Assoc Prof Jennie King

Background: Rapid and accurate testing of blood ketone levels (BKL) can assist in the assessment of insulin insufficiency and detection of diabetic ketoacidosis (DKA) in the acute care setting. We assessed the potential for introducing point of care measurement of BKL into an Australian emergency department. Methods: After providing informed consent, 72 patients (80 separate presentations) with insulin-requiring diabetes who presented to an emergency department with hyperglycaemia (capillary blood glucose level of =10.0. mmol/L) underwent testing for BKL at triage. Staff were guided by a protocol developed for interpretation of elevated BKL = 1.0. mmol/L and subsequent actions. Urine ketones and arterial blood gas testing occurred as usual. Time to testing was recorded for all measures. Results: BKL testing occurred immediately in 91% of the presentations, whereas urine ketones and arterial blood gas testing was uncommon (24% and 15% respectively) and not immediate. Elevated BKL (=1.0. mmol/L) occurred in 17% of presentations, of whom five were diagnosed with DKA within the Emergency Department. However, testing for BKL decreased over the duration of the study. Patients most frequently tested for BKL were younger (58.59 years) than patients who were not tested (79.5 years) (p= .011). Conclusions: Implementation of point of care BKL testing in the Emergency Department can assist in the detection of significant numbers of patients with insulin insufficiency, however, ongoing education and support is required to sustain the change in practice. © 2012.

The ultimate goal of research into type 1 diabetes is to find a cure. There are currently a number of research strategies under investigation to meet this goal, which aim to replace the destroyed insulin-producing beta-cells of the pancreas. It is important that people with type 1 diabetes and their healthcare professionals keep informed about these advances in research, as it can provide motivation to maintain diabetes self-management behaviour. This article presents the findings of an Australian study which evaluated the effectiveness of a DVD developed as an educational tool to provide information to people with type 1 diabetes, their families and healthcare professionals on the latest advances in islet-cell therapy.

The transition from student to an accountable health professional is a difficult time for the novice nurse and can result in significant anxiety, stress and poor socialisation into the nursing profession. A strategy applied at a major tertiary teaching hospital to address transitional issues for novice nurses is that of group debriefing sessions. This qualitative study used focus groups to explore the effectiveness of these debriefing sessions for new graduate nurses and trainee enrolled nurses. The results demonstrated that the sessions provided nurses with a supportive environment, access to peer support and a sense of belonging. This provided an opportunity to develop confidence in their nursing competence and improvement in interpersonal communication skills. Debriefing sessions are an effective psychosocial support mechanism that can ameliorate the 'reality shock' experienced by nurses in their first year of practice. Group debriefing is an important component in the transitional support process and should be used to complement other strategies to enhance the psychosocial experiences of novice nurses.

Self-directed learning is a method of instruction used increasingly in adult education. A scale was developed in response to a need for a valid and reliable instrument to measure self-directed learning readiness. Such a scale will allow nurse educators to diagnose students' attitudes, abilities and personality characteristics, necessary for self-directed learning. This study was undertaken in two stages. In the first, the Delphi technique utilizing a panel of 11 nurse educator experts was used to assess the content and construct validity of a number of items perceived to reflect self-directed learning readiness. Each panel member was asked to independently rate the relevance of each item on a Likert scale. The second stage involved the administration of the questionnaire to a convenience sample of 201 undergraduate nursing students. The questionnaire was analysed using principal components factor analysis with varimax rotation, Chronbach's coefficient alpha, and item-to-total correlations to measure the scale's construct validity, internal consistency (reliability), and unidimensionality, respectively. The resulting self-directed learning readiness scale appears homogeneous and valid. The scale will assist nurse educators in the diagnosis of student learning needs, in order for the educator to implement teaching strategies that will best suit the students. Furthermore the development of this scale will provide valuable data for curriculum development. © 2001 Harcourt Publishers Ltd.

This paper reports on the use of video and self-assessment as a tool to guide and support undergraduate students in the practice of nursing. This method of learning and assessment promoted self- and peer evaluation as well as critical thinking. It encouraged students to take more responsibility for their learning and assisted academic staff and students to identify learning issues associated with clinical practices. Evaluative comments by teachers, students and educational experts have established the credibility and continued use of this approach within the Bachelor of Nursing program at a major university in Sydney, Australia.

Clinical facilitators play an important role in the clinical practicum component of an undergraduate nursing programme. Part time teachers are often employed in this role, however very little has been written about the needs of these facilitators. An exploratory study design incorporating focus group interviews and questionnaires was used to identify the needs of clinical facilitators at a large Australian university. This study showed that they are committed nurses who often feel inadequate in a role they feel lacks support and identity. The findings of the study have implications for the preparation of clinical facilitators.

Currently available short-acting insulin preparations fail to mimic the postprandial insulin profile of non-diabetic individuals. The activity of a novel insulin designed for faster absorption has been tested after subcutaneous injection. Magnesium insulin (50 U ml-1) given by sprinkler needle was compared with unmodified human insulin (100 U ml-1) given by conventional needle and unmodified human insulin (50 U ml-1) given by sprinkler needle in normal volunteers using a euglycaemic clamp. Magnesium insulin had a significantly faster onset of action resulting in a higher exogenous insulin level by 15 min, peak level was reached after 60 min compared with 75 min for the unmodified insulins, and duration of action was significantly shorter than both unmodified insulins. No significant differences were observed between the unmodified insulins for the first 5 h after injection, indicating that the observed differences to magnesium insulin could not be attributed to the insulin concentration or the type of needle used for insulin administration. Injection of magnesium insulin prior to a test breakfast in people with Type 2 diabetes resulted in significantly lower total and 0 to 120 min areas under the glucose curve, an earlier rise in exogenous insulin levels and a higher area under the insulin curve from 0 to 120 min compared with unmodified 100 U ml-1 human insulin. 1992 Diabetes UK