A quality of life study of discharged long-term psychiatric patients

A survey of 48 discharged long-stay patients was carried out. The purpose of the survey was to identify the patients' perceptions of: (a) the preparation given to them in the rehabilitation wards prior to discharge; (b) the quality of their life in the community; (c) the care given by the community psychiatric nurses. A structured interview was conducted in the ex-patient's own home and objective measures of quality of life were also used. Most patients felt that they were well prepared for discharge. More received skills training then received health education. Every respondent (48, 100%) preferred living in the community to being in a psychiatric hospital. Most respondents (46, 95%) were satisfied with life in general. Twenty-eight were visited by community psychiatric nurses and 24 (85%) were satisfied with the care given.     

Continence and potency preserving cystoprostatectomy and substitution cystoplasty for patients with bladder cancer

Fifteen potent men with T3 M0 transitional cell carcinoma of the bladder underwent a technique for cystoprostatectomy designed to preserve the innervation of the distal sphincter mechanism and the corpora cavernosa, and substitution cystoplasty. All patients had previously had radiotherapy. When the neurovascular bundles were seen to be preserved all patients were continent by day (although one had objectively demonstrable stress incontinence) and 60% were potent. Damage to the neurovascular bundles was usually associated with impotence and a degree of stress incontinence, although the latter was correctable by implantation of an artificial sphincter. Cystectomy need not necessarily lead to an abdominal stoma or to impotence.     

Nurse socialization: issues and problems

A comparative study was conducted of the professional socialization process of student nurses in three nurse education centres in South Wales. Patterns and problem areas can be identified of relevance to issues in role theory and with practical implications for the more effective implementation of Project 2000. Three cohorts of students were interviewed using a semi-structured interview schedule whilst in the introductory block and at the end of the first year. The teaching and ward staff directly involved in the socialization process were also interviewed so that their views could be compared with those of the students. There were differences between the types of ward in the opportunities they offered for role modelling. It was doubtful whether the three categories of students, teaching staff and ward staff were all employing a single conception of 'the good nurse'. The student has to find her own pathway through the divergent and often conflicting values and philosophies of the teaching staff and those in authority on the wards. It is recommended that a more unified approach be adopted to reduce the conflict which learners experience. In accordance with Project 2000, the teaching staff should act as practitioners and thereby be perceived as a professional role model with clinical credibility.     

Pressure support and elevation following the removal of a radial artery for coronary artery bypass grafting

The saphenous vein was once the standard coronary artery bypass graft. Alternate grafts, primarily the radial artery and the internal mammary artery are now being utilised for revascularisation of the heart. However, the radial artery graft site can be at risk of oedema and the development of haematoma during the post-operative period. Also tension on the suture line may compromise circulation and create functional problems for the patient. The aim of this study was to assess the effect of pressure support (elastic support bandage) and elevation in reducing swelling and arm discomfort in the harvest arm.

The patients in the study undergoing coronary artery bypass grafts were randomly assigned to one of three groups: elastic support bandage, collar and cuff sling and elevation on two pillows. There were 30 patients in each group. The circumference at three locations on the forearm was measured pre-operatively and on post-operative days 3 and 5. Pain was measured on a visual pain scale, which went from 1-10, with 10 being the most painful. The patients were also asked whether their arm movement felt restricted. The study found that there was no statistically significant difference (at the 0.05 level) between the three groups in the amount of swelling witnessed at the different forearm locations. There was, however, a significant decrease in swelling for all groups between days 3-5, but no difference in pain scores between the groups. Moreover, the collar and cuff sling group reported movement restriction, which was not apparent in the other two groups.

In view of the findings, the researchers advocate the elastic support bandage. Patient compliance has practical implications when applying treatment and this is enhanced by the non cumbersome elastic support bandage. This can be compared to the collar and cuff

sling and pillow elevation groups where the patient's daily activities affects compliance with these two treatments. It is recommended that future research be conducted comparing the effects of the elastic support bandage with a control group.     

Role conflict in student nurses: towards a positive approach for the 1990s

This review paper seeks to adopt a constructive approach towards the subject of the role conflict experienced by student nurses. The significance of role conflict is explored, as are its causes and its effects on the student. Role conflict is then discussed from the perspectives of social psychology in general and nursing in particular, and the paper concludes with an emphasis on the role of the nurse educator in helping the students deal actively and constructively with the role conflict that they will inevitably experience during their careers in nursing.