depends on many factors, with curve magnitude (Cobb angle) and skeletal maturity (Risser sign) being the most important indices. In progressing curves of <40°, bracing is recommended. Different types of braces are available, most of them are of a rigid type. The SpineCor dynamic brace is a system of elastic bands designed to directly correct the spinal column deformity without restricting motion of the spine. Aim of the paper: The aim of this paper is to present early results of adolescent idiopathic scoliosis treatment with the SpineCor brace. Material and methods: Inclusion criteria for brace the application included the presence of a progressing curve in a skeletally immature child (Risser 0 - 3). The SpineCor brace was applied according to the principles of the method. The study group comprised 42 patients: 36 girls, 6 boys. The mean age at brace application was 11.9 years. The mean follow-up was 11 months. The mean initial curve size in the whole group was 33.1° in the thoracic spine and 29.4° in the lumbar spine. The evaluated group was subsequently divided into different subgroups depending on: initial curve size, curve type and sex. Results were classified as correction (decrease of curve size of >=5°), stablisation (curve change +/- 5°) or progression (increase of curve size of >=5°). Results: Mean curve size at the final follow-up was 29.7° in the thoracic spine and 25.5° in the lumbar spine. Twenty one patients improved (50%), 14 had curve stabilisation (33.3%) and 7 progressed (16.6%). The best results were achieved in curves lower than 25° Cobb angle (p < 0.05) - 60% of patients improved. In contrast, in the over-45° group, only 37.5% of patients improved. No significant differences were found between treatment results with regard to sex. Conclusion: SpineCor brace seems to be a good alternative for rigid braces, especially in minor curves. It enables preservation of motion of the spine. This type of brace is easily accepted by young patients. Further follow-up is needed to present long-term results

Health-promoting activities performed by nurses for patients with COPD

Wstęp: Przewlekła obturacyjna choroba płuc (POChP) stanowi czwartą przyczynę zgonów na świecie. Wśród działań, które powinna podejmować pielęgniarka w stosunku do chorego na POChP, podkreśla się przede wszystkim znaczenie tych, które można określić jako promujące zdrowie.Celem pracy jest analiza częstości i charakteru podejmowanych przez pielęgniarki działań wchodzących w zakres promocji zdrowia wobec pacjentów z POChP.Materiał i metody: Dokonano analizy ilościowej danych zebranych od 132 pielęgniarek (100%) zatrudnionych w zamkniętej i otwartej opiece zdrowotnej województwa lubelskiego. Zastosowano metodę sondażu diagnostycznego, wykorzystując kwestionariusz ankiety własnego autorstwa. Materiał zgromadzono w 2008 roku.Wyniki: Pielęgniarki pracujące w szpitalach znacznie częściej uczestniczyły w diagnozowaniu POChP (62,30%) aniżeli pielęgniarki podstawowej opieki zdrowotnej (33,40%). Poradnictwo antytytoniowe realizowało 69% respondentów. Badane pielęgniarki rzadko używają profesjonalnych narzędzi do pomiaru i oceny stopnia uzależnienia od nikotyny (6%) oraz do pomiaru poziomu motywacji do walki z nałogiem (4%). Prowadzenie edukacji zdrowotnej wobec chorych na POChP deklarowało 66,67% pielęgniarek z POZ i 76,81% pielęgniarek zatrudnionych w szpitalach. Pielęgniarki nie prowadzą monitoringu udzielanych przez siebie porad oraz nie poddają ocenie ich skuteczności. O udziale w programach wielodyscyplinarnej rehabilitacji oddechowej mówiło tylko 9,53% ankietowanych z POZ oraz 40,58% ankietowanych ze szpitali.Wnioski: Prowadzone przez pielęgniarki działania w stosunku do chorego na POChP mają charakter głównie edukacyjny, niestety są jednak powierzchowne, okazjonalne i nie mają znamion zaplanowanego procesu. Zaleca się planowe, formalne włączenie pielęgniarek w realizację programów promocji zdrowia w grupie chorych na POChP poprzez zaplanowanie środków finansowych na realizowane przez nie zadania, jak również zwrócenie większej uwagi na przygotowanie pielęgniarek do realizacji procesu edukacji zdrowotnej, szczególnie poradnictwa antynikotynowego.Introduction: Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. The significance of health promotion is usually emphasised among the activities which nurses should undertake in relation to patients suffering from COPD. The aim of the study was to analyse the frequency and types of health promotion activities undertaken by nurses in relation to patients suffering from COPD.Material and methods: The diagnostic survey with the use of a questionnaire constructed by the authors was applied in the study. Data collected in 2008 among 132 nurses (100%) working in outpatient and hospital healthcare sectors in Poland were quantitatively analysed.Results: Nurses working in hospitals more frequently took part in diagnosing COPD (62.30%) than those working in outpatient establishments did (33.40%). Anti-smoking counselling was performed by 69% of respondents. Nurses very rarely used professional tools for the measurement of the level of nicotine addiction (6%) or the level of motivation to fight the addiction (4%). Activities in terms of health education carried out on a patient with COPD were declared by 66.67% of primary care nurses, and by 76.81% from hospitals. The nurses surveyed did not perform any monitoring of their recommendations and did not assess their effectiveness. Participation in interdisciplinary pulmonary rehabilitation programmes was declared by 9.53% of outpatient sector nurses and by 40.58% of nurses from hospitals.Conclusions: Nurses’ activities in relation to patients suffering from COPD have a mainly educational nature, but unfortunately they are casual, occasional and unplanned. Planned and formal inclusion of nurses in the process of realisation of health promotion programs for patients with COPD is recommended, i.e. by planning funds for the tasks which can be performed by them. More attention should be payed to professional training of nurses for realisation of the process of health education, especially anti-smoking intervention

