Sunday, February 22, 2009

primary health care • workforce issues • nursing
kemp l.a., harris e. & comino e.j. (2005) Journal of Advanced Nursing49(3), 307–314
Changes in community nursing in Australia: 1995–2000


Aim. This paper reports a study whose aim was to examine the congruence between community nurses' perceptions and the realities of changes in their work.

Background. There have been increasing challenges to the delivery of community nursing services in Australia over the past decade. Acute care sector changes and the recent focus on health promotion, prevention, early identification and intervention adds pressure and creates tensions for community nurses, which are well-documented in the literature. There is, however, a lack of empirical evidence of actual changes in community nurses' workloads and the focus of their work. Validation of nurses' perceptions would enable them to have a stronger voice in the future development of community health care.

Methods. Four sources of data were used: community health client administrative data 1995–2000; occasions of service data 1995–2000; staffing numbers 1998–2001; and interviews with 14 community nurses in late 2001.

Results. Documentary evidence shows that there has been a large increase in the number of adult clients, and all clients are increasingly receiving a shorter, more intensive, clinically focussed service and are then discharged from care, rather than receiving a lower intensity service over a longer period of time. Staffing numbers have not increased to match this higher acuity and intensity. These changes were echoed by the nurses, who reported that expanded acute care roles were impacting on their workload and resulting in a loss of holistic primary health care focus. There has been a lack of leadership and proactive planning by community nurses in response to these changes.

Conclusion. Community health care in Australia is shifting from primary to short-term clinical care. Greater opportunities for community nurses to engage proactively in defining and promoting their role in the health care system are needed in order to ensure an appropriate balance of acute clinical and holistic primary health care in the community.

Submitted for publication 14 November 2003 Accepted for publication 19 April 2004

taken from:

M. JONES 1 sen(m) rmn msc, J. BENNETT 2 bsc(hons) phd rn rm, R. GRAY 3 rn bsc(hons) msc phd, P. ARYA 4 & B. LUCAS 5 ma mbbs mrc psych
1 Nurse Consultant, Hillingdon Primary Care Trust and Buckinghamshire and Chilterns University, Riverside Centre, Uxbridge, 2 Workforce Development Manager, The Sainsbury Centre For Mental Health, London, 3 Senior Lecturer, Institute of Psychiatry, De Crespigny Park, Camberwell, London, 4 Specialist Registrar in Psychiatry, Hillingdon Primary Care Trust, Riverside Centre, Uxbridge, and 5 Consultant Psychiatrist, Hillingdon Primary Care Trust, Ruislip Manor, UK
Correspondence to M. Jones
Hillingdon Primary Care Trust and Buckinghamshire and Chilterns University
Riverside Centre
Copyright 2006 Blackwell Publishing Ltd
akathisia • nurse consultant • nurse prescribing

JONES M., BENNETT J., GRAY R., ARYA P. & LUCAS B. (2006) Journal of Psychiatric and Mental Health Nursing13, 26–32
Pharmacological management of akathisia in combination with psychological interventions by a mental health nurse consultant


The article describes the management of akathisia by a mental health nurse (MHN) prescriber, working in partnership with the patient. A single-case design was used to evaluate this. It highlights three features: first, MHN can safely prescribe psychiatric medication in combination with concordance therapy. Second, the value base underpinning prescribing practice is partnership, honesty and choice for the patient. Finally, the pharmacological mechanism of antipsychotic medication, which contributes towards akathisia, requires further analysis.

Accepted for publication: 22 June 2005

Niels Buus
The University of Southern Denmark and The Centre for Innovation in Nursing Education in the County of Aarhus, Aarhus N, Denmark
Correspondence: Niels Buus, The University of Southern Denmark and The Centre for Innovation in Nursing Education in the County of Aarhus, Olof Palmes Alle 17, 1, 8200 Aarhus N, Denmark.
E-mail: <>
Copyright © 2005 Blackwell Publishing Ltd
discourse analysis • edit and review • methodological research • serial publications • social sciences

BUUS N. Nursing Inquiry 2005; 12: 27–33

Nursing scholars appropriating new methods: the use of discourse analysis in scholarly nursing journals 1996–2003


Nursing scholars appropriate the analysis of discourse. 'Discourse analysis' covers a wide spectrum of approaches to analysing meaning and language and there is no widely accepted definition of either a concept or an analysis of discourse. A sample of the discourse analyses indexed in the CINAHL database was analysed in order to identify what notions of discourse and discourse analysis are preferred by nursing scholars. The results showed that nursing scholars prefer approaches to discourse that resemble mainstream qualitative research avoiding social life and interaction. Explanations for these findings are briefly outlined.

Accepted for publication 20 April 2004

taken from:

Barry W. Rovner a1, Pearl S. German a2, Jeremy Broadhead a3, Richard K. Morriss a4, Larry J. Brant a5, Jane Blaustein a1 and Marshal F. Folstein a1
a1 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
a2 Department of Health Policy and Management, John Hopkins University School of Public Health and Hygiene, Baltimore, Maryland
a3 Maudsley Hospital, London, England
a4 University of Leeds, Leeds, England
a5 Gerontology Research Center, Francis Scott Key Medical Center

The prevalence of psychiatric disorders among new admissions to nursing homes is unknown. Such data are needed to estimate the psychiatric needs of this population. We report the prevalence of specific psychiatric disorders in 454 consecutive new nursing home admissions who were evaluated by psychiatrists and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised. Eighty percent had a psychiatric disorder. The commonest were dementia syndromes (67.4%) and affective disorders (10%). Also, 40% of demented patients had additional psychiatric syndromes such as delusions or depression, and these patients constituted a distinct subgroup that predicted frequent use of restraints and neuroleptics, and the greatest consumption of nursing time. These data demonstrate that the majority of nursing home residents have psychiatric disorders on admission, and that their management is often quite restrictive. Research is now needed to determine the best methods of treatment for nursing home patients with mental disorders.


