Clinical decision making in nursing

In this paper, the author reflects on the new practitioner envisaged by developers of the Project 2000 curriculum in Scotland, and focuses on the need to develop critical thinking ability, in particular in relation to clincal decision making. Two approaches to decision making are outlined: the rationalist perspective and the phenomenological perspective, and a model illustrating each is discussed. The models examined are, respectively, decision analysis and hypothetico-deductive reasoning, and their relevance to nursing outlined. The author concludes by discussing the nursing process model from both perspectives; and by recommending that nurses learn from the work done by other disciplines on professional judgement. The suggested role of Nurse teacher in preparing the new practitioner is outlined.     

The specialist learning disability nurse in Wales

Fisher M. International Journal of Nursing Practice 1997; 3: 188–190
The specialist learning disability nurse in Wales
This paper reflects on the development of services for people with learning disabilities within the United Kingdom and focuses on the role of the specialist nurse. The nurse's contribution to the care of this client group has been the subject of debate and controversy for a number of years. Developments within the learning disability field in Wales in particular are explored, with the All Wales Strategy for People with Learning Disabilities providing the background and context for these developments. An example of how specialist nurses from around Wales came together in order to share good and best practice is discussed. The conclusion is that the specialist learning disability nurse has a great deal to offer, but must be prepared to work together with other professionals as well as service users and their families.     

Inappropriate attendance at accident and emergency departments: a literature review

This literature review was written as part of a pilot study into staff perceptions of inappropriate attendance at accident and emergency (A&E) departments The pilot study was earned out m the final year of the BSc Nursing Studies course at Birmingham Polytechnic The literature under review looks at various aspects of inappropriate attendance at A&E, including what actually constitutes inappropriate attendance, who is responsible for misuse of A&E and why A&E is so often abused Suggestions are offered that the role of A&E is more diverse than simply a receiving station for sudden injury or illness and that there are quite pertinent reasons why people choose to attend A&E rather than their own GFs surgery The review covers quite a span of years, the oldest piece of literature under review dating back to 1849 Some 143 years show that indeed this particular problem is not necessarily a modern one but one that has its origins in another century     

Educational intervention with international nurses and changes in knowledge, attitudes and willingness to provide care to patients with HIV/AIDS

This paper reports the findings of a study which examines the relationship between the use of an educational intervention with nurses from several Asian countries and changes in knowledge, attitudes and willingness to care for patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). A pre-test and post-test questionnaire was used to collect the data. The results indicate, that whilst there was an improvement in knowledge following the educational intervention, there is a need for further improvement in the knowledge levels of the nurses. The method of contracting the virus is less influential in shaping students' attitudes towards people with HIV/AIDS. Fear of contagion is evident; this increases when more invasive clinical procedures are being carried out. What is also evident is that multiple levels of infection control protocols are used with patients. Fear of contagion is also apparent in the participants' willingness to work with colleagues and patients with HIV/AIDS. While the participants stated that they were more willing to work with colleagues and patients with HIV/AIDS following the educational intervention, they said that they would continue to take additional precautions for fear of contracting HIV in the workplace. The conclusion emphasizes that it is important for education about HIV/AIDS to be incorporated within current undergraduate and in-service programmes.     

A comparison of nurse-related behaviour, philosophy of care and job satisfaction in team and primary nursing

The study compares team and primary nursing modes of organization of nursing care on three related variables, namely: nurse-related behaviour and quality of care, philosophy of care and job satisfaction for nurses. The historical dimension and evolution of modes of care, quality of care, philosophy of care and theories of job satisfaction are discussed within the context of the study. The literature and previous research studies conducted on team and primary nursing are reviewed and comparisons of the two are made. Analysis of data collected yielded results which are compared for differences and benefits between team and primary nursing. The results of the study suggest that when compared to team nursing mode of organization of care, primary nursing affords increased quality of care, a more coherent philosophy of nursing and increased job satisfaction for nurses. Methodological problems are examined and implications for policy explored.     

Sociological issues in the conceptualization of mental illness

This paper explores the conceptual knowledge base underpinning 'mental illness type behaviour' and offers a sociological and philosophical perspective. The role of values in concepts of health and illness is presented as widespread not only within psychiatry, but also in regard to general/physical health. The controversial nature of the psychiatric enterprise is believed to be due to the lack of consensus regarding notions of mental health and mental illness. Psychiatry is presented as a form of social control, akin to the legal system, dictated by moral norms. These are presented as value-loaded and maintained in accordance with the dictates of particular interest groups. Social control concepts are explored and Freud's psychodynamic model is presented as a legitimate model that incorporates a meaningful concept of 'illness'. No theory, though, is presented as value-free. Psychiatry is thus presented as being socially and politically constructed. The implication for health care professionals is presented as that of trying to liberate professional work from the narrow responsibility of the 'individual', whilst also trying to create a more democratic enterprise.     

The previous training and present training needs of nurses in charge of alcohol treatment units and community alcohol teams

The aim of the study was to collect information on the educational needs of nurses in charge of alcohol treatment units and community alcohol teams. The sample of all such nurses in England and Wales was asked to complete a postal questionnaire and give information on the training and education they had already received, what further training they needed and brief details about their background and future plans. It was expected that a small proportion of the respondents would have had specialized training and this expectation was borne out. The results do provide evidence of considerable dissatisfaction amongst the group as to the training they receive. It is shown that these nurses wish to develop behavioural and psychotherapeutic skills and that training provided so far has not met these needs. Suggestions are made as to the content of future training events for nurses.     

Peri-operative anxiety in patients undergoing extracorporeal piezolithotripsy

Twenty-four patients undergoing extracorporeal piezolithotripsy took part in this study and underwent treatment on a Wolf Piezolith 2300 Lithotripter, which does not require any type of anaesthesia and enables the patient to be treated as an out-patient. Previous work has investigated anxiety states of patients during investigative procedures and found that information given prior to the procedure is beneficial in reducing the levels of anxiety reported. Modern urological surgery carried out to remove kidney stones has progressed to non-invasive techniques with the introduction of extracorporeal piezolithotripsy (EPL). However, little work has examined the patient's reaction to this new procedure. Since patients undergoing EPL are awake throughout the procedure, it is possible to perform continuous assessment of anxiety by measurement of palmar sweat. The results demonstrated significantly increased levels of palmar sweat throughout treatment, with a return to pre-treatment levels afterwards. This was demonstrated by just under 50% (n = 10) of patients who appeared to be agitated during treatment, and by the comments made by patients about their treatment. One-third of patients (n = 8) described pain as far more severe than had been anticipated when asked if they could identify a cause for anxiety. It is recommended that adequate patient preparation and education prior to the procedure should be provided, but that such education must also include a warning that some discomfort may occur.