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Commentary: causal processes leading to antisocial behavior.

Conceptual, and empirical, questions are raised regarding the notion that physical aggression is the main individual risk factor for antisocial behavior, that language impairment also constitutes a risk factor, the meaning of the male preponderance for antisocial behavior, the findings on environmentally mediated risk; the role of biosocial interplay; social context effects; the construct of antisocial behavior, developmental trends; processing of experiences; and transactional effects. The main blocks to using research to develop policy are the lack of evidence on (a) the mediators of the causal processes, (b) what is needed to bring about change, (c) ways to ensure that individuals who need interventions actually receive them, and (d) differences in levels of antisocial behavior.

Adolescent↗

Psychology in the public sector: addressing the psychological effects of combat in the U.S. Navy.

The response of military psychology in times of war or other great public crises may presage the success of the profession in less perilous times. The ability of public-sector psychologists to provide assistance and improve the common welfare during conflict or turmoil is generally followed by an increased demand for psychological services. This likely reflects the success of the psychological response during those crises, and it underscores the fact that psychological consequences of war or disaster require both immediate clinical attention and long-term policy development. The U.S. Navy serves as a model for public-sector psychological service provision. A brief history of Navy psychology is provided, followed by an examination of how Navy psychologists are responding to the issues raised by the current conflict in the Middle East and the problems associated with stigma in the treatment of posttraumatic stress disorder.

Awards and Prizes↗

Psychology impaired?

This article comments on M.J. Layman and J.R. McNamara's (1997) article about remediation for ethics violations. The author addresses the practice of regarding ethical violation, and its subset, boundary violation, and its subset, sexual misconduct, as synonymous. When professional impairment (disability) is seen as equivalent to sexual misconduct, the resulting generalized confusion impedes much needed progress in critical areas. The profession awaits structured assistance from the American Psychological Association to clarify and provide leadership in policy development.

Ethics, Professional↗

Ethnic identity and mentoring among Latinas in professional roles.

This study examined ethnic identity and mentoring (a known strategy to promote career success and advancement) in a sample of 103 Latina women with professional roles in the areas of business, academia, policy, and politics. Other variables examined included traditional gender roles and perceptions of professional success. Findings indicated that the women's ethnic identity was consistent with a bicultural profile; some received mentoring and, if given a choice, would prefer to be mentored by someone of similar ethnicity. This finding is critical and can allow researchers, service providers, and policy developers to apply culturally responsive strategies in communities and in organizations. Other hypotheses were not supported. A discussion of the findings, implications, and suggestions for future research are presented.

Acculturation↗

Global notes: counting the world's poor--how do we define poverty?

Health professionals are in constant interaction with parents and infants who are victims of poverty and poor socioeconomic status. But an important question remains: do we know how to define poverty? Defining poverty accurately is important as the definition is the basis of policy development. The definition of poverty has changed during the last quarter century. In addition to economic considerations, it is broadened to include other dimensions of life such as literacy, health and longevity. This article attempts to provide national and international definitions of poverty, the magnitude and effects of poverty.

Food↗

An action research project in a night shelter for rough sleepers.

From October 1999 to June 2000, an action research project was undertaken in a homeless night shelter called Jimmy's. This project was grounded in user-consultation and sought the involvement of staff and management to institute tangible improvements in service delivery using the Power Audit. A brief overview of Jimmy's is given, then this research is placed in local and national context by describing policy development in homelessness. A brief description is given of the research methodology and a short description of the Power Audit. Following this, the lives and experiences of the guests (Jimmy's residents) are conveyed using ethnography. This tells of the development of relationships with guests, staff and management without which the project could not have succeeded. Finally, an overview is provided of the interview content and the practical changes made.

Female↗

Communicating about pupils in mainstream school with special health needs: the NHS perspective.

