Advanced practice nursing: parameters for successful integration

This article analyzes advanced practice nursing roles through a literature review and a pilot stakeholder survey in relation to five strategic areas: (1) definitions and scope of practice; (2) education, credentialing and regulation; (3) new roles in healthcare; (4) costs and benefits in health reform; and (5) implementation and relationships. The Canadian health services environment is best served by a multifaceted APN role, defined by a nursing paradigm that invokes collaborative relationships with physicians, and education and credentialing that is based on national standardization.

An international survey of death education trends in faculties of nursing and medicine

The purpose of this study was to identify and describe the availability of death education, including teaching and evaluation methods, specific content areas, issues being addressed, and the background and expertise of the faculty members involved in teaching death and dying content. A questionnaire was developed based on the current literature and sent to 80 faculties of nursing and 36 faculties of medicine in Canada and the United Kingdom. The majority of nursing and medical schools that responded to the survey included death education, an integrated approach, through all years of their programs. Despite recent criticisms of Kubler-Ross's model of grieving, the majority of programs reported using her theory most frequently. The findings identify the current status of death education for health professionals in Canada and the United Kingdom, and implications for curriculum changes are discussed.

Pilot mental health assessment and diversion scheme for an English Metropolitan Petty Sessional Division

A three-month pilot mental health assessment and diversion scheme was carried out at one of the busiest magistrates' courts outside London. In terms of demographic characteristics the sample of prisoners seen in this study was similar to those seen in diversion schemes in London and Manchester. Although 77 per cent of prisoners were found to be suffering from a psychiatric disorder, almost half were suffering from alcohol or drug dependence or misuse and the number with psychotic illnesses was small compared with the London sample. These differences may be partly due to the earlier diversion of acutely mentally ill prisoners from police custody into the health care system in Leeds. The low rate of psychiatric admission from the pilot scheme largely reflected these differences although in the cases of four patients admission was recommended by the assessing psychiatrist but not effected because of the lack of regional secure beds. Other problems identified by those involved in the scheme were the need for the provision of bail hostels specializing in the care of those with psychiatric difficulties and the need for the involvement of community psychiatric nurses within the assessment and diversion scheme.

Joint nursing appointments: a vehicle for influencing health care change

With the rapid pace of health care change nurses need to organize and respond quickly to the debate on future health care policy. Nurses from practice and academia working together can capitalize on their unique knowledge and expertise to influence the development of consumer- and health-oriented policies. In the past joint appointments have served to unite nurses in the education and research domains. These appointments must evolve to encompass policy-focused activities that will enable nurses to make a significant contribution to the transformation of the health care delivery system.

Memory impairment in schizophrenia: its extent, affiliations and neuropsychological character

In a sample of 60 schizophrenic patients encompassing all grades of severity and chronicity memory impairment was found to be prevalent, often substantial, and disproportionate to the overall level of intellectual impairment. The deficits were not easily attributable to poor cooperation, attention or motivation; nor were they related to neuroleptic or anticholinergic medication. Memory impairment was significantly associated with severity and chronicity of illness and also with negative symptoms and formal thought disorder. There was evidence from the sample as a whole, and from a more detailed examination of five patients with relatively isolated deficits, that schizophrenic memory impairment conformed to the pattern seen in the classical amnesic syndrome. Additionally, there was preliminary evidence for a marked deficit in semantic memory.

Amnesic syndrome in schizophrenia

Memory impairment is not usually considered to form part of the clinical picture of schizophrenia, except perhaps in severely deteriorated patients. In a survey of 60 patients encompassing all grades of severity and chronicity poor memory performance was found to be common, sometimes substantial, and disproportionately pronounced compared to the degree of general intellectual impairment. Although associated with severity and chronicity of illness, impaired memory was by no means confined to old, institutionalized, or markedly deteriorated patients. The pattern of deficit appeared to resemble that of the classic amnesic syndrome rather than that seen in Alzheimer-type dementia.