The intensity of stress in patients with hypertension and its relationship to self-control of patients’ treatment

Wstęp Częstość występowania nadciśnienia tętniczego ma istotny związek ze stopniem rozwoju cywilizacyjnego oraz narażeniem na bodźce stresowe. Ekspozycja na stres przyczynia się do wystąpienia nadciśnienia tętniczego u niektórych osób, natomiast czy poziom stresu odczuwanego przez pacjentów z nadciśnieniem tętniczym ma związek z umiejętnością skutecznej kontroli tego schorzenia? To pytanie pozostaje przedmiotem poznania badawczego. Celem pracy była ocena nasilenia odczuwanego stresu w grupie pacjentów z nadciśnieniem tętniczym oraz jego związku z samokontrolą leczenia choroby.Materiał i metody W badaniach zastosowano metodę sondażu diagnostycznego z techniką ankiety, pomiarów antropometrycznych, analizy dokumentacji medycznej oraz oceny uzależnienia od nikotyny Testem Fagerströma. Do oceny poziomu stresu zastosowano skalę PSS-10 (Skala Odczuwanego Stresu). Materiał badawczy kolekcjonowano w 2011 roku w klinice kardiologii i poliklinice SPSK-4 w Lublinie. Udział w badaniach był anonimowy i dobrowolny.Wyniki Badaniem objęto grupę 100 pacjentów z rozpoznanymi leczonym nadciśnieniem tętniczym średnio 7,8 roku, SD ± 5,6. Większość ankietowanych (67%) deklaruje, że leki zapisane przez lekarza przyjmuje zawsze według wskazań. Średni wynik w grupie w skali postrzegania stresu wyniósł 6,27, SD ± 1,43. Nie stwierdzono istotnych (p &gt; 0,05) różnic w rozkładzie wyników skali odczuwania stresu w zależności od wieku, płci, wykształcenia i miejsca zamieszkania.Wnioski We wszystkich grupach wiekowych zaobserwowano przewagę przeciętnego poziomu nasilenia stresu oraz wykazano istotny związek między nasileniem odczuwanego stresu a przyjmowaniem leków zapisanych przez lekarza w badanej grupie wiekowej powyżej 60 rż.Background The incidence of hypertension is significantly associated with the civilization development degree and exposure to stress stimuli. Exposure to stress contributes to the onset of high blood pressure in some people. However, the question if the level of stress experienced by patients with hypertension is associated with the ability to effectively control the disease — is the subject of research.Aim of the study was to assessment of severity of the experienced stress in patients with hypertension and its relation to self-monitoring of patients’ treatment.Material and methods The study used a method of diagnostic survey with a questionnaire technique, anthropometric measurements, and analysis of medical records and assessment of nicotine dependence by Fagerström test. To assess the level of stress, PSS-10 scale (scale of experienced stress) was used. The research material was collected in 2011 at the clinic of cardiology and out patients department of Clinical Teaching Hospital No. 4 in Lublin. Participation in the study was anonymous and voluntary.Results The study group consisted of 100 patients with diagnosed and treated hypertension on average for 7.8 years, SD ± 5.6. The majority of respondents (67%) say that they took drugs prescribed by the doctoral ways according to indications. The average perceived stress scale score was 6.27, SD ± 1.43. There were no significant differences (p &gt; 0.05) in the distribution of the results of stress perception scale depending on age, gender, education and place of residence.Conclusions In all age groups, the dominance of average level of stress intensity was observed, and a significant relationship between the severity of experienced stress and taking prescription drugs in the studied age group above 60 years of age, was demonstrated

