Involvement of Advanced Practice Nurse in the Management of Geriatric Conditions: Examples from Different Countries

The increasing demand for healthcare services is placing great strain on healthcare systems throughout the world. Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric conditions (e.g., frailty, sarcopenia, falls, anorexia of aging, and cognitive decline) will delay or avert the development of disability. At the same time, recent years have seen an increased interest and use of advanced practice nurses (APN). Models of best practices of supervision and collaboration have been promulgated by many organizations. APN's roles and scope of practice have been expanded in many countries and the quality and cost-effectiveness of healthcare systems have improved. Nevertheless, in older people, evidence of advanced practice roles remains scattered, and there is little synthesis of evidence, and therefore it is not easy to visualize the different practice models and their components. The aim of this paper is to explain the need for advanced practice nurses to manage geriatric conditions.

Use of a think-aloud procedure to explore the relationship between clinical reasoning and solution-focused training in self-harm for emergency nurses

Self-harm is a risk factor for further episodes of self-harm and suicide. The most common service used by self-injurers is the emergency department. However, very often, nurses have received no special training to identify and address the needs of these patients. In addition this care context is typically biomedical and without psychosocial skills, nurses can tend to feel unprepared and lacking in confidence, particularly on the issue of self-harm. In a study that aimed to improve understanding and teach solution-focused skills to emergency nurses so that they may be more helpful with patients who self-harm, several outcome measures were considered, including knowledge, professional identity and clinical reasoning. The think-aloud procedure was used as a way of exploring and improving the solution-focused nature of nurses' clinical reasoning in a range of self-harm scenarios. A total of 28 emergency nurses completed the activity. Data were audiotaped, transcribed and analysed. The results indicated that significant improvements were noted in nurses' ability to consider the patients' psychosocial needs following the intervention. Thus this study has shown that interactive education not only improves attitude and confidence but enlarges nurses' reasoning skills to include psychosocial needs. This is likely to improve the quality of care provided to patients with mental health problems who present to emergency settings, reducing stigma for patients and providing the important first steps to enduring change - acknowledgment and respect.

Women's experience of early miscarriage: a phenomenological study

This paper describes the experience of three women who had experienced early miscarriage within the previous 12 months. Three major themes of loss emerged: the loss of a baby, the loss of the role of motherhood and the loss of the hopes and dreams the women possessed for their baby. These losses were complicated by the women's negative thoughts about the care they received while in hospital, their perceptions of health professional's negative attitudes, the lack of information given to them, and the lack of understanding shown by family and friends about their situation. The authors recommend a number of changes to practice including the need for an increased sensitivity towards women following early miscarriage.

Breastfeeding duration of Thai women

This quantitative study aimed to determine Thai working women's planned intention to breastfeed and to identify why the mothers chose to breastfeed their infants, how long they initially planned to breastfeed and how long they actually breastfeed. Ninety-nine Thai working mothers who had breastfed within the last 18 months, or who were still breastfeeding their infants and who used the services at three clinics in Ubon Ratchathani Province, Northeast Thailand were asked to participate in the study. The study findings show a strong correlation between the women's planned duration of breastfeeding and between the length of time she actually breastfed. The authors recommend that breastfeeding educational programs include partners and that the work environment provides support facilities to encourage and support the continuation of breastfeeding.

Cultural beliefs and breastfeeding duration of Thai working women

Breastfeeding's crucial role in infant health is universally recognised and yet there are a number of influences on the duration of breastfeeding. This quantitative study undertaken in Thailand explored whether personal beliefs and values influenced Thai working women's duration of breastfeeding. Ninety-nine Thai working mothers were asked to complete a questionnaire to explore the relationship between their cultural beliefs and their breastfeeding practices. Although the majority of the women undertook techniques based on their cultural beliefs, which they believed would encourage breastfeeding practice, the findings demonstrate that the women's cultural beliefs had no significant effect on the duration of their breastfeeding.