1 First Place Winner of the 1989 IPA Research Awards (sponsored by Bayer AG)

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Thursday, February 19, 2009

Chronic Disease

Sexuality: A Critical Component of Quality of Life in Chronic Disease

Margaret C. Wilmoth PhD, MSS, RN

aSchool of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA

Available online 12 November 2007.

Nursing is a science and an art. The science aspect of including sexuality in nursing practice requires knowledge about “normal” sexual functioning, an understanding of the pathophysiology and pharmacotherapies that may cause changes in sexuality, and knowledge about assessing and treating sexual difficulties. The art of including sexuality into nursing practice comes from awareness of one's beliefs and values, and comfort in talking about sexuality. The nurse will find that most patients will be pleased that he/she has taken the time to broach this important concern with them. This article provides an overview of the relationship among sexuality, chronic disease, and quality of life. Two frameworks are suggested that are useful in operationalizing sexuality in nursing practice.

taken from:

Clinical Nurse Specialist:Volume 19(5)September/October 2005pp 255-259

Nursing Attitudes and Beliefs Toward Human Sexuality: Collaborative Research Promoting Evidence-Based Practice



From the Karmanos Cancer Hospital, Detroit Medical Center, Detroit, MI (Ms Reynolds); and School of Nursing, Oakland University, Rochester, MI and College of Nursing, Wayne State University, Detroit, MI (Dr Magnan).

Corresponding author: Morris A. Magnan, PhD, RN (e-mail:


Purpose and Objectives: The purpose of this study was to use a collaborative process between Advanced Practice Nurses and a nurse researcher to identify barriers to incorporating sexuality assessment and counseling into nursing practice.

Design/Approach: This article provides an historical account of the collaborative group processes leading to the development and testing of the Sexuality Attitudes and Beliefs Survey (SABS).

Background/Rationale: Nurses often are called upon to talk to patients about their sexuality and sexual concerns. Many nurses believe that sexuality assessment, evaluation, and counseling is a part of their professional role, however, nurses do not necessarily integrate this awareness into their patient care. Discomfort, embarrassment, or strongly held attitudes about the nurse's role in discussing sexuality with patients can act as barriers to responding to these patient concerns.

Setting: A Midwestern urban healthcare facility, affiliated with a university served as the setting.

Sample: Thirty-five nurses working outpatient and inpatient settings in oncology and HIV/AIDS.

Method: Instrument development and voluntary survey.

Outcomes: The collaborative initiative developed and piloted an instrument to measure nurses' attitudes and beliefs about human sexuality. Results of the pilot study suggest that what nurses believe patients expect from them, time availability, and confidence in one's ability to address issues related to human sexuality present significant barriers to incorporating sexuality assessment and counseling into nursing practice.

Conclusion: Successful collaboration among clinicians and researchers required administrative support as well as a individual commitment and is a model that can be adapted to other settings and for other projects.

Implications for Practice: This study highlights the benefits of collaboration between clinicians and researchers to support evidenced based practice. The findings from this study will be used to develop strategies for removing barriers to sexuality assessment by nurses.

© 2005 Lippincott Williams & Wilkins, Inc.

taken from:


Spirituality and family nursing: spiritual assessment and interventions for families
Doctoral Student in Public Health: Preventive Care, Loma Linda, California, USA
Correspondence to Ruth A. Tanyi,
Family Nurse Practitioner,
Lifestyle and Wellness Services,
PO Box 1185,
Loma Linda,
CA 92354,
Copyright 2006 The Author. Journal compilation 2006 Blackwell Publishing Ltd
family health • nursing • spiritual assessment • spirituality
tanyi r.a. (2006) Journal of Advanced Nursing53(3), 287–294
Spirituality and family nursing: spiritual assessment and interventions for families


Aim. The aim of this paper is to propose a guideline for spiritual assessment and interventions explicitly for families, while considering each family member's unique spirituality.

Background. Spirituality's positive effect is pervasive in health care and in the lives of many families; therefore, there is a need to integrate spiritual assessment and interventions in total family care.

Discussion. The majority of published guidelines on spiritual assessment and interventions are designed predominantly for individuals. They fail to differentiate between individual and family spirituality or offer only brief discussions on family spirituality. Such guidelines are potentially problematic. They may lead nurses to focus only on individual spirituality and neglect to discern family unit spirituality or recognize the presence of conflicts in spiritual perspectives within the family. While other disciplines such as social work and family therapy have several guidelines/strategies to assess family spirituality, there is a dearth of such guidelines in the family health nursing and spirituality literature, in spite of the rhetoric about incorporating spirituality as part of total family assessment. As a beginning solution, guidelines are proposed for spiritual assessment and interventions for the family as a unit, and the category of spiritual interpretation to represent diagnosis is introduced. Case studies exemplify how to integrate the guideline, and illustrate elements that may favour specific interpretations which would guide the interventions.

Conclusion. As nurses continually strive to assist families with their health needs, they must also attend to their spiritual needs, as one cannot truly assess a family without assessing its spirituality.

Accepted for publication 5 April 2005

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