Editorial introduction: community-based rehabilitation: the promise and the paradox

Purpose : According to many researchers, rehabilitation is being prevented from developing as a distinct profession due to two major problems. First, it has been claimed that rehabilitation is in need of a professional identity and a sense of cohesion if it is to emerge as a discipline. Second, it has been recognized that there is a need for a rehabilitation framework to challenge the restorative approach that continues to dominate rehabilitation, linking it back to the medical model from which it has attempted to escape. The model of community-based rehabilitation (CBR) is offered as a model that can provide the impetus for an additional shift from the restorative tradition and unite rehabilitation workers through a cohesive framework. Method : Unfortunately, the implementation of communitybased rehabilitation in urban societies has been disappointing. The current paper is a conceptual discussion of communitybased rehabilitation that explores some potential causes of this poor implementation. Results : To some extent, the implementation failure of community-based rehabilitation can be attributed to the paradoxes that are inherent in its fundamental constructsempowerment and community inclusion. These paradoxes occur at a conceptual level, a practical level and a contextual level. Conclusions : Some solutions are offered to enable the paradigm to be implemented more fully. In particular, it is suggested that there is a need to develop useful working definitions of these constructs, favourable attitudes among rehabilitation workers and a focus on community development.     

Rescuing the NIH: the response

The feedback received regarding my recent editorial "Rescuing the NIH before it is too late" has been fascinating to read. The opinions expressed illustrate a huge divide between those in charge of the NIH and those who rely on extramural funding to support their research.     

Nephrology nursing: blurring the boundaries: the reality of expert practice

Background. Expertise in nursing has been widely studied; there have been no previous studies into what constitute expertise in nephrology (renal) nursing. This paper describes a ‘real‐world’ characteristic of expert nephrology nursing practice. Aims and objectives. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept blurring the boundaries. Design. The study utilized grounded theory methodology and symbolic interactionism. Methods. The study took place in one renal unit in New South Wales. Sampling was purposive then theoretical; the sample consisting of six non‐expert and eleven expert nurses. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semi‐structured interviews was undertaken. Results. The study revealed that only expert nephrology nurses ‘blurred the boundaries’ of professional nursing practice. They did this by moving intermittently and purposefully, for the benefit of particular patients, into medical domains in the areas of prescribing, dispensing and ordering of pathology tests. Non‐expert nurses did not cross these professional boundaries. Conclusions. Blurring the boundaries was a significant feature of expert nursing practice, and this study was the first to describe explicitly nursing boundaries as two distinct entities; that is, formal and informal. Relevance to clinical practice. There are some nephrology nurses who have sufficient knowledge and experience to prescribe some medications and to order certain investigations.     

Tuberculosis: the latest

Tuberculosis (TB) is a complex disease with a long history of human infection. This article provides an overview of TB and discusses ramifications for anesthesia practitioners. Specific individuals and groups are at an increased risk of developing TB. The acid-fast bacilli that causes TB is transmitted via the airborne route. The anesthesia provider must adapt his/her approach to the patient with TB so that protection is afforded that practitioner, colleagues, and the patient. Future patients are also shielded from potential exposure to acid-fast bacilli. To minimize the risk of transmission of acid-fast organisms, the anesthesia practitioner must consider TB as a possible diagnosis when performing a preanesthetic evaluation. Standard precautions for bloodborne pathogens must be followed. In addition, appropriate respiratory precautions must be taken. Proper cleansing, decontaminating, sterilizing, or disposal of equipment must occur. Screening of anesthesia providers for the possibility of infection with TB is to be conducted at intervals recommended by the Occupational Safety and Health Administration. Each anesthetist has a responsibility to practice safely. In today's anesthesia practice, safety includes vigilance against TB.