Access to harm reduction services in Atlantic Canada: implications for non-urban residents who inject drugs.

Awareness of drug use in rural communities and small towns has been growing, but we know relatively little about the challenges injection drug users (IDUs) living in such places face in accessing harm reduction services. Semi-structured interviews were conducted with 115 IDUs in urban and non-urban areas of Atlantic Canada. In many instances, geographic distance to a needle exchange program (NEP) meant that individuals living outside of urban areas and who were not provided services through an NEP's outreach program were at a disadvantage in terms of an array of supports offered through many NEPs. These include access to free clean injecting equipment, and such ancillary services as clothing, food, referrals, information and social support. The integration of the services and approaches provided by NEPs into mainstream health services in non-urban places is one possible model for improving such access.

Supporting clients on methadone maintenance treatment: a systematic review of nurse's role.

This paper discusses findings from a systematic review of literature pertaining to methadone maintenance in relation to the role of the nurse working in a general practice setting. Five electronic databases were searched for period of 2000-2008: Medline, CINAHL, Embase, PsycINFO and Cochrane Database of Systematic Reviews. Included studies were peer-reviewed literature articles that: (1) were dated no earlier than the year 2000; (2) represented a primary study (qualitative and quantitative), systematic review or meta-analysis; (3) focused on methadone maintenance for treatment of opiate dependence, not for pain; and (4) were published in English. In this review, three broad themes emerged as being significant to the role of the nurse in relation to methadone maintenance treatment (MMT) programming. These themes included: (1) identifying the client's personal characteristics; (2) having knowledge about methadone; and (3) supporting clients in MMT programmes. In conclusion, it is important to address the needs of health professionals working with clients on MMT, in order for them to provide the necessary care for this patient population. In particular, nurses need to gain knowledge about MMT to assist them in carrying out their nursing role competently when caring for this vulnerable population.

Nurses' voice: influencing the restructuring of the New Brunswick healthcare system.

Although nurses make up the largest group of professionals working in th healthcare field, they are often left out of the decisions that shape the restructuring of healthcare in Canada. A feminist philosophy guided this qualitative study, conducted in New Brunswick, to gain an in-depth knowledge of the impact of restructuring on nurses working in all types of healthcare facilities across the province. Sixty-five nurses were interviewed, and a number of themes, including "having a voice," emerged from the data. While many of the nurses interviewed reported that they were not invited to participate in decisions related to healthcare restructuring, others noted that when they did have an opportunity to participate, they were frequently not heard. However, a number of nurses also reported that they believed they had some influence and could continue to make a positive difference when they were asked to be involved at the outset of a change process.

Challenges to HIV service provision: the commonalities for nurses and social workers.

Interdisciplinary collaboration can be enhanced through an understanding of the challenges and needs associated with service provision. This study explores the experiences of 192 service providers, with additional comparisons of nurses and social workers. Service providers reported fear of contracting HIV, feeling helpless, problems getting up-to-date information, grief and inadequate referral resources. Except for many more nurses expressing worry about contracting HIV, nurses and social workers shared many of the same problems. In addition, both groups were concerned with the comprehensive health needs of people living with HIV/AIDS. Moreover, they demonstrated shared professional values such as the importance of self-awareness and professional knowledge, positive and non-judgemental attitudes, and non-discriminatory treatment of client groups. This commonality makes nurses and social workers natural allies in responding to the many challenges associated with HIV service provision. Study findings support collaboration in the areas of service delivery, policy development, advocacy and professional development.

Should Canadian physicians have a mandatory duty to report woman abuse?

As in other countries, woman abuse is a leading public health issue in Canada. In recognition of its seriousness and the need to interrupt the cycle of violence, several jurisdictions outside of Canada have enacted mandatory reporting laws for woman abuse that require health care workers to report cases. This article reviews the major debates surrounding mandatory reporting of woman abuse with an emphasis on where knowledge is incomplete but would be of benefit when weighing the pros and cons of such laws. We conclude with comments and recommendations with respect to Canada and its health legislation.

The unexpected challenges of clinical research, or what they do not tell you in school.

Nurse clinicians are being asked more and more frequently to be involved in nursing research. After all, who better to conduct clinical research than those people who spend much of their working day dealing with direct patient care issues. Although more nurses are beginning to understand the value of research in their clinical practice and more articles discussing clinically based research are becoming available, little information is available concerning the process of doing research in a clinical setting. Educational institutions teach research methodology but do little to prepare nurses for the reality of conducting research as part of the daily work load. The following is a discussion of a number of realities encountered by a nursing research team conducting a qualitative study dealing with an outpatient population. Included are a number of suggestions that the research team believes will help other clinical researchers better prepare for conducting research in their clinical setting.

Human immunodeficiency virus: early steps in management.

Although articles concerning AIDS care and its complexities are increasing in number, the nursing literature still does not adequately address the management of asymptomatic HIV disease. This paper presents the management of an asymptomatic client using a case study format. Management and treatment options are discussed as they relate to the problems arising from the assessment of the client on the initial visit to the outpatient clinic. Suggestions for follow-up care also are provided.

Bioethics for clinicians: 4. Voluntariness.

In the context of consent, "voluntariness" refers to a patient's right to make health care choices free of any undue influence. However, a patient's freedom to make choices can be compromised by internal factors such as pain and by external factors such as force, coercion and manipulation. In exceptional circumstances--for example, involuntary admission to hospital--patients may be denied their freedom of choice; in such circumstances the least restrictive means possible of managing the patient should always be preferred. Clinicians can minimize the impact of controlling factors on patients' decisions by promoting awareness of available choices, inviting questions and ensuring that decisions are based on an adequate, unbiased disclosure of the relevant information.

Drug interactions: how they affect people living with HIV/AIDS.

Given the diversity and increasing life span of HIV-positive people, medical management of the associated complications is becoming more complex. This complexity is compounded by the growing number of drugs available to treat people with HIV/AIDS. Information regarding the adverse reactions and/or interactions of these drugs in combination is limited. The purpose of this paper is to review what is currently known about synergistic, antagonistic, and potentially toxic interactions. Included is a table containing side effects and interactions among drugs commonly used to treat clients with HIV/AIDS.

Nurses' attitudes towards primary health care: development of an instrument.

In many countries nurses are the largest group of professionals providing health care. If health care is to be provided following a primary health care philosophy, nurses must be among the leaders in making the change in the way health care is delivered. To be effective nurses must develop positive attitudes towards primary health care and incorporate its principles into practice. The purpose of this paper is to present the development and testing of an instrument to measure nurses' attitudes towards primary health care. The instrument has 35 items divided into five domains based on the principles of primary health care. Two scales, one for attitude and one for importance of concept of professional role, are scored on six-point Likert scales. Initial psychometric evaluation resulted in alpha coefficients of 0.07 to 0.58 for the domains; 0.70 for the attitude scale and 0.93 for the importance scale. Details are provided on the measures taken to establish validity of the instrument. Plans for future testing are included.

The science of unitary human beings: an integrative review.

This article is an integrative review of the research which has been carried out based on Martha Rogers' conceptual framework, the science of unitary, irreducible human beings. Results of the review supported the model and theories which have been derived from the framework. However, because of methodological difficulties in measuring the concepts and because of the instruments being used, this support is not statistically significant. More research is needed using methods and instruments which better fit the concepts that are basic to the Rogerian principles of homeodynamics. Also, theories being used as the basis of the study need to be more definitively stated in future research.