Nursing and substance misuse: responding to the challenge

The widespread use and misuse of alcohol, drug and other psychoactive substances are major health and social concerns that affect the lives of many The social and health sequelae of psychoactive drugs and alcohol are preventable and manageable with minimal interventions Nurses and other health workers can effectively respond to substance misuse problems and their existing generic skills can be easily adapted in working with substance misusers This paper considers some of the issues such as the extent of the problem, attitudinal considerations, response to substance misusers and a brief outline of the role of the nurse The urgent need for education and training in substance misuse and addictive behaviour for nurse practitioners is also addressed     

A comparison of the home‐care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home‐care service

Restorative home‐care services, or re‐ablement home‐care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home‐care services had only been investigated in terms of singular outcomes such as length of home‐care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure – the use and cost of the home‐care and healthcare services received over the 2‐year period following service commencement. Seven hundred and fifty older individuals referred for government‐funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home‐care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home‐care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow‐up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50–0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50–0.95)]. Additionally, the aggregated health and home‐care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72–0.96) over the 2‐year follow‐up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost‐effective option than providing conventional home care.     

Student nurse attitudes to teaching/learning methods

This article outlines the findings of a study which investigated the attitudes of 203 general and psychiatric student nurses from nine schools of nursing towards a defined number of teaching/learning methodologies. All students were at the end of their first year or the beginning of their second year of a 3-year first-level training. Data were collected using an instrument based on a semantic differential scale. The findings, when compared against certain variables, for example, gender, showed that there were very few significant differences in relation to the defined and tested methodologies. Students generally showed themselves to be a homogeneous group and the findings indicate that students were more positively predisposed towards student-centred teaching/learning methodologies.     

Identifying the practice characteristics of advanced practitioners in acute and critical care settings

This paper reports the results of a longitudinal, qualitative study into the role transition of advanced nurse practitioners (ANPs) in the UK. Following the completion of a Master's Degree in Health Studies programme, eleven ANPs working in high-dependency and acute care settings completed a purpose-designed 'role development diary' for the first six months they practised in their new role. In the diary, ANPs recorded the nature and focus of practice activities, identified the components of their practice perceived to be 'advanced', and documented the factors that influenced role implementation and development. Once completed, the diaries were subjected to a comparative analysis, which revealed that the level of patient dependency and the type of clinical environment had a direct bearing on the nature and extent of certain aspects of role performance. The findings also indicated that, whilst practitioners identified multiple components in their roles, priority was initially given to the acquisition and development of technical and diagnostic skills. It was concluded that variations in the performance of ANPs could be attributed not only to the nature of the clinical environment, but prevailing personal, political and organizational agendas.