Primary care nursing workforce in Australia--a vision for the future

The National Health and Hospital Reform Commission Report (NHHRC) and the Draft National Primary Health Care Strategy offer a vision for a better coordinated, multidisciplinary primary health care system in Australia. Equitable access, improved care and care coordination in primary health care are core components of this vision. Integral to this is a workforce that can work in an interprofessional way to provide quality and timely care to patients. There is good evidence supporting nurses undertaking an expanded role in the primary health care team.

Patients' decision-making strategies for managing postoperative pain

Despite technological advances, many postoperative patients continue to suffer unrelieved pain. The aim of this study was to identify the strategies used by postoperative patients to bring about pain management decisions. A single-group noncomparative study design was chosen using observations as the means of examining pain activities in 2 surgical units of a metropolitan teaching hospital in Melbourne, Australia. A total of 52 nurses and 312 patients participated in the study, and 316 pain activities were observed. The most common strategy used was patients acting as a passive recipient for pain relief (60%), whereas problem solving (23%) and active negotiation (17%) were less commonly used. Patients in this study were admitted for surgical treatment of a particular condition, and their subsequent pain was specifically related to this acute event. Therefore, the lack of familiarity of the situation and the severity of pain experienced may have encouraged passivity. Patients may have also felt uncertain about how to approach the pain decision, preferring to defer to nurses. Because increased pain levels can be associated with fear, patients could have been unwilling to speak with nurses to discuss their need for pain relief.

PERSPECTIVE

This paper shows that patient decision making for postoperative pain relief largely involves the use of passive requests, compared with problem solving and active negotiation. Effective communication must be supported between health professionals and patients if shared understandings about treatment options are to become a reality.

Nostalgic and nostophobic referencing and the authentication of nurses' use of complementary therapies

In recent years what can loosely be described as a sociology of complementary and alternative medicine (CAM) has begun to emerge. Although work has been conducted with lay therapists, orthodox practitioners, and consumers, overall, research in this area remains patchy and underdeveloped. Despite its role at the forefront of integration, the sociological study of the apparent affinity between nursing and CAM is virtually non-existent. This paper provides an exploratory analysis of how writers within the CAM nursing sub-world adopt a recourse to history (nostalgic and nostophobic referencing) as a strategy to authenticate the relationship between nursing and CAM and so facilitate continuing integration. A text analysis, of articles written on CAM in four nursing journals, was conducted. Eighty papers satisfied the inclusion criteria. Evidence is presented of the way in which writers attempt to authenticate integration of CAM through reference to its apparent interconnectedness with the historically grounded core of nursing values, and more specifically, with the key historical figure of the nurse Florence Nightingale (1820-1910). It is argued that these rhetorical strategies can be understood in the context of the need to engage in (primarily) intra-professional persuasion: to protect and develop the values of their nursing sub-world over alternatives. The findings are preliminary. Themes identified are illustrative of the potential offered by an analysis of nostalgic and nostophobic referencing in this context, and not a definitive account of it. Further research should examine individually produced texts from other sources, and documents produced by relevant professional bodies.

The 1990s and beyond: determining the need for community health and primary care nurses for rural populations

Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community-based nurses in rural practice settings during the next decade. A back-to-basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.

Restructuring hospital nursing: reversing the trend toward a professional work force

Registered nurses are currently threatened by a new managerial strategy to restructure work on hospital wards through the implementation of "Continuous Quality Improvement" and the "downsizing" of the professional work force. The strategy reintroduces nonprofessional and unlicensed nursing personnel in a manner that may displace large numbers of registered nurses (RNs) and affect patient care adversely. Ironically, not only is this change being implemented principally to reduce hospital costs rather than to improve quality, it reverses the cost-containment strategy implemented in the 1980s when hospitals displaced nonprofessional nursing workers and moved toward a professional work force. In this article, the author reviews the prior shift from "team nursing" with a stratified work force that included licensed practical nurses and nurses' aides to "primary nursing" and the trend toward all-RN staffing, and explains how this trend contributed to the present effort to reverse the process. The author then discusses current work redesign methods that have been adapted from traditional industrial applications to destroy work jurisdictions and further rationalize hospital production through the downsizing of the professional work force and the creation of cross-trained workers in a new team-based management approach. The article concludes by discussing nursing's response to corporate-imposed work restructuring and the significance of these changes.

In search of the 21st century nurse for Ghana

In this paper an attempt is made to identify the nurse who will best meet the health needs of developing countries in the 21st century. In the course of doing so, the current and emerging health needs of the Ghanaian society are reviewed as an example of a developing country.

Primary team nursing: the 90s model

The nursing shortage of the late 80s necessitated development of an alternative to primary nursing to meet patient needs. After assessing the strengths and limitations of functional nursing, team nursing and primary nursing, a team designed a new model which incorporated the best features of the three. After a pilot period, "primary team nursing" has proven effective and feedback from nurses has been positive.