An innovative nurse education program in the Torres Strait Islands

As the most numerous and geographically dispersed professional group, registered nurses in Australia work with Aboriginal and Torres Strait Islander health workers and other members of the multidisciplinary team in a variety of practice contexts to provide health care to Indigenous and non-Indigenous people. Despite the introduction of a variety of recruitment and proactive support strategies by employers, universities and State and Commonwealth governments, few Indigenous people in Australia enrol in, and graduate from, entry level higher education courses in the health professions. The reasons for this are complex and, as yet, not well understood or described; however, it is clear that the well-documented execrable health status of Indigenous Australians demands a response from universities, which are largely responsible for the education of health professionals. An innovative model of registered nurse education in the Torres Strait region of Australia is reported in this paper. A satellite campus established by James Cook University (JCU) on Thursday Island delivers the undergraduate nursing course by mixed mode, supplemented by specific strategies designed to improve Indigenous student recruitment and retention and thus increase the likelihood of graduation. The course and the strategies implemented are discussed in this paper.

Meeting the challenges of recruitment and retention of Indigenous people into nursing: outcomes of the Indigenous Nurse Education Working Group

It has been recognised internationally that increasing the number of Indigenous people working as health professionals is linked to the improved health status of Indigenous people. When comparing Australian Indigenous and non-Indigenous populations, Indigenous people continue to have poorer health standards and are much less likely to be involved in employment in health professions than other Australians. In 2000, the Indigenous Nurse Education Working Group (INEWG) was formed by government with the mandate to work collaboratively with universities and important professional nursing bodies across the nation in an attempt to increase the number of Indigenous registered nurses and to prepare nursing graduates with better understanding of, and skills to assist with, Indigenous health issues. This paper describes the work of the INEWG from 2000 to mid-2003; firstly in developing and implementing strategies aimed at increasing the recruitment and retention of Indigenous people into undergraduate nursing programs; and secondly by helping university schools of nursing increase faculty and student understanding of Indigenous culture, history and health issues through educational processes. Lastly, it summarises the INEWG's 2002 recommendations to achieve a higher rate of Indigenous participation in nursing. The results of research into the success of these recommendations will be the subject of a later paper.

The nurse practitioner role in Fiji: results of an impact study

The Nurse Practitioner role, a relatively new role in Fiji, was introduced by the Ministry of Health in order to increase local access to adequate health care for people living in remote areas. Both developed and developing countries have introduced Nurse Practitioner or similar roles in order to provide a cost effective and sustainable health workforce. This paper provides the results of a qualitative, descriptive study undertaken to explore the introduction of this role and its impact on health service delivery in Fiji. It involved semi structured and focus group interviews with nurse practitioners, key stake holders and community members. The findings demonstrate the positive impact of the role and its benefits to people living in the remote areas of Fiji. It also outlines the satisfaction of villagers with Nurse Practitioners and the extensive scope of practice undertaken by these practitioners. Issues related to the introduction of the role are also discussed. Finally, recommendations for future research and practice are offered.

Psychotropic PRN: a model for best practice management of acute psychotic behavioural disturbance in inpatient psychiatric settings

PRN, or 'as needed', medications are administered frequently by mental health nurses in psychiatric inpatient settings to manage difficult and disturbed behaviour when other strategies fail. Research indicates that approximately 50% of psychiatric inpatients receive a PRN medication at some stage of their treatment. Although evidence indicates that traditional antipsychotics and benzodiazepines are equally effective in managing acute agitation and other psychotic symptoms, it has been recommended that benzodiazepines should be the first-line of action because they do not cause the serious side-effects that are common with the traditional antipsychotics. Unfortunately, research indicates that doctors and nurses are not taking advantage of the latest evidence to guide their practice. This paper reviews the limited research available in the area and makes recommendations for evidence-based practice.

PRN psychotropic medications: the need for nursing research

This paper highlights the inadequacy of existing research for the purposes of evidence-based prn (Latin, pro re nata or 'as needed') medication practice in psychiatric settings and notes the absence of relevant evidence-based clinical practice guidelines and policies, both nationally and internationally. The professional, ethical and legal importance of PRN medication practices is also discussed, and shown to add to the urgency of developing a research agenda which will serve as an adequate basis for good clinical practice. This paper summarises the relevant research and identifies problems that can arise for clinicians involved in the administration of prn medications in mental health settings. It concludes by highlighting key issues which urgently require empirical investigation.

