Difficulties in the measurement of outcome in people who have serious mental health problems

In the present drive towards evidence-based health care it is essential for nurses to be able to define and measure their contribution in the health services and thereby ensure that resources are deployed to provide maximum improvement in the health of the population. Yet there exist few rigorous studies which examine the impact of the nursing contribution on patient health gain. One explanation for this is the sheer complexity of outcome measurement. This paper considers the multitude of factors which must be taken into account when designing studies to measure the impact of interventions for people with serious mental health problems. The heterogeneous nature of the population, the range of services these people might use, the composite of possible interventions and the paucity of adequate measurement tools are among the issues to be tackled. Although no single methodology can be prescribed, a number of principles are offered to guide study design.     

A comparison of the reported early experiences of student nurses with those of a group of people outside the helping professions

In order to investigate the psychodynamic concepts of 'reparation' and 'compulsive caring' as possible motivations for a career in nursing, a questionnaire was given to two groups of respondents, 115 nursing students 97 people not involved in any of the helping professions. Both groups were asked whether or not they had experienced specific, potentially distressing events and circumstances in their childhood and teenage years. The null hypothesis was that there would be no statistically significant differences between the two groups on frequency of affirmative responses to these questions. Chi-square tests were used to determine the differential frequency responses to 11 of the 14 questions, and statistically significant differences were identified. The nursing students had a significantly greater total number of recollected adverse experiences, and there was a significantly greater number nursing students recollecting at least one. Significance on this result was maintained when males and females were analysed separately and together, with a higher level of significance reached for males than for females. Statistically significant differences between the two groups on their response specific questions were greatest for the questions about separations from mother or main carer and about the occurrence of major difficulties not covered in other questions. There is strong evidence for a rejection of the null hypothesis, the implications of which are discussed.     

People with learning disabilities who also have mental health problems: practice issues and directions for learning disability nursing

The plight of people with learning disabilities who have mental health problems has become an issue of contemporary importance in the provision of health services to this section of the population. This paper will argue that learning disability nursing has a central role to play in the promotion of mental health for this client group ( Department of Health 1995a ). However, learning disability nursing presently operates without a clear model of mental health. Therefore, before this potential can be realized there is a need to establish the common ground between the discourses of learning disability nursing and those of psychiatric nursing which might be related to this client group. This paper begins by identifying the background issues relating to the problems of meeting the mental health needs of people with learning disabilities. It then proposes that an applied behavioural approach has the potential to provide a coherent theory that can link the discourses of normalization, developmental psychiatry and mental health nursing, whilst also establishing the applied behavioural approach as a powerful technology upon which meaningful interventions can be designed.     

Flow-cytometric detection of terminal deoxynucleotidyl transferase and other intracellular antigens in combination with membrane antigens in acute lymphatic leukemias

Development of a new fixation procedure allowed flow-cytometric analysis of nuclear and other intracellular antigens in acute lymphatic leukemia (ALL). A short fixation of the cells with buffered formaldehyde acetone (BFA) rendered the cell membrane permeable, allowing the monoclonal antibodies (MoAbs) to penetrate the cell. Through this method, a rapid analysis of intracellular antigens, specific for acute lymphatic leukemia [such as terminal deoxynucleotidyl transferase (TdT), immunoglobulin M (IgM) heavy chain, and antigens recognized by the CD22 or CD3 MoAbs) was performed by flow cytometry. The surface antigens remained intact after this fixation procedure, enabling simultaneous detection of membrane and intracellular antigens. The binding of biotinylated antibodies against several B- and T-lymphoid membrane antigens was detected with streptavidin-phycoerythrin (red fluorescence), whereas the intracellular antigens were stained with FITC-labeled polyclonal antibodies, or indirectly with FITC-labeled goat anti-mouse IgG (green fluorescence). Through this combination of markers, minor cell populations can be detected and a rapid and quantitative immunodiagnosis can be performed.     

How hospital ward members treat learner nurses: an investigation of learners'' perceptions in a British hospital

Twenty-five learner nurses who had just completed their first two wards were questionned about the behaviour of other ward members towards them. Although many ward sisters' and charge nurses' behaviour was positive towards learners, just under 50% of learners' responses indicated that the ward sister/charge nurse was sometimes rude and did not make them feel 'at home'. The ward sister/charge nurse's behaviour was, on average, more negative than another liked qualified staff, whose behaviour was more negative than a more experienced student on the ward. The ward sister/charge nurse's behaviour was the major determinant of ward preference by the learner. However, the behaviour of ward members tended to correlate, providing evidence of a 'ward atmosphere'. There is a need for leadership and educational training for ward sisters and charge nurses.     

Nurse–patient negotiation: assumption or reality?

The current socio-political philosophy in the United Kingdom promotes the belief that consumers of health care should exercise choice and express opinions about the care they receive. This view challenges the traditional paternalistic approach to health care which espoused that 'the professional knows best'. In association with general socio-political trends, nursing is undergoing radical reform. The nursing literature widely promotes the importance of a nurse–patient relationship which fosters the involvement of the patient in negotiation and decision-making regarding his care. Nurses who advocate individualized, holistic care must hold such an ideology as a central tenet to their philosophy. However, it is questionable whether this philosophy is widely expressed in the reality of clinical practice. There is also an absence of empirical evidence to support the assumption that patients wish to participate in decision-making. This paper critically reviews some of the debate centred around the concept of nurse–patient negotiation. It is suggested that the issues are complex and that there remains a need for further research which takes into account multiple factors, including the social and organization context of nursing care.     

The emotional experience of caregivers to relatives who are chronically confused—Implications for community mental health nursing

This paper examines the emotional experience of informal caregivers to family members who are chronically confused. Six informal caregivers were taken from the caseloads of community mental health nurses working with elderly people. Data were collected by means of a daily diary and in-depth interviews relating to their emotional experience as caregivers. The data are presented in the form of six vignettes and the implications for theory, practice and research in community mental health nursing are examined.     

Worldwide overview of critical care nursing organizations and their activities

While critical care has been a specialty within nursing for almost 50 years, with many countries having professional organizations representing these nurses, it is only recently that the formation of an international society has been considered. A three-phased study was planned: the aim of the first phase was to identify critical care organizations worldwide; the aim of the second was to describe the characteristics of these organizations, including their issues and activities; and the aim of the third was to plan for an international society, if international support was evident. In the first phase, contacts in 44 countries were identified using a number of strategies. In the second phase, 24 (55%) countries responded to a survey about their organizations. Common issues for critical care nurses were identified, including concerns over staffing levels, working conditions, educational programme standards and wages. Critical care nursing organizations were generally favourable towards the notion of establishing a World Federation of their respective societies. Some of the important issues that will need to be addressed in the lead up to the formation of such a federation are now being considered.     

Explorations in body image care: Peplau and practice knowledge

Practitioners in mental health care have long utilized the work of Hildegard Peplau, both for nursing discourse and for practice. At a time when the role of theory in practice is once more being debated, and when theories are being applied in new contexts, this paper examines the contribution that Peplau's work may have to offer altered body image nursing care. A case study is used to highlight concepts in practice, the paper examining the ways in which Peplau's Theory of Interpersonal Relations complement the other elements of practice knowledge that the nurse uses to assist patients and lay carers alike.