Doing practice differently: solution-focused nursing

BACKGROUND: Critical thinking and reasoning take many forms; however, a problem-orientation remains the favoured approach in health care. PURPOSE: This paper considers the effects of a problem-orientation and argues that a solution-orientation fits nursing's interests more closely and represents an exciting way forward in both education and practice. DISCUSSION: Whilst a problem-focus is criticized by some, it remains largely unchallenged as the guiding light for nursing practice. A major reason is that the problem focused approach has strong cultural roots. It is deeply embedded in our thinking, and has become taken-for-granted and not often recognized or debated. Whilst problem-solving has an important place in helping to diagnose disorder and overcome difficulties, nursing needs to move beyond its borders because the role also concerns problem-free issues such as health and well-being. Creativity, imagination and focusing on strengths not problems are also important cognitive processes. CONCLUSION: A problem-orientated approach in nursing has had a constraining rather than enabling influence. By refocusing on a solution-focused approach, we could show how we are different from medicine, and how we aim to do nursing differently through using skills such as engagement, resilience-building, community development, primary health care and health education.     

Fusarium proliferatum superficial suppurative thrombophlebitis

Fungi are increasingly recognized as microorganisms causing superficial suppurative thrombophlebitis being managed by aggressive surgical therapy and antifungal agents. We report a case of Fusarium proliferatum superficial suppurative thrombophlebitis in an immunocompetent patient with no evidence of systemic infection and who responded to venotomy alone.     

Effects of bone block position and orientation within the tibial tunnel for posterior cruciate ligament graft reconstructions: a cyclic loading study of bone-patellar tendon-bone allografts

BACKGROUND: Posterior laxity occurring after posterior cruciate ligament reconstruction with a tibial tunnel could be related to thinning and permanent elongation of the graft as it is cyclically loaded in vivo. HYPOTHESIS: The orientation and position of the bone block within the tibial tunnel will have a significant effect on thinning and elongation of the graft after cyclic loading. STUDY DESIGN: Controlled laboratory study. METHODS: In test series 1 (27 fresh-frozen graft pairs), all bone blocks were positioned flush with the posterior opening of the tibial tunnel; 1 graft was oriented with the bone block facing posteriorly, whereas its pair was tested with the bone block facing anteriorly. In test series 2 (20 graft pairs), all grafts were oriented with the bone block facing posteriorly; 1 graft had the bone block positioned flush with the posterior tunnel opening, whereas its pair was tested with the bone block recessed 1 cm from the posterior opening. RESULTS: In series 1, 3 of 27 grafts with posterior bone block orientations failed at the tunnel edge before 2000 cycles of testing could be completed; all specimens with anterior bone block placements survived the testing intact. In series 2, 3 of 20 grafts with recessed bone blocks failed at the tunnel edge, whereas all those with flush bone blocks survived. CONCLUSIONS: The best position for the bone block of a bone-patellar tendon-bone graft was flush with the posterior tunnel opening with the bone block facing anteriorly in the tibial tunnel.     

Genetic polymorphisms in the expression and treatment of neuropsychiatric disorders

Recent advances in molecular genetics have greatly increased the understanding of the pathophysiology of certain neurobehavioral disorders and the core symptoms of these disorders. This paper reviews key concepts important in understanding the genetics of neuropsychiatric disorders, and gives an overview of several different types of genetic disorders, including trinucleotide repeat disorders, and functional polymorphisms of monoamine neurotransmitter systems.     

Principles for curriculum development in Australian nursing: an examination of the literature

The teaching and learning environment involves a complex interplay of various elements, each of which has been the subject of much educational research. This paper uses a framework for understanding these teaching and learning elements and provides a review of relevant literature. This critical review provided a foundation and focus for the development of a new bachelor of nursing program within a School of Nursing in a Queensland University.     

In harm's way: a postmodern narrative inquiry

Deliberate self-harm is a traumatic experience which has serious consequences at individual and social levels. Differing motivations for self-harm and different modes of injury require that therapeutic responses vary. Yet, according to the literature and personal observation, nursing responses tend to be uniform and inflexible. Not only are such responses inadequate for effectively dealing with individuals who self-harm, they also have unintended, hidden deleterious consequences for nurses and nursing. In this paper, a story about self-harm is analysed using a postmodern perspective that helps to illuminate multiple dimensions to this complex issue. The approach enriches understanding, opening up possibilities to improve the quality of the nurse--patient relationship.     