Peer mentorship in clinical education: outcomes of a pilot programme for first year students

Identifying effective strategies for promoting learning in the clinical setting continues to pose challenges for nurse educators. The aim of the present paper is to examine the potential that peer mentorship may have in helping nursing students to improve clinical learning outcomes. An example of a peer mentorship programme for nursing students undertaking their first clinical practicum is described, and preliminary findings from an evaluation of this pilot programme are presented. The results suggest that peer mentorship may be of some benefit to students, particularly in relation to reducing anxiety and improving confidence with clinical practice experiences, and is therefore a strategy which is worthy of further investigation.

The problem of arriving at a phenomenological description of memory loss

This paper discusses a methodological difficulty that arose when uncovering the conscious experience of being nurtured as an in-patient with depression on a psychiatric ward. It considers the problem of arriving at a phenomenological description of memory loss in a patient who had undergone electroconvulsive therapy (ECT). The paper begins by describing the prevalence of depression and its significance for nurses working in in-patient settings. Examples of empirical research into memory loss in depression are used to show what researchers must set aside if they are to arrive at a phenomenological description of memory loss. The choice of a phenomenological approach to the wider study from which the methodological problem discussed here arose is then justified. The phenomena of memory is introduced to show the methodological significance of attempting to arrive at a phenomenological description of the statement made by one of the participants, a woman being treated as an in-patient for major depression. A possible description of the phenomena of memory loss based on the existential phenomenology of Sartre is offered to call into question the ability of researchers to bracket their assumptions. The significance for nurses of the wider study from which our example is taken is then described. Finally it is argued that despite the methodological difficulty described, a phenomenological perspective based on the philosophy of Husserl can point nurses in the direction of meeting the human needs of their patients.

Discipline and passion: meaning, masochism and mythology in popular medical romances

This paper is an interpretive analysis of the discourses within popular romance literature, with a particular focus on the genre that includes constructions of the images of nurses and nursing. An historical contrast is made along with examinations of the uses and meanings encompassed within this body of literature, and its messages for women as nurses as it reflects/creates societal change. Deviations from the formulaic nature of these works are explored. Discipline and passion are the recurring themes evident throughout in juxtapositions of romance and power differentials in the hospital/medical scene. The soft-core, sado-masochistic images evident in many titles are explored in a way that raises questions about sexuality, romance, nursing mythology, and the future of this sub-genre of the popular romance.

The humanities and nursing: using popular literature as a means of understanding human experience

The rapid advances in technology during the twentieth century have encouraged science and technology to be the main focus of the nursing curricula. The effect of this focus tends to hinder the importance of the human condition. This paper discusses the benefits of including the humanities, particularly but not exclusively the inclusion of literary study in nursing curricula. It is argued that the study of popular literature by students of nursing provides them with the opportunity to understand and to appreciate life experiences. This assists them in gaining awareness and sensitivity to the many physical and psychological components of people's reactions to health, illness and hospitalization. The power of literary study to promote an appreciation of the hurt and pain of disease is considered by the authors to be an effective teaching tool within a comprehensive programme for students of nursing.

Perceptions of stressors and reported coping strategies in nurses caring for residents with Alzheimer's disease in a dementia unit

A study was undertaken on the perceptions of stressors and coping behaviours in a group of nurses caring for residents with Alzheimer's disease in a dementia unit. The purpose of this paper is to report on the preliminary findings of the study. Repertory grid data were used to explore how nurses perceive residents, the stressors nurses experience in their work, and the coping strategies nurses use when caring for residents. The nurses identified 92 sources of stress, 683 coping behaviours and 708 coping strategies. Analyses of selected repertory grid data are presented and the stressors reported by the nurses are summarized. The coping strategies the nurses report using are classified into categories of adaptive and maladaptive responses to stress. In addition, the nursing implications of the coping strategies used by the nurses are also considered.

Apparent positive cooperativity in the mechanism of action of luteinizng hormone

In vitro accumulation of cyclic AMP by rat Leydig cell preparation and mouse tumor Leydig cells in response to exogenous LH appears to display an apparent Hill coefficient of 2.5. This is suggestive of positive cooperativity at a level intermediate between binding and cyclic AMP production, although several alternative hypothesis cannot be excluded on the basis of these data alone. The Hill coefficient for testosterone is higher than unity, although it has not been established with adequate precision in these experiments.