Mental health nurses' PRN psychotropic medication administration practices

PRN psychotropic medications (medications given with the aim of changing the patient's mental state on an 'as needed' basis) are frequently prescribed and administered in mental health facilities. Their administration is largely an autonomous nursing role. However, little research has explored this important area of nursing practice in any detail and therefore the use of this intervention by mental health nurses is not fully understood. A descriptive project was undertaken to explore the factors involved in the administration of PRN psychotropic medications. It utilized a retrospective chart audit, conducted at one regional and one urban setting in Queensland, Australia. The results indicate a lack of clarity surrounding psychotropic PRN medication administration practices, confusion surrounding decision-making processes related to this intervention, and poor documentation practices. The study found a high incidence of PRN psychotropic medication administration when compared to similar studies, and an excessive reliance on the use of typical antipsychotics over benzodiazepines. This practice is not supported by contemporary literature. As a result of our findings, we recommend further studies in areas of related importance, in order to increase our understanding of the complexities surrounding this important nursing intervention, and an investigation into documentation practices in inpatient mental health settings.

Moving from technical to critical reflection in journalling: an investigation of students' ability to incorporate three levels of reflective writing

This paper outlines a research project aimed at changing the levels of reflection of preregistration nursing students in a tertiary institution. Whilst reflection is widely espoused now in nursing, few studies have been found that identify whether the level of reflective writing can be identified or developed by students. Anecdotal and research evidence (Powell 1989; van Manen 1977) however indicates that most student reflective writing occurs at the technical level. A descriptive exploratory study using both qualitative and quantitative techniques was undertaken to apply van Manen's (1977) levels in a structured way in an attempt to facilitate the student's understanding and use of the levels in their reflective writing. The findings of the study indicate that student self evaluation and identification of the levels in their own writing can lead to change in the levels of critical reflective writing achieved by undergraduate students.

Taking neuroleptic medications as the treatment for schizophrenia: A phenomenological study

Research in the area of neuroleptic medications has traditionally relied on quantitative methodologies which view the problem from the researcher's perspective. This phenomenological study was undertaken to explore the experience of taking neuroleptic medications from the individual's perspective using a research approach which has the potential to illuminate and respect participant experiences. Interviews were conducted with 10 individuals who take neuroleptic medications as their main treatment for schizophrenia. Interviews were analysed using an interpretive method which seeks to generate a deeper understanding of the phenomenon under study. The experience of taking neuroleptic medications emerged as incorporating hope for recovery, learning to live with the side-effects, embodiment of illness, experiencing issues of control, and struggling to stay well. The results have relevance for practicing and novice mental health nurses, for teachers of undergraduate nursing and allied health students, and carer and consumer groups.

The wartime experience of Australian Army nurses in Vietnam, 1967-1971

AIMS

To provide a synthesis of the experience of nursing in the Vietnam War.

RATIONALE

War and nursing are linked unequivocally. As battles have raged over the centuries, nurses have attended the ill and wounded soldiers, nursing them back to health or into death and the study of this phenomenon forms a significant part of Australia's nursing history. However, a review of the Australian scholarly nursing and military history literature revealed that the experiences of Australian nurses in the Vietnam War has not been widely published. In an attempt to redress this gap in Australian nursing and military history, the aim of this study was to analyse the nature of the nursing work in the Vietnam War, and to increase awareness and understanding of the experience of nurses in the war within the nursing profession.

METHODS

Using oral history interviews, this study investigated the nature of nursing work as experienced by 17 Australian Army nurses who served in the Australian Military Hospital in Vung Tau between 1967 and 1971.

FINDINGS

The vast majority of the nursing sisters sent to Vietnam knew little about the type of work or the environment into which they were entering and were, therefore, clinically unprepared. It appeared that, by virtue of their being a nurse, it was an expectation that the nurses would adapt to the nature of their work in the war zone. However, this study also revealed that, although the nurses adapted professionally, their memories of their experiences have affected many personally.

CONCLUSIONS

This paper will increase current knowledge significantly regarding the phenomenon of nursing in the Vietnam War, enabling a greater understanding of the experience.

What you ask is what you get: learning from interviewing in qualitative research

This paper outlines some important issues discovered about undertaking qualitative interviews. A description of a study that involved interviewing the authors' students is followed by discussion of aspects of the interviewing process that became apparent during analysis of those interviews. Problems that were encountered with retrospective interviews, power differentials, question sequencing, some interview techniques, and a prior knowledge of the students are illuminated to assist other qualitative interviewers to be aware of these potential areas of difficulty.

