The role of the inpatient mental health nurse in facilitating patient adherence to medication regimes

Non-adherence to antipsychotic medication is associated with relapse of psychiatric symptoms and readmission to inpatient mental health services. The important role of the mental health nurse in facilitating adherence has been acknowledged, however, there has been little exploration of how nurses themselves perceive this aspect of their role. A qualitative study was conducted to explore the perceptions of mental health nurses employed in inpatient settings regarding their role in facilitating medication adherence. Focus groups were conducted with 22 nurses from three inpatient settings in metropolitan Melbourne. The main themes to emerge from the data were: nurses' responsibilities in medication management; ways in which nurses are educated about antipsychotic medication; barriers to the provision of medication management, and barriers to effective patient adherence. Recommendations for more effective practice are discussed.

A community-based free nursing clinic's approach to management of health problems for the uninsured: the hepatitis C example

Poverty, as an outgrowth of lack of opportunity in employment, basic education, affordable housing, and racism, directly affects disparities in health status. Health care providers are challenged to identify and overcome systemic barriers to health services for the poorest patients. This article describes the population of patients and the model of care offered by the Wald Community Nursing Center, a free nurse-managed clinic in Baltimore, Maryland. Hepatitis C infection is used to illustrate the confounding factors of a costly, chronic health problem and the interventions that have been instituted to overcome them.

Cultural competence in nursing: foundation or fallacy?

Propelled by a national concern with social justice and health disparities, the notion of cultural competency is being incorporated into both government regulation and professional standards. Although most of the standards that are being developed nationally apply at the institutional level, it is in the clinical setting where the expectation of cultural competency is the most demanding. The recommendations for clinicians to become culturally competent generally fall into 2 major categories. The first focuses on the content and structure of the clinical encounter between provider and patient. The second category charges providers with becoming knowledgeable about the cultures of their constituent patients and learning their lifestyles,health beliefs, and behaviors. Although individuals may belong to the same cultural group, the assumption that they are, in fact, the same, is an ecological fallacy. The health care system has nested the accountability for cultural competence with the clinician who provides direct services to individuals, where the application of cultural information is likely to be least useful. We contend that cultural competence is really nursing competence.

Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists

BACKGROUND

Propofol is under evaluation as a sedative for endoscopic procedures.

METHODS

Eighty outpatients (ASA Class I or II) undergoing colonoscopy were randomized to receive either propofol or midazolam plus meperidine, administered by a nurse and supervised by an endoscopist. Endpoints were patient satisfaction, procedure and recovery times, neuropsychological function, and complications.

RESULTS

The mean dose of propofol administered was 218 mg; mean doses of midazolam and meperidine were, respectively, 4.7 mg and 89.7 mg. Mean time to sedation was faster in the propofol patients (2.1 min vs. 7.0 min; p < 0.0001), and depth of sedation was greater (p < 0.0001). On average, after the procedure, the propofol patients could stand at the bedside sooner (14.2 vs. 30.2 min), reached full recovery faster (14.4 vs. 33.0 min), and were discharged sooner (40.5 vs. 71.1 min) (all p < 0.0001). Patients who received propofol also expressed greater overall mean satisfaction on a 10-point visual analog scale (9.3 vs. 8.6; p < 0.05). At discharge, the propofol group had better scores on tests reflective of learning, memory, working memory span, and mental speed. Four patients in the midazolam/meperidine group developed minor complications (1 hypotension and bradycardia, 2 hypotension alone, and 1 tachycardia) and 1 patient in the propofol group had oxygen desaturation develop during an episode of epistaxis.

CONCLUSION

For outpatient colonoscopy, propofol administered by nurses and supervised by endoscopists has several advantages over midazolam plus meperidine and deserves additional investigation.

Implementation of the Essential Elements of Service Learning in Three Nursing Courses

The students' creativity, enthusiasm, energy, and excellent planning skills made a tremendously positive impression on the community agencies that participated in this project. The students applied principles of: Epidemiology, including collecting meaningful descriptive data. Community and family intervention. Community partnerships. Leadership. Cultural competence. As students visited the homes of families of different ethnic and socioeconomic status than themselves, perhaps the most poignant outcome was the opportunity for students to experience cultural sensitivity, relativity, and accommodation-Implementing the essential elements of service learning provided the foundation for a successful service learning experience. It took the time, energy, and commitment of all involved, but the end result was an educational experience that benefited students, faculty, and the community. Service learning presents an effective, unique, and valuable means for nursing students to master the objectives of community health, leadership and management, and pediatrics courses, and to prepare to function in a health care environment that demands partnering with the community to use resources more effectively to promote public well-being.

Special feature: an approach to cardiac care in rural settings

Rural people with cardiovascular disease-and the nurses caring for them-face unique health care challenges. Obstacles facing patients living in small rural communities include lack of critical care specialists, inadequate technological support, and inconsistent or variable levels of 24-hour patient care services requiring patients to travel to distant tertiary centers for advanced cardiac care. Rural critical care nurses face reduced access to continuing education and inservice presentations, professional isolation, and lack of anonymity. This article introduces "Mr Smith," a rancher with cardiovascular disease living in a rural Western state. In so doing, it reviews the issues and challenges faced by rural patients and nurses. In addition, the article describes a continuing education course developed to enhance collaboration between nurses working in rural settings and a tertiary medical center.

CORRESPONDENCE

In an increasing culture of ‘blame and claim’, the need to provide nurses with clear direction appears to be more important than ever. The primary function of such direction must be to promote a high quality of service. Policies and procedures (including standards and guidelines) help to formalize and clarify expected levels of practice. Is it possible that these measures could actually cause problems?

[Characterization of nursing activities in public health developed in the Northern Regional Health Unit of the Federal District]

The purpose of this study is to identify and analyze the activities developed by the nursing team at the Northern Regional Health Unit of the Federal District. A questionnaire, which described a variety of daily nursing activities, was administered to 29 nurses, 91 nurse assistants and 42 health care agents. Focus group sessions for each of the professional categories were also conducted. Results showed that all members of the nursing team concentrate their effort in organizing, controlling and attending spontaneous demands as well as providing support to doctors. As a consequence, these professionals prioritize individual attendance to detriment of collective practice.

[Rehabilitation day-hospital of the heart failure unit: structure and functions]

Chronic heart failure has emerged as an important public health problem. The consequent increase in the sanitary services has induced an increased consumption of financial resources and conditioned the need to investigate new sanitary models that guarantee, by integrating the inpatient and outpatient health care delivery, the continuity of health assistance. Cardiac rehabilitation in the context of a day-hospital Heart Failure Unit allows for the organization of a rehabilitation program including various health approaches aimed at guaranteeing a multidisciplinary program and the relief continuity. This article describes the experience developed in the Heart Failure Unit of Montescano.