Zero tolerance: A policy in conflict with current opinion on aggression and violence management in health care

Aggression and violence are common in the emergency department setting. In recent years, there has been a greater recognition of this problem with State Governments in Australia responding with zero tolerance policies. This paper examines the current recommendations from nursing and medical literature with regard to the minimisation and management of aggression and violence in health care. A consistent theme throughout the literature is that early recognition and use of de-escalation strategies aimed at diffusing a volatile situation is the preferred approach. Use of restraint and a zero tolerance approach are last resort measures. It is important to have practical policies, protocols and procedures in place to manage aggression and violence in the emergency department. An emphasis on training and skill development, particularly communication and negotiation strategies, is imperative for all health care professionals.     

Florence Nightingale, feminism and nursing

Three key aspects of Florence Nightingale's remarkable life are examined. First, the influences during her formative years: the education and guidance provided by her father, the resistance by her family when she decided to become a nurse; and the rejection by Nightingale of the societal expectations of a woman in the Victorian era. Secondly, her professional life is examined, in particular how she appears to have been viewed by certain members of society, and how in turn she viewed them. It is anticipated that her position as an early feminist will be postulated and illuminated. Thirdly, an analysis of her personal and professional life indicates a way forward for the nursing profession.     

The development of theory in British nursing: current position and future prospects

This paper is concerned with the development of theory in the discipline of nursing as it is practised in Great Britain. It stems from dissatisfaction with the generally uncritical adoption by British nurses of models of nursing which have been developed to explain and enhance North American practice. After the introductory paragraph, four roles for nursing theory are proposed. These are: to define nursing by describing nursing phenomena; to form a realistic basis for curriculum design; to provide tools for the professional practice of nursing; and to provide a nursing language. It is then argued that although British nurses have recognized the need for an adequate theoretical basis for practice, their response has been rather uncritical adoption of American models of nursing. As a basis for practice, it is argued that American models generally fail to meet the needs described above, and therefore fail to have impact on clinical work. Structural and philosophical reasons for this failure are identified. Following a brief discussion of the inductive and deductive approaches to the development of theory, the paper closes with the argument that British nurses should be concerned with the development of new theory which, if grounded in the reality of practice, would be likely to be both useful and realistic.     

The health belief model and use of accident and emergency services by the general public

There has been much debate about the use made by the general public of accident and emergency services A strong element of professional dissaproval has been present, as shown by phrases such as 'inappropriate attender' This paper examines the reasons why people attend accident and emergency and the factors that delay or accelerate attendance, utilizing a framework espoused in the medical sociology literature, i e the Health Belief Model This predicts that individuals carry out a treatment cost-benefit analysis when making decisions about seeking medical assistance A sample of 200 adult, ambulatory accident and emergency patients was interviewed whilst waiting to see the casualty officer for this study The data demonstrated that much of the medical, sociological literature concerning patient consultation with doctors is applicable to the accident and emergency situation, in particularthe Health Belief Model A range of factors was shown to make statistically significant differences to the delay times involved in deciding to attend accident and emergency and the time it took to then subsequently attend and register as a patient These factors also fit the cost-benefit analysis which the Health Benefit Model predicts takes place Accident and emergency attendance therefore needs to be seen as a logical decision-making process thatrequires hospitals to provide appropriate services, rather than merely labelling the patients as inappropriate     

The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness?

The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the “Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey” developed by Robson and Haddad (2012). The 28‐item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.     

Correlation between symptoms of diabetic gastroparesis and results of gastric scintigraphy

Background  

delayed gastric emptying is detectable in 20–40% of patients with type 1 and type 2 diabetes. The prevalence of symptoms suggestive for diabetic gastroparesis is much lower. The aim of the study was to evaluate the gastric emptying and to correlate the results with dyspeptic symptoms.