AIM: To add to previous research carried out with young people, parents and teachers, by investigating health staff's perspectives on the difficulties, and possibilities for, achieving good communication with school staff with regard to children in mainstream school with a chronic illness or physical disability. RESEARCH DESIGN AND METHODS: A qualitative research study was carried out in one NHS Trust. Twenty semi-structured interviews were carried out with a purposive sample of health staff to cover the spectrum of professionals who have responsibility for meeting the needs of children with a chronic illness or physical disability in mainstream schools (paediatricians, school doctors, school nurses, specialist nurses, health visitors, GPs, speech and language therapists, paediatric occupational therapists, paediatric physiotherapists, clinical psychologists and psychiatrists). RESULTS: The extent to which health professionals communicated with school staff, and the way in which they went about it, varied widely. Communication was facilitated by joint meetings, shared documentation, and local policy development. Sources of difficulty in communication between health and education staff were: the parent as a conduit of information; the practical difficulties of arranging meetings; and lack of knowledge about other professionals' roles. The ethos of the school with regard to health matters, and the flow of information within health services, also had an impact on the communication process. Participants' recommendations focused on two key issues: clarification of the roles of health and education staff with regard to this group of pupils; and how information should flow from health to school staff. DISCUSSION: Many of the findings parallel the previous research with teachers, indicating agreement between professionals from different agencies about aspects of the communication process which are problematic and require attention. The findings suggest that improving communication requires both joint work between health and education staff, and improvements to practice within each agency.

Child↗

Early steps in implementing the new community care: the role of social work practice.

This paper presents findings from a research project in which needs-led assessments and care management were examined during the early years of implementation of the 1990 NHS and Community Care Act. The findings are analysed in relation to a model of social work processes, i.e. phases of assessment, intervention and evaluation. A purposive sample of 24 cases was used, spanning elderly, physical disability, learning disability and community mental health teams in two divisions of a 'county' social services department. Practitioners, providers, users and carers were interviewed. The research illustrates the enduring importance of social work values, knowledge and skills in situations of rapid organizational change and policy development.

Journal Article↗

A concept analysis of autonomy.

Clinical and policy developments in health care have recently created demand for a professional response in terms of the development of advanced roles for nurses, notably 'nurse practitioner' roles. Such roles demand the exercise of autonomy, a term which eludes succinct definition despite the fact that the preparation of practitioners for these roles relies on a clear understanding of its nature. Utilizing an approach described by Wilson, this paper undertakes a concept analysis of autonomy, each step illustrated with examples taken from clinical practice, with the ultimate aim of offering an operational definition of autonomy.

Freedom↗

Factors influencing nursing leadership effectiveness in Hong Kong.

BACKGROUND: Nursing education in Hong Kong has undergone major reform in recent years, similar to that in Australia and the United Kingdom (UK), involving the introduction of degree level preparation. Although there were some changes in the nursing education system, the reform was considered slow. While a combination of complex factors contributed to the reform, the effects of nurse leaders was instrumental in influencing policy development. AIM: This study investigated the factors that influenced the effectiveness of nursing leadership in the reform of nursing education in Hong Kong. DESIGN: A case study approach was used. Methods of data collection included document search and semi-structured interviews (n = 27). The time frame of the study extended from the first proposal of nursing degree programme in the year 1985 to 2000 by which 200 nursing degree places were secured. RESULTS: Situational variables that impacted on leadership effectiveness were categorized as barriers and facilitators. Barriers were related to nursing professional socialization in a health care system that was dominated by the medical profession. Facilitators were related to socio-politic-economical changes in the wider environment. CONCLUSION: This study suggests the importance of education, positive socialization and unity in promoting nursing leadership development.

Education, Nursing↗

Practice nurses and clinical guidelines in a changing primary care context: an empirical study.

