An exploration of nurses' attitudes to the nursing care of the suicidal patient in an acute psychiatric ward

Suicidal patients admitted to hospital following a suicidal attempt or expressing suicidal ideation present a real challenge to health professionals with regard to their therapeutic Co. Antrim care. This study was undertaken to explore the attitudes of psychiatric nurses caring for such patients. Results reveal that psychiatric nurses do hold positive views on caring for potentially suicidal patients, contradicting previous studies where more negative feelings were expressed by nurses, especially those with initial contact. Findings also show that some nurses experience an element of distress, and the length of experience within such a working environment does not affect the nurses' level of satisfaction gained on caring for the suicidal patient. This study also identifies an expression of need for further education and practice in interpersonal skills and therapeutic modalities to enhance and develop a more effective delivery of care for this group of patients.     

Overview and critique of judgement and decision making in health care: social and procedural dimensions

This paper presents an outline of the scope for the application of decision theory to health care. Firstly, the main approaches to and assumptions of decision theory are discussed. Secondly, health care decision making is reviewed. It is noted that decision theory can be applied to either the health care professional or to the lay person. Applications of decision theory to clinical practice, to the management of care and to resourcing are considered. Thirdly, some areas which would repay further research are identified. These include social processes in individual and group decision making, the temporal distribution of outcomes and the development of techniques capable of dealing with the complex and dynamic features of decisions. On the basis of the foregoing, some conclusions are drawn.     

Evaluation of a low-threshold clinic for opiate-dependent drug users

This study reports on the development and outcome of a Low Threshold Clinic (LTC) for opiate-dependent drug users. The service originated as a nursing initiative within an inner city Drug Dependency Centre (DDC) and its rationale and treatment approach are explored in relation to the literature and local circumstances. Client baseline and outcome data were systematically gathered to assess service uptake and service efficacy in terms of client outcome. Data are presented for the first two years of operation during which a total of 59 clients entered the LTC. The sociodemographic characteristics and patterns of drug use among this group suggest the service was successful in targeting clients who previously failed to enter traditional treatment programmes despite initial referral to the DDC. Outcome data indicate a tendency for clients to inject less frequently, engage in less criminal activity and, by 12 months, to reduce their dose of prescribed methadone whilst attending the LTC. Tentative conclusions are drawn concerning the value of this service for 'hard-to-reach' drug users and those who may be at a precontemplation stage of change. Recommendations are made for a more comprehensive evaluative study that involves comparison with other treatment approaches.     

Work and family role juggling and mood states of Hong Kong public health nurses with children

This study aims to investigate the daily mood states of public health nurses (PHNs) in managerial roles with children in Hong Kong, as a result of multiple role juggling (i.e. simultaneously attending to demands of different roles) using the experience sampling method. Convenience sampling was used to recruit 20 subjects. A watch was worn that beeped at six random times each day for 7 days as a signal to complete an experience sampling diary. PHNs on average responded to 34 signals (80%) to complete the experience sampling diaries. Two major findings provide the focus of this paper. First, results show that PHNs had minimal inter-role juggling between work and family as compared with previous studies in the United States. Cultural factors, sequentially dealing with family and work issues, having a domestic maid or a relative to see to household chores as well as strong spouse support are suggested as the reasons. These results have implications for nursing management and nursing practice. Second, the results also reveal PHNs as having an overall flat affect. It is suggested that PHNs may be using a 'calm and detached' coping style for occupational stress. This coping style has implications on the PHNs' emotional health as well as nurse-client relationships.     

Indwelling catheterization and related nursing practice

A survey of patients with an indwelling urethral catheter was conducted over a 14-day period in five randomly selected district general hospitals in England. The demographic characteristics of the patients and the types of catheter and urinary drainage bags used were recorded. Observational techniques were used to describe nursing care during meatal cleansing and bag emptying Over the 14-day study period 294 patients were catheterized giving an overall daily incidence of catherization of 11.2 per 1000 of the average daily population. Nurses inserted over 50% of catheters and subsequently maintained all closed urinary drainage systems. The closed system was broken for 42% of patients and only 48% of drainage bags were always observed in the correct position. Techniques aimed at preventing infection were observed more frequently when meatal cleansing was performed separately from daily hygiene. The frequency of hand washing, both before and after meatal cleansing and bag emptying, was low. It is concluded that the procedures and practices involved in the care of the urinary drainage system require re-evaluation and re-emphasis.     

An extended literature review of health professionals' perceptions of illicit drugs and their clients who use them

The literature relating to health professionals and illicit drugs and clients who use them shows many common themes. It is evident that the majority of health professionals hold negative, stereotypical perceptions of illicit drug-users. Consequently, these negative attitudes become prejudicial, hence blocking the professional from carrying out effective and humane nursing care to this client group.
Evidence also shows that health professionals' perceptions on the legalization of currently illicit drugs is linked to their own use of these drugs rather than any social or health reasons. Professionals' views on the different illicit substances are also coloured by their use, not by the actual evidence relating to the effects of that drug, in particular, cannabis. The literature shows that health professionals project heavily on to the client all their own negative perceptions of illicit drug use, in the care setting. This has produced very unsatisfactory and unsafe care, resulting in both client and carer being dissatisfied with the whole aspect of care. In addition, specialist teams are being swamped by health professionals who are referring almost every illicit drug-user to these services. The future may be brighter with the generalist and specialist working closely together for the benefit of all, especially the client and, ultimately, the community.