Credentialling Australian critical care nurses: the pilot study.

In October 1998, the Australian College of Critical Care Nurses (ACCCN) launched a model to credential specialist level critical care nurses. This model was 'road tested' during a pilot study, when experienced critical care nurses were invited to apply to become the first Australian credentialled critical care nurses. The pilot study was designed to ensure all individuals taking part in the process were surveyed regarding adequacy of the credentialling package and the credentialling process. Applicants were required to provide evidence of practise at the specialist level, as described in the Competency Standards for Specialist Level Critical Care Nurses. Evidence was presented via curriculum vitae, professional journal and supported by three peer reviewers and two referees. Each application was sent to a three-person assessor panel, which assessed the evidence in the application against the Competency Standards for Specialist Level Critical Care Nurses. A total of six applications from five states and one territory were received by April 1999. Five of the applicants were assessed to have met the Competency Standards and were awarded the credential, Australia Credentialled Critical Care Nurse (ACCN), which they will hold for a period of 3 years. Feedback from assessors, applicants, peer reviewers and referees involved in the pilot study has resulted in the further refinement of the credentialling package and processes. Australian critical care nurses will now have the opportunity to seek to be credentialled four times per year.

Insight, neurocognitive function and symptom clusters in chronic schizophrenia.

Only recently has there been interest in the systematic study of insight in schizophrenia. The present investigation was designed to evaluate the specific relationship between psychopathological symptoms, neurocognitive deficits and awareness of illness in chronic schizophrenia. Fifty-eight outpatients with the DSM-III-R diagnosis of schizophrenia were rated on David's Schedule for Assessing Insight, the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale and the Wisconsin Card Sorting Test (WCST). Results indicate that there is a significant association among these variables and that approximately 44% of the variance in the dependent variable could be explained by this combination of independent variables. Notably, however, negative symptoms were only moderately inversely correlated with awareness of illness, and they were not associated with scores on the WCST. Moreover, neither negative symptoms nor per cent perseverative errors contributed significantly to the prediction of insight in schizophrenia. These findings argue against the notion that unawareness of illness is the product of neuropsychological dysfunction in the frontal lobes. Instead, the most significant associations and predictors of insight were related to the positive symptoms of schizophrenia.

Depression in schizophrenia: a comparison of three measures.

Depression, as a feature of schizophrenia, is well established. However, clarifying the exact nature of this relationship has been problematic. The clinical measures routinely utilized to evaluate depression have not been specifically designed for use in schizophrenia, and it is well recognized that a variety of depressive symptoms overlap with other features common to this illness, e.g. negative symptoms, neuroleptic induced side effects. The present study compared three commonly used measures of depression (Hamilton Depression Rating Scale (Ham-D), Calgary Depression Scale (CDS) and the depression subscale of the Positive and Negative Syndrome scale (PANSS-D) in a group of outpatients with schizophrenia, evaluating the degree of association between the scales. Additionally, the relationship between each of the depression measures, negative symptoms and extrapyramidal symptoms (EPS) was calculated. Results revealed that all three measures of depression were significantly correlated, although the CDS was unique in its ability to distinguish between depression, negative symptoms and EPS. It is concluded that the CDS, when compared with the HAM-D and the PANSS-D, is the most suitable measure of depression in schizophrenia.