BACKGROUND: Practice Nurses form an increasingly large proportion of the English National Health Service primary care workforce and the delegation to them of clinical work from General Practitioners has attracted some academic attention. Central to this process are clinical guidelines, which provide the interface between the movement towards 'evidence-based practice' and a range of government-driven policy developments in primary care. AIMS: To identify the attitudes of practice nurses to clinical guidelines; to investigate the impact of guidelines on nurse/physician relationships; and to describe the impact of the changing primary care context on nurses. METHODS: We interviewed a sample of 29 Practice Nurses three times during a 16-month period to clarify their attitudes towards guidelines, their use of guidelines in practice and their assessment of guidelines' importance. We gathered further data on organizational culture and perceptions of national reforms of primary care structures. RESULTS: We found that practice nurses are generally supportive of clinical guidelines. Moreover, nurses' role and influence within primary care is in a process of transition to one in which they may undertake responsibility for influencing General Practitioners' clinical behaviour so as to adhere to guidelines. Practice nurses themselves recognize and welcome this, though with some reservations. CONCLUSIONS: Our findings support the proposal that explicit codification of the scientific basis of the work of lower paid groups may enhance their relative professional status.

Attitude of Health Personnel↗

Mental health training needs of primary health care nurses.

The primary health care team (PHCT) has a critical role to play in the care of people with mental health problems. However, little attention has been paid to the mental health training and preparation required by primary health care nurses. This paper reports on a training needs assessment undertaken in one London health authority area. The findings indicate that primary health care nurses are undertaking a wide range and increasing volume of mental health work with little preparation and training. Specific training needs include time and space to identify training gaps; basic training in mental health, safe working practices and management of role boundaries; and multidisciplinary training. In addition, NHS trusts, primary care groups and health authorities need to clarify which aspects of nurses' mental health workloads are appropriate to their role and develop policies, procedures and training to support them in undertaking that role.

Attitude of Health Personnel↗

Consumer issues in navigating health care services for type I diabetes.

Despite increasing interest in consumer awareness and participation in health care service delivery, there has been little exploration of consumer views in relation to services for people with type I diabetes. The purpose of this qualitative exploratory study was to identify strategies people with type I diabetes used to access health services and the barriers they perceived in accessing the services they needed. Data gathered in semi-structured interviews revealed that consumers experience significant barriers when navigating the health care system. Three dominant themes were identified. They relate to access to specialist medical skill, to the transition from teenager to young adult and to pre-pregnancy and obstetric care. Directions for change in service delivery and policy development are discussed.

Adaptation, Psychological↗

Clinical governance and the learning organization.

AIM: This paper compares and contrasts clinical governance and organizational learning. BACKGROUND: Clinical governance represents one of the most significant policy developments in recent years. It places on all health care delivery organizations a statutory duty to develop the systems, standards and processes necessary to improve health care quality and manage risk. At the same time, many health care organizations are seeking new ways in which learning can be retained and deployed more widely within the organization (organizational learning). KEY ISSUES: Both approaches emphasize cultural changes as essential underpinnings to quality improvement. However, the two approaches also differ fundamentally in their logic of action. Clinical governance is essentially 'top down', being built around formal standards, established procedures, and regular monitoring and reporting. In contrast, organizational learning emphasizes 'bottom up' changes in values, beliefs and motivations in such a way that learning and change are prioritized. The challenge for managers and practitioners lies in seeking a creative tension between these two contrasting styles of organizational change.

Attitude of Health Personnel↗

Non-incarcerated psychopaths: why we need to know more about the psychopaths who live amongst us.

On 1 November 2000, Robert Stewart, aged 20, was jailed for life for bludgeoning to death his Asian cellmate, Zahid Mubarek, aged 19 years because 'he felt like it'. During the court hearing the term 'psychopathic personality' was used in relation to Stewart and, following this and other similar cases, the average man or woman could be forgiven for believing that psychopathy is inextricably linked with dangerousness and criminality. In the light of the Government consultation paper entitled Managing Dangerous People with Personality Disorder. Proposals for Policy Development and the Government White Paper Reforming the Mental Health Act -- Part II: High-risk patients, this article proposes that whilst studies conducted with incarcerated psychopaths will continue to increase our knowledge and understanding of criminality, non-incarcerated psychopaths have an arguably equal potential to illuminate our understanding of the emotional difficulties, such as lack of empathy and lack of conscience, which underlie psychopathy and which lead to offending behaviour. Although a range of obstacles have hindered progress in this field of study, this paper proposes that developing an understanding of the nature of the emotional difficulties of the psychopath, unconfounded by criminality, has the potential to make a valuable contribution to the field of child psychiatry in ways which have implications for mental health nurses and society as a whole. It theorizes that if the psychological constructs which underlie psychopathy were better understood, children who display those emotional difficulties could be more accurately identified and strategies be generated which carry the ultimate aim of minimizing the risk of those children developing the offending behaviour associated with psychopathy.