Effective communication in an intensive care setting: nurses' stories

Effective communication has been long considered an important aspect of nurse-patient interactions. However, follow up of people who have been patients in intensive care units (ICUs) indicates that nurses' communication in this setting is at times unsatisfactory. Patients have described how they were left feeling frustrated and alienated by this failure in the communication process and unconscious patients report how they were aware of nurses' attempts at communication with them while unconscious (Lawrence, 1995). Because most of the research to date has focused on patients' perceptions of nurses' communication in an intensive care unit, this study sought to explore what nurses believed constituted effective communication in an intensive care setting. Therefore, a qualitative study was undertaken to explore nurses' perceptions of effective communication with patients in an intensive care setting. The stories of four intensive care nurses were utilized as the means of data collection. The analysed data revealed the following themes: nurses' perceptions, presencing and reassurance. The findings have relevance for nurses in many settings.

Testis unis, testis nullas: one witness is no witness. Criticisms of the use of oral history in nursing research

In research, there is no perfection: no perfect method, no perfect sample, and no perfect data analyses tool. Coming to this understanding helps the researcher identify the inadequacies of their preferred method. This paper discusses the criticisms of the oral history method, drawing reference to its challenges and difficulties in relation to its use in nursing research. Oral history has the advantage over more traditional historical approaches in that the narrators can interpret events, personalities and relationships within the interview that are not accessible from written sources. The oral history interview may also provide a forum for unveiling documents and photographs, which might not have been otherwise discovered. Nonetheless, oral history, like most methodologies, is not flawless. This paper discusses the limitations of oral history and suggests ways in which a nurse can use oral history to provide an account of aspects of nursing history.

Constitutive activity of the light-sensitive channels TRP and TRPL in the Drosophila diacylglycerol kinase mutant, rdgA

Mutations in the Drosophila retinal degeneration A (rdgA) gene, which encodes diacylglycerol kinase (DGK), result in early onset retinal degeneration and blindness. Whole-cell recordings revealed that light-sensitive Ca2+ channels encoded by the trp gene were constitutively active in rdgA photoreceptors. Early degeneration was rescued in rdgA;trp double mutants, lacking TRP channels; however, the less Ca2+-permeable light-sensitive channels (TRPL) were constitutively active instead. No constitutive activity was seen in rdgA;trpI;trp mutants lacking both classes of channel, although, like rdgA;trp, these still showed a residual slow degeneration. Responses to light were restored in rdgA;trp but deactivated abnormally slowly, indicating that DGK is required for response termination. The findings suggest that early degeneration in rdgA is caused by uncontrolled Ca2+ influx and support the proposal that diacylglycerol or its metabolites are messengers of excitation in Drosophila photoreceptors.

Reflective writing: a strategy to foster critical inquiry in undergraduate nursing students

Whilst nursing has recognised the importance of reflective practitioners, few strategies designed to achieve this outcome are currently apparent in nursing education literature. Writing, forwarded as one way to enhance the development of critical thinking and reflection in undergraduate nursing students, is the focus of this article. The article describes a project undertaken to explore the ways writing could be incorporated into an undergraduate curriculum as a strategy to enhance and extend personal and professional meaning-making. It examines a number of strategies utilised in the project and offers some insightful understandings developed by the team.

An exploration of the preceptor role: preceptors' perceptions of benefits, rewards, supports and commitment to the preceptor role

This Australian study, a replication of Canadian research by Dibert & Goldenberg, was undertaken to explore the relationship between preceptors' perceptions of benefits, rewards and support, and their commitment to the preceptor role. A convenience sample of 134 nurse preceptors involved in an undergraduate nursing course were invited to complete a four-part questionnaire consisting of the Preceptor's Perception of Benefits and Rewards Scale, the Preceptor's Perception of Support Scale, the Commitment to the Preceptor Role Scale, and demographic details. The results, in the main, parallel those of the original research, with differences reflecting the distinct nature and the more recent use of preceptorship in Australia. The results indicate a clear commitment to the preceptor role and a perception that both material and non-material benefits are derived from acting in the role. Additionally, support from the institution and coworkers was considered vital for participation in the role. This not only has implications for nursing educators, administrators and potential preceptors, but also for those being preceptored.

Taking neuroleptic medications: a review

Failure to take neuroleptic medications as prescribed often results in relapse and readmission to a psychiatric facility. It is the responsibility of the psychiatric/mental health nurse to ensure that clients have sufficient knowledge and support to enable them to make informed decisions regarding their medication regimen. In addition, the nurse has an important role as client advocate with regard to this treatment option. However, the issues surrounding noncompliance represent a major challenge to psychiatric/mental health nurses. This paper explores these complex issues surrounding the taking of prescribed neuroleptic medication, in particular, the impact of personal factors, knowledge of neuroleptic medications, therapy factors and the helper relationship upon the medication taking behaviour of psychiatric clients is presented in relation to the literature and recent research findings. Finally, the implications of these factors towards the role of the mental health nurse is discussed.

