The Impact of Disclosure of Unfitness to Drive in Persons with Newly Diagnosed Dementia: Patient and Caregiver Perspectives

Health professionals caring for those with dementia must frequently address fitness to drive, which is often the most difficult and emotional task in dementia care. This qualitative study explores the perspectives of patients with dementia who were told to cease driving and their caregivers. Most patients agreed with or resigned themselves to the geriatric team's recommendations regarding the need for driving cessation. Of those who did not, reactions included shock, anger, and denial. Almost all caregivers agreed with the recommendations to cease driving. Caregiver suggestions included: addressing the driving concern earlier, more detail about the tests, focusing on physical problems, providing a letter of explanation, and discussing alternative transportation. The study findings were used to develop a practical list of recommendations on how to address cessation to drive in patients with dementia.     

Presentation, delay, and contraindication to thrombolytic treatment in females and males with myocardial infarction

BACKGROUND: This study seeks to explore gender-relevant factors of medical history, sociodemographics, symptom presentation, and delay on thrombolysis administration (or recorded contraindication) in a sample of men and women with confirmed myocardial infarction (MI). METHODS: Cross-sectional examination of self and nurse-report data collected in the coronary care unit (CCU) from 12 hospitals across south-central Ontario, Canada. A total of 482 MI patients (347 males, 135 females; 63% response rate) were recruited. MAIN FINDINGS: There was no gender difference in the report of chest pain (chi(2)(1) = 3.78, p =.052), or in prehospital delay time (median = 96.5 minutes). Thrombolysis was administered in 158 males (68.4%) and 50 females (50.0%) without reported contraindication. Females (median = 27 minutes) had a significantly longer interval between diagnostic electrocardiogram (ECG) and administration of a thrombolytic than males (median = 22, U = 3,056). No contraindication was indicated for not administering a thrombolytic (i.e., too late, risk of bleed) in approximately 40% of females. In accordance with clinical practice guidelines, thrombolysis was more often administered in participants with a shorter time interval between symptom onset and hospital arrival. For females, thrombolysis was more often administered in younger participants (Kruskal Wallis = 5.88). CONCLUSIONS: Reducing gender, age, and socioeconomic disparities in access to thrombolysis treatment is imperative. Hospital delays with female cardiac patients may be precluding thrombolysis administration.     

Commentary

Carol Wong comments on an article that appeared in Nursing Forum more than 20 years ago, which is reprinted in this issue: Moore, M. A. (1968). Nursing: A scientific discipline? Nursing Forum, 7, 340–348.     

How male nursing students learn to care

The current definitions of caring in nursing education denote a mutual relationship between teachers and students in which they interact to provide an environment which supports the students' personal and professionaldevelopment The learning of caring in an interactional context is typical of the female experience It is unknown if this is representative of the male experience The lived experience of 20 male students as they learned to care as nurses was the focus of this phenomenological research study The participants concurred that, although caring as a nurse could be learned if one was 'open to learning', teachers could only facilitate this learning, they could not directly teach it The interactional strategies of storytelling, modelling, being cared for, the 'aha' encounter, and observing and giving care, were used by the participants in learning to care as nurses The implications of these findings for nursing education and research are presented     

Deputed power of medical control: the hidden message in the ritual of oral shift reports

The exchange of oral shift reports between nurses is a prominent part of the everyday routine in a hospital ward Increased awareness of the more or less explicit functions of such communication is likely to have a positive impact on the nursing profession Oral shift reports in a nursing care system based on task allocation were therefore observed and analysed Using an ethnographic approach, reports were tape-recorded, and nurses were interviewed regarding their experiences During the shift report session, the nurses were found to receive ritually mediated deputed power of medical control from their colleague, but little attention was paid to nursing needs and measures The nurses clearly demonstrated that they were caught in a system dominated by a medical paradigm that effectively obstructed the progress of nursing as a professional discipline in its own right     

Minimal Breastfeeding

Current advice to breastfeeding mothers is that breasts must be emptied regularly and frequently to help maintain lactation. A method of maintaining lactation, minimal breastfeeding, in which mothers nurse once or twice a day without expressing the breast between breastfeedings was investigated. A convenience sample of 30 mothers using minimal breastfeeding was interviewed monthly until weaning. These mothers used minimal breastfeeding as a method of slow weaning, a way to combine breastfeeding and work, and a means of comfort-nursing older infants. In all cases, weaning occurred because the mother or the infant chose to wean, not because of insufficient milk. The authors conclude that for working mothers who cannot express between feeds, breastfeeding can still be maintained, and that minimal breastfeeding is an important alternative to weaning.     

Partnership in education: working toward the baccalaureate degree as entry to nursing practice in Canada

In the early 1980s Canadian professional nursing associations officially adopted the goal of baccalaureate entry to practice by the year 2000 In the ensuing years, nursing educators have explored a variety of means to work toward achieving this goal This paper describes a collaborative model of baccalaureate programme delivery developed between a university school and a hospital-based diploma school in Vancouver, British Columbia The paper documents the history of the collaboration and the organization of human and physical resources for implementation The issues and challenges encountered in the transition, the strategies used to facilitate the process, and the benefits gained by each partner are discussed