Adult↗

The psychiatric consultation-liaison nurse: thriving in a general hospital setting.

One outcome of mainstreaming of psychiatric services into the general health system is that nurses working in general hospitals now have increased contact with patients experiencing mental health problems. The literature suggests that general and comprehensive nurses do not believe they have the skills, confidence and knowledge to care adequately for patients in their care who have a mental health problems. The Psychiatric Consultation-Liaison Nurse (PCLN) can assist and educate general nurses in the care of patients with mental health problems who are receiving care in a medical/surgical setting. This study is based upon the findings of a Nurse Practitioner Pilot Study funded by the Department of Human Services (Victoria). In this paper the authors will present a brief overview of the role and model of practice of the PCLN, the means of referral, a profile of consultations and an overview of educational and policy development activity. The findings of the evaluation based on a combination of a Health Professional Satisfaction Survey and Focus Group Interviews will also be presented. The positive contribution of the PCLN to the confidence of nurses and how this might impact on patient outcomes will be highlighted. The value placed on the PCLN role by general hospital staff is evidence of psychiatric nursing not just surviving but thriving.

Attitude of Health Personnel↗

Parents, infants and health care: utilization of health services in the first 12 months of life.

OBJECTIVE: To describe patterns of health-service use in the first 12 months of life. METHODS: In this prospective cohort study, 173 first-born infants and their families living in two middle socio-economic urban areas of Melbourne were enrolled consecutively when presenting for their initial maternal and child health nurse (MCHN) visit (at approximately 4 weeks of age). Families kept a daily "health diary" for the entire 12-month period, recording use of all health services for their infant, and reasons for the contact. RESULTS: There was an 87% completion rate of diaries. The mean number of visits to any health service, including medical, hospitals, MCHN services, pharmacists, allied health services and naturopaths, was 35.7 (95% CI 34.7-36.6) during the 12 months. Of these, 31% (mean 10.9 visits) were visits to a general practitioner (GP) and 41.5% (mean 14.3 visits) were visits to the MCHN. Infants' visits to the MCHN were far more frequent in the first 6 months of life compared with the second 6 months (10.3 vs 3.6, P < 0.001). Rates of GP use were constant over the same periods (5.3 vs 5.7, P = 0.8). CONCLUSIONS: In a universal health-care system, this high rate of health-service use equates to approximately one visit to a health service every 2 weeks in the first year of life. The majority of these visits appeared unrelated to illness. This previously undocumented data has implications for future integrated service delivery, health-professional training and policy development for this age group.

Adult↗

Decision analysis as a tool to support an analytical pattern-of-reasoning.

Decision analysis is offered as a tool to aid nurses' decision-making in complex and troublesome situations where there are mutually exclusive actions and time is available for deliberation. Decision analysis can be formal or informal. Formal decision analysis provides a structure for representing the decision situation and a mathematical procedure for prescribing the alternative action that is most consistent with what is known and what one values. Informal decision analysis uses the concepts and sometimes the structure of decision analysis, but usually does not include the mathematical calculations. In the present paper, the authors illustrate how formal and informal decision analysis might be used by nurses to: (i) enhance their own decision-making; (ii) assist patients or family caregivers with decision-making and; (iii) promote informed health care policy development. Finally, the advantages and limitations of decision analysis are discussed.

Caregivers↗