Integrating Nursing Care into Systems of Care for Children with Emotional and Behavioral Disorders

PROBLEM: Recent developments in providing care to children with emotional and behavioral disorders, especially those with serious emotional disturbance, have included the establishment of systems of care. Guided by a set of principles and values, these systems of care have organized and delivered services to children and families with complex needs. To date, nurses have not had a salient role in systems of care. RESULTS: It is estimated that 20% of American children and adolescents have an emotional or mental disorder. As many as two thirds of these children are not receiving services. Systems of care have been funded to provide services for these children, particularly for the most severely affected. To date, nursing has not had a prominent role in these systems of care. CONCLUSIONS: Based on their knowledge, skills, and holistic approach to care, nurses could better integrate nursing care into systems of care. Possible roles as case managers, primary therapists, in-home interventionists, and in educational programs are suggested.     

Autonomy and modernisation: the management of change in an English primary care trust

Recent New Labour policy for the ‘modernisation’ of Government places a good deal of emphasis on decentralisation. This emphasis is particularly marked in relation to the organisation of primary care. However, like hospitals and other National Health Service institutions, primary care trusts (PCTs) are subject to a substantial raft of centrally established performance targets and indicators, including those which contribute to the public award of between zero and three performance ‘stars’. This raises questions about the extent to which employees can exercise autonomy in the context of rigid top‐down directives. This paper presents findings from a study using participant observation and interviews to examine the impact of a training course aimed ostensibly at increasing employee autonomy in an English PCT. The suggestion is that attempts to make employees more autonomous can be seen as a strategy for increasing central control based upon the internalisation by the employees of centrally promulgated values. The attraction of such strategies is that they may be potentially more effective and less costly than alternative strategies of direct control. However, the study suggests that the outcome of attempts by such methods as programmes to increase employee autonomy may be very different from those intended.     

End-of-life Models and Emergency Department Care

Many people die in emergency departments (EDs) across the United States from sudden illnesses or injuries, an exacerbation of a chronic disease, or a terminal illness. Frequently, patients and families come to the ED seeking lifesaving or life-prolonging treatment. In addition, the ED is a place of transition-patients usually are transferred to an inpatient unit, transferred to another hospital, or discharged home. Rarely are patients supposed to remain in the ED. Currently, there is an increasing amount of literature related to end-of-life care. However, these end-of-life care models are based on chronic disease trajectories and have difficulty accommodating sudden-death trajectories common in the ED. There is very little information about end-of-life care in the ED. This article explores ED culture and characteristics, and examines the applicability of current end-of-life care models.     

Development of a Device for Removing a Partial Denture in a Patient with Scleroderma

Scleroderma is a chronic disease that has been associated with immune dysfunction. One of the oral manifestations is microsomia, a result of collagen deposition in the perioral tissues. The complexity of treating these patients includes limited mouth opening ability, and difficulty inserting and removing dentures due to finger deformity. This article will describe an appliance specially designed especially for scleroderma patients, which facilitates treatment of the patient with removable partial dentures (RPD).     

International Family-planning Training for Nurse Practitioners

Since the mid-1970s, the Margaret Sanger Center of Planned Parenthood of New York City has prepared nurses and nurse midwives from less developed countries to be family-planning nurse practitioners. These nurse practitioners then provide services to patients, train other staff, and manage integrated family-planning clinics. More than 120 nurses and nurse midwives have arrived in groups of 10 at the Sanger Center, with 72 attending since 1981. Each course lasts 10 weeks. The core curriculum provides trainees with skills in women's health care including contraception, in training and advocacy, and in management of clinics. Whether, in the current period of scarce resources, cross-cultural training programs of this type remain a worthwhile investment, and if so, which of their components are most important to this success, is assessed.     

Passive smoking: A danger to children''s health

The most common cause of illness in infancy and childhood is acute infection of the respiratory tract. Several recent studies have reported that life-threatening respiratory disease in infancy, such as pneumonia and bronchiolitis, is directly related to the smoking habits of parents. The effects of smoking are more hazardous to youngsters because babies and young children breathe more rapidly than adults. Because of this higher breathing rate, they inhale more air—and more pollution—in comparison to their total body weight. The harmful effects of cigarette smoking on infants and children and recommendations for specific interventions to minimize or eliminate this health hazard are discussed.     

Depressive Symptoms and Associated Factors in Children With Attention Deficit Hyperactivity Disorder

PROBLEM: To compare depressive symptoms in children with attention deficit hyperactivity disorder (ADHD) to those in healthy children, and to explore the influence of individual and family factors on level of depression. METHODS: Individual interviews with 68 children, ages 7 to 12 years, in order to complete the Children's Depression Inventory. FINDINGS: Children with ADHD reported significantly more depressive symptoms than did children without ADHD; 14.7% of children with ADHD reached the threshold of a 19 point score, which suggests clinical depression. No significant effects of individual and family factors on level of depression were found. CONCLUSIONS: Children with ADHD are more inclined to experience depressive symptoms than are healthy children. To plan appropriate interventions, nurses evaluating and working with children with ADHD should always consider a possible coexistence of depressive symptoms.