Ethical aspects of phenomenological research with mentally ill people

Given the dramatic rise in the frequency of nursing research that involves eliciting personal information, one would expect that attempts to maintain the balance between the aspirations of researchers and the needs and rights of patients would lead to extensive discussion of the ethical issues arising. However, they have received little attention in the literature. This paper outlines and discusses some of the issues associated with qualitative research. The discussion converges on the specific case of phenomenological research, which involves the invasion of participants' personal worlds, and draws attention to some of the ethical issues that arise when the participants are psychiatric patients.

Neuroleptic medication: the literature and implications for mental health nursing

The past twenty years have been a period of consolidation in the pharmacotherapy of schizophrenia followed more recently by a period where a number of new, atypical neuroleptics have enhanced the treatment options available to people with schizophrenia. In this article the contemporary research into neuroleptic medications, the mainstay of treatment for schizophrenia, is reviewed and critiqued. In particular, the article addresses important issues such as drug efficacy and action, the therapeutic effects of neuroleptics, side effects, including the recent research related to these side effects and, finally, the implications for mental health nurses. The issues raised here have sufficient relevance for mental health nurses for items to be considered in all undergraduate nursing and postgraduate mental health nursing courses.

Carbon Monoxide Poisoning: Nursing Priorities and Treatment

A man in his mid 30s arrived for admission by ambulance to the psychiatric unit of a private hospital after transfer from a small rural hospital. His voluntary admission was the result of a suicide attempt by carbon monoxide (CO) poisoning. On arrival the patient was receiving oxygen via nasal prongs at 3 liters per minute, appeared to be extremely distressed, and complained of severe headache. The nurses became extremely concerned after reading the transfer notes--the poisoning incident had occurred 4 hours prior to arrival at the unit. Furthermore, the patient was discovered unconscious and resuscitated by paramedics. The nursing staff immediately notified the supervisor and requested that the medical registrar examine the patient. The psychiatrist was notified of the concerns of the nursing staff. Eventually, after many tests, phone calls and arrangements, the patient was transferred to a large city hospital for hyperbaric oxygen therapy.

The nature of the traK4 mutation in the F sex factor of Escherichia coli

The sequence of traK gene of the F sex factor of Escherichia coli is presented; the traK gene product is predicted to be a protein of 25,627 Da with a signal sequence of 21 amino acids to give a mature protein of 23,307 Da. The traK4 mutation is an extremely polar mutation in the F plasmid that affects F pilus synthesis and plasmid transfer. traK genes carrying the traK4 mutation and a nonpolar mutation traK105 were cloned, sequenced, and identified as an amber nonsense and a frameshift mutation, respectively. The traK4 mutation occurred within one predicted rho-dependent transcription termination element (TTE) and immediately upstream of another, while the traK105 mutation occurred after the two potential TTEs within the traK gene. S1 nuclease protection analysis and Northern (RNA) blot analysis were used to confirm that the traK4 mutation, but not the traK105 mutation, caused premature termination of transcription. Computer analysis of the F transfer region suggested the presence of TTE motifs at regular intervals throughout the 33.4-kb sequence.

An application of nursing faculty practice: clinical camps

The incorporation of clinical practice into nursing faculty role expectations has triggered much debate. Despite the urge for the incorporation of practice into faculty roles, past research has demonstrated that the majority of faculties do not in fact include clinical practice. Reasons given for the failure of nurse academics to practise include lack of time, the failure of academia to value the practice, and the failure to include the practice as criteria for tenure and promotion. For faculty practice to occur it has been argued that clinical practice needs to be more a matter of individual intent: adaptable, and creative. Clinical camps provide potential opportunities for clinical practice for faculties. These camps, it is argued, offer the possibility of clinical teaching, promotion of collegial relationships between faculty and health care agencies, development of positive faculty-student relationships, and a valuable research site. For this reason, it is argued that clinical camps be considered a viable venue for faculty practice.

Outcome from multiple joint replacement surgery to the lower limbs

All patients who had three or more major joints (hips or knees) replaced were identified from operation records at one hospital and reviewed to assess outcome. Forty-three were found to suffer from rheumatoid arthritis, four from osteoarthritis and three from psoriatic arthritis. Eight patients had died an average of 2.6 years (range 1-7 years) after their last operation and this was higher than expected, even for RA. Average follow-up in the 36 surviving RA sufferers was 1.8 years, with a minimum of 6 months since last operation. Range of joint movement, pain relief, satisfaction, mobility, disability and social outcomes were assessed and are reported. Patients were satisfied with outcome because of pain relief and functional improvement. No patient required permanent in-patient care, although they still represented a very disabled group with mean HAQ score of 2.75.