Przewlekła biegunka podczas leczenia lapatynibem w skojarzeniu z kapecytabiną u chorej leczonej z powodu rozsianego raka piersi z nadmierną ekspresją receptora HER2

Powikłania ze strony układu pokarmowego są częstym objawem niepożądanym leczenia przeciwnowotworowego [1, 2]. Biegunka występuje u około 65% chorych leczonych skojarzaniem lapatynibu z kapecytabiną [3, 4] i może być przyczyną wtórnych powikłań, konieczności zmniejszenia dawek leków, a także negatywnie wpływać na funkcjonowanie chorych [1]. Poniżej przedstawiono opis przypadku chorej z rozpoznaniem HER2-dodatniego raka piersi w stadium rozsiewu leczonej na Oddziale Onkologii Szpitala Specjalistycznego we Wrocławiu. Ze względu na nadmierną ekspresję receptora HER2 chora otrzymywała leki ukierunkowane molekularnie antagonizujące HER2.Podczas leczenia 3. linii lapatynibem w skojarzeniu z kapecytabiną wystąpiła biegunka. Po wprowadzeniu leków zapierających i zmianie diety jej nasilenie się zmniejszyło, pozwalając na kontynuację leczenia z dobrym efektem klinicznym

Androgen signaling disruption during fetal and postnatal development affects androgen receptor and connexin 43 expression and distribution in adult boar prostate

To date, limited knowledge exists regarding the role of the androgen signaling during specific periods of development in the regulation of androgen receptor (AR) and connexin 43 (Cx43) in adult prostate. Therefore, in this study we examined mRNA and protein expression, and tissue distribution of AR and Cx43 in adult boar prostates following fetal (GD20), neonatal (PD2), and prepubertal (PD90) exposure to an antiandrogen flutamide (50 mg/kg bw). In GD20 and PD2 males we found the reduction of the luminal compartment, inflammatory changes, decreased AR and increased Cx43 expression, and altered localization of both proteins. Moreover, enhanced apoptosis and reduced proliferation were detected in the prostates of these animals. In PD90 males the alterations were less evident, except that Cx43 expression was markedly upregulated. The results presented herein indicate that in boar androgen action during early fetal and neonatal periods plays a key role in the maintenance of normal phenotype and functions of prostatic cells at adulthood. Furthermore, we demonstrated that modulation of Cx43 expression in the prostate could serve as a sensitive marker of hormonal disruption during different developmental stages

