Salford alcohol assertive outreach team: a new model for reducing alcohol-related admissions.

OBJECTIVE: Alcohol-related admissions are increasing. A significant number of these admissions are attributable to a small number of complex patients with other comorbidities who do not engage well with mainstream services. Assertive outreach teams have been used in the field of psychiatry to engage patients who are poorly compliant. This study examines whether an alcohol assertive outreach team (AAOT) can engage with this group and reduce hospital admissions. DESIGN: The AAOT is a multidisciplinary team with medical, psychiatric, substance misuse, psychology, nursing and social work specialists. The team worked with patients with the highest number of alcohol-related admissions and case managed in a community setting for 6 months. The admission and emergency department attendances of the cohort were compared for the 3-month period before and after the intervention. Christo inventory for substance misuse services (CISS) scores were determined pre and post the intervention period. RESULTS: 54 patients were case managed. The total number of admissions in 3 months fell from 151 prior to the intervention period to 50 following the intervention. Emergency department attendances also fell from 360 in 3 months to 146 following the intervention period. CISS scores fell from 11 preintervention to eight postintervention. CONCLUSIONS: An AAOT model appears to reduce hospital admissions and emergency department attendances in a complex group of patients that display high alcohol-related admissions.

Utilising the Hand Model to promote a culturally safe environment for international nursing students.

The rising number of international students studying outside their own country poses challenges for nursing education. Numbers are predicted to grow and economic factors are placing increasing pressure on tertiary institutions to accept these students. In adapting to a foreign learning environment international students must not only adapt to the academic culture but also to the social cultural context. The most significant acculturation issues for students are English as a second language, differences in education pedagogy and social integration and connectedness. Students studying in New Zealand need to work with Maori, the indigenous people, and assimilate and practice the unique aspects of cultural safety, which has evolved in nursing as part of the response to the principles underpinning the Treaty of Waitangi. The Hand Model offers the potential to support international nursing students in a culturally safe manner across all aspects of acculturation including those aspects of cultural safety unique to New Zealand. The model was originally developed by Lou Jurlina, a nursing teacher, to assist her to teach cultural safety and support her students in practising cultural safety in nursing. The thumb, represents 'awareness', with the other four digits signifying 'connection', 'communication', 'negotiation' and 'advocacy' respectively. Each digit is connected to the palm where the ultimate evaluation of The Hand Model in promoting cultural safety culminates in the clasping and shaking of hands: the moment of shared meaning. It promotes a sense of self worth and identity in students and a safe environment in which they can learn.

Utilising the Hand Model to promote a culturally safe environment for international nursing students.

The rising number of international students studying outside their own country poses challenges for nursing education. Numbers are predicted to grow and economic factors are placing increasing pressure on tertiary institutions to accept these students. In adapting to a foreign learning environment international students must not only adapt to the academic culture but also to the socio-cultural context. The most significant acculturation issues for students are English as a second language, differences in education pedagogy and social integration and connectedness. Students studying in New Zealand need to work with Maori, the indigenous people, and assimilate and practice the unique aspects of cultural safety, which has evolved in nursing as part of the response to the principles underpinning the Treaty of Waitangi. The Hand Model offers the potential to support international students in a culturally safe manner across all aspects of acculturation including those aspects of cultural safety unique to New Zealand. The model was originally developed by Lou Jurlina, a nursing teacher, to assist her to teach cultural safety and support her students in practising cultural safety in nursing. The thumb, represents 'awareness', with the other four digits signifying 'connection" 'communication', 'negotiation' and 'advocacy' respectively. Each digit is connected to the palm where the ultimate evaluation of the Hand Model in promoting cultural safety culminates in the clasping and shaking of hands: the moment of shared meaning. It promotes a sense of self worth and identity in students and a safe environment in which they can learn.

M-Support: keeping in touch on placement in primary health care settings.

Lecturer support for nursing students in clinical placements is essential to assist students in consolidating their clinical experience and making links between theory and practice. The primary health care context poses challenges different from those of secondary or tertiary clinical settings. To deal with these challenges in primary health care settings a project using eTXT and SMS (Short Message Service) was introduced. This provides M-Support for students via a lecturer's computer and students' mobile phones. M-Support was provided to motivate, support and communicate with these student nurses. To evaluate the project a mixed methodology using data from surveys, eTXT and mobile phone message history, and a lecturer's field notes were used. Findings demonstrated that the introduction of this innovation reduced barriers to timely and effective support that arise from the mobile nature of some primary health care nursing roles and the geographical dispersion of placements across the region. These findings suggest that M-Support is an acceptable, cost-effective form of support to motivate, encourage and communicate with nursing students in primary health care clinical placements.

A programme for children with nocturnal enuresis.

AIM: To describe and evaluate the implementation, effects and outcomes of a nurse-managed nocturnal enuresis treatment programme. METHOD: The research design comprised three data sources: focus group interviews with six public health nurses providing the nocturnal enuresis treatment programme, case notes of a convenience sample of 30 children who had completed the treatment programme and interviews with seven children who had completed the programme. RESULTS: The study showed a success rate of 87 per cent (n = 26). Success was defined as maintaining nocturnal continence for 14 consecutive nights. Key aspects in the programme's success and delivery included the child taking responsibility for the programme instead of the parent, the nature of the nurse-child interaction and the nurses' flexibility in adapting the programme for each child. CONCLUSION: The children had experienced low self-esteem as a result of nocturnal enuresis, but success on the programme dramatically improved their self-esteem and ability to socialise with other children. The study affirmed the value of the nurse as the facilitator of this programme. The study has contributed to the knowledge base on the management of nocturnal enuresis in a community-based nurse-managed programme.

General practitioners' perceptions of the nurse practitioner role: an exploratory study.

AIMS: To explore perceptions of general practitioners (GPs) in the Northland District Health Board (NDHB) regarding the nurse practitioner (NP) role, identifying their knowledge of and perceived problems with that role, and their experience of nurses in advanced practice. METHODS: A purposive sample of all 108 GPs in NDHB were surveyed. Fifty replied, representing a response rate of 46.3%. RESULTS: GPs favourably viewed NP functions traditionally associated with nursing, such as health teaching, home visiting, obtaining health histories, and taking part in evaluation of care, but less favourably viewed those functions associated with medicine, such as prescribing, ordering laboratory tests, and physical assessment. While expecting few problems with patient acceptance, the GPs felt that funding and doctors' acceptance would be problematic. Most GPs indicated they have knowledge of the NP role and have experienced working with a nurse in advanced practice, but some uncertainty and lack of knowledge about the NP role was evident. CONCLUSIONS: More education and discussion with Northland GPs is needed to ensure they are fully informed about the NP role and its potential positioning in primary healthcare, to reduce uncertainty, minimise role confusion and promote collaboration between GPs and NPs.