Public perception of alcohol policy issues relating directly or indirectly to privatization: results from a 1999 Ontario survey

OBJECTIVE: The purpose of this study is to measure public opinion on alcohol policy issues relating to youth, litigation, outlet density, and government action. The authors comment on the implications of public opinion with regard to proposals for privatization of alcohol retailing in Ontario. METHOD: Using data from a 1999 provincial survey (n = 1,288), the authors examine the opinions of Ontario adults (male and female over the age of 18) on seven alcohol policy-related items. In order to identify characteristics of persons tending to express certain opinions, the opinion items are cross-tabulated with sex, age, drinking pattern, marital status, and education. A scale is created to show the level and strength of aggregate support for alcohol controls. A logistic regression confirms associations between demographic characteristics and opinions. RESULTS: The majority expresses opinions favouring alcohol controls and disagreeing with privatization (73% of total sample against). However, differences of opinion are observed within groups, between groups, and between items. In particular, higher-risk drinkers stand out for their dislike of most control measures. DISCUSSION: Taken as a whole, the results suggest that privatization of alcohol retailing in Ontario would run contrary to the wishes of the majority. Disapproval would probably be even stronger if more people realized there is often a connection between privatization and increased outlet density, relaxation of other controls, and less consideration for public health.     

Traceability in cattle and small ruminants in Canada

Traceback systems for cattle and small ruminants are of international concern after the outbreaks of bovine spongiform encephalopathy in the European Union and foot and mouth disease in the United Kingdom and South America. Implementation of a national or international identification system depends on meeting a balance between cost, reliability/durability, ease of use, data transfer speed, protection from fraud, avoidance of entry into the food chain and animal welfare issues. As of 1 January 2001, Canada has instituted a national identification programme for cattle, which will have annual operating and administrative costs of Can$0.20 per head, excluding ear tags. The system will provide herd of origin traceback and individual animal identification by ear tags for all beef cattle. A number of identification technologies are available that would have advantages over visual tags, but these are currently too costly without government support (electronic identification, deoxyribonucleic acid [DNA] fingerprinting), too slow (DNA fingerprinting) or have not been tested sufficiently (retinal imaging) to warrant mandatory inclusion in a national traceback/identification system.     

Morphology of the spermatozoa of the iguanian lizards Uta stansburiana and Urosaurus ornatus (Squamata, Phrynosomatidae)

The spermatozoa of Uta stansburiana and Urosaurus ornatus show the following squamate autapomorphies: a single perforatorium extending anteriorly from the apical tip of the paracrystalline subacrosomal cone; the presence of an epinuclear electron lucent region; intermitochondrial dense bodies; and the fibrous sheath extending into the midpiece. The acrosome vesicle is flattened and concentrically zoned apically; basally it overlies a subacrosomal cone which invests the nuclear rostrum. A stopper-like perforatorial base plate, rounded nuclear shoulders and a basal nuclear fossa are present. The proximal centriole contains a density within its centre for approximately one half its length and lies at approximately 80 degrees to the distal centriole. The two central singlets of the axoneme extend into the short distal centriole. A peripheral dense fibre is associated with each of the nine triplets of the distal centriole, and the fibre continues posteriorly with each of the nine doublets of the axoneme. A central fibre is associated with the two central singlets. All fibres are absent or vestigial at the level of the annulus. Mitochondria are short sinuous with a maximum of eight seen in transverse section. Uta and Urosaurus sperm differ from each other in their arrangement of intermitochondrial dense bodies in two ways: 1) longitudinally, Uta has five incomplete 'rings' of dense bodies, whereas Urosaurus has only four such rings; 2) in cross section, each individual 'ring' of Uta may contain up to four irregularly spaced dense bodies, whereas Urosaurus contains a maximum of only two dense bodies. The sperm of Uta and Urosaurus show strong similarities to those of the agamids and polychrotids. No spermatozoal autapomorphies for the Phrynosomatidae were found.