Flutamide induces alterations in the cell-cell junction ultrastructure and reduces the expression of Cx43 at the blood-testis barrier with no disturbance in the rat seminiferous tubule morphology

BACKGROUND: Present study was designed to establish a causal connection between changes in the cell-cell junction protein expression at the blood-testis barrier and alterations in the adult rat testis histology following an anti-androgen flutamide exposure. Particular emphasis was placed on the basal ectoplasmic specialization (ES) in the seminiferous epithelium and expression of gap junction protein, connexin 43 (Cx43). METHODS: Flutamide (50 mg/kg body weight) was administered to male rats daily from 82 to 88 postnatal day. Testes from 90-day-old control and flutamide-exposed rats were used for all analyses. Testis morphology was analyzed using light and electron microscopy. Gene and protein expressions were analyzed by real-time RT-PCR and Western blotting, respectively, protein distribution by immunohistochemistry, and steroid hormone concentrations by radioimmunoassay. RESULTS: Seminiferous epithelium of both groups of rats displayed normal histology without any loss of germ cells. In accord, no difference in the apoptosis and proliferation level was found between control and treated groups. As shown by examination of semi-thin and ultrathin sections, cell surface occupied by the basal ES connecting neighboring Sertoli cells and the number of gap and tight junctions coexisting with the basal ES were apparently reduced in flutamide-treated rats. Moreover, the appearance of unconventional circular ES suggests enhanced internalization and degradation of the basal ES. These changes were accompanied by decreased Cx43 and ZO-1 expression (p < 0.01) and a loss of linear distribution of these proteins at the region of the blood-testis barrier. On the other hand, Cx43 expression in the interstitial tissue of flutamide-treated rats increased (p < 0.01), which could be associated with Leydig cell hypertrophy. Concomitantly, both intratesticular testosterone and estradiol concentrations were elevated (p < 0.01), but testosterone to estradiol ratio decreased significantly (p < 0.05) in flutamide-treated rats compared to the controls. CONCLUSIONS: Short-term treatment with flutamide applied to adult rats exerts its primary effect on the basal ES, coexisting junctional complexes and their constituent proteins Cx43 and ZO-1, without any apparent morphological alterations in the seminiferous epithelium. In the interstitial compartment, however, short-term exposure leads to both histological and functional changes of the Leydig cells

The role of G-protein-coupled membrane estrogen receptor in mouse Leydig cell function : in vivo and in vitro evaluation

AbstractIn this study, G-coupled estrogen receptor (GPER) was inactivated, by treatment with antagonist (G-15), in testes of C57BL/6 mice: immature (3 weeks old), mature (3 months old) and aged (1.5 years old) (50 μg/kg bw), as well as MA-10 mouse Leydig cells (10 nM/24 h) alone or in combination with 17β-estradiol or antiestrogen (ICI 182,780). In G-15-treated mice, overgrowth of interstitial tissue was found in both mature and aged testes. Depending on age, differences in structure and distribution of various Leydig cell organelles were observed. Concomitantly, modulation of activity of the mitochondria and tubulin microfibers was revealed. Diverse and complex GPER regulation at the mRNA level and protein of estrogen signaling molecules (estrogen receptor α and β; ERα, ERβ and cytochrome P450 aromatase; P450arom) in G-15 Leydig cells was found in relation to age and the experimental system utilized (in vivo and in vitro). Changes in expression patterns of ERs and P450arom, as well as steroid secretion, reflected Leydig cell heterogeneity to estrogen regulation throughout male life including cell physiological status.We show, for the first time, GPER with ERs and P450arom work in tandem to maintain Leydig cell architecture and supervise its steroidogenic function by estrogen during male life. Full set of estrogen signaling molecules, with involvement of GPER, is crucial for proper Leydig cell function where each molecule acts in a specific and/or complementary manner. Further understanding of the mechanisms by which GPER controls Leydig cells with special regard to male age, cell of origin and experimental system used is critical for predicting and preventing testis steroidogenic disorders based on perturbations in estrogen signaling.</jats:p