Ethical conflicts reported by registered nurse/certified diabetes educators: a replication

The purpose of this study was to identify types of ethical conflicts reported by certified diabetes educators who are also registered nurses (RN/CDEs) and to examine their relationship with demographic, educational and practice setting variables. This study is a replication of an earlier pilot study. Ethical conflicts expressed by RN/CDEs in active practice in New York and Pennsylvania were analysed according to four themes. Disagreement with medical practice was by far the most dominant clinical context for the conflicts (61%), as it had been in the pilot study (75%). Participants believed that 32% of the ethical conflicts were resolved. Ethics committees and consultants were very rarely used. Of the relationships between the kinds of conflicts and their resolution, and demographic, educational and practice setting variables of the participants, only kind of position was significantly (P < 0.005) related to practice context of the ethical conflict.     

Ethical conflicts reported by certified registered rehabilitation nurses

Psychological and neuropsychological assessment of children is focused on behavioral disorders of various dimensions (e.g., abilities and limits of perceptual, expressive, cognitive and emotional functions). Additionally neuropsychological diagnosis attempts to explain relationship between behavioral and brain states. The purpose of diagnosis formulated in this way requires careful selection of test procedures and overall integration of different kinds of data. Especially, severally handicapped cases need this kind of diagnostical approach. Limits of valid diagnostic conclusions are determined by many factors that affect coherent interpretation of the test scores (e.g. the lack of a consistently employed neurologic model of brain development to relate to behavioral functions, significant impairment with coexisting sensory and motor deficits, the different effects of brain lesion depending on age of onset, the interference of maturational and experimental variables with manifestation of brain damage).     

A missed opportunity: master's education for certified nurse practitioners

Many nurse practitioners were prepared in nondegree certificate programs and lack academic credentials desired in today's marketplace. The history of nurse practitioner education is reviewed, and a master's completion program for certified nurse practitioners is presented.     

Psychotropic prescriptive patterns among nurse practitioners in nonpsychiatric settings

Dissemination of metastases from primarily extraneural tumors with the cerebrospinal fluid (CSF) is rare and most often seen in association with a leptomeningeal involvement. Here we present 2 cases of bronchogenic and 1 case of prostata carcinoma with multiple CSF metastases within the entire cerebral ventricles and the spinal canal.     

Nurse practitioners, certified nurse midwives, and physician assistants in California

A monoclonal antibody (MAb) targeting human hepatocellular carcinoma (HCC) has been produced by immunizing BALC/c mice with HCC SMMC-7721 cells. Solid phase enzyme-linked immunoabsorbent assay (ELISA) analysis showed that this mAb (mAb 95) was reactive with human HCC cell lines and tumor biopsies, but not tumors of other origin or normal tissues tested. Immuno-gold labeling and flow cytometry indicated that mAb 95 bound specifically to HCC cell membrane protein. Western blot analysis showed mAb 95 reacts only with HCC cell lysates, but not with 10 different human normal tissue lysates. The approximate molecular size of the reactive proteins were 40,000 and 60,000 daltons. The specificity of mAb 95 indicates it may be a potential candidate for a targeting agent in HCC immunotherapy or immunodetection.     

Ethical and professional conflicts in correctional psychology.

The role of the mental health professional in a prison setting has changed to reflect the prevailing ideology of the correctional administration that deemphasizes treatment and emphasizes security and custodial concerns. As a consequence, mental health professionals who work in corrections have experienced unique ethical and professional conflicts. Standards were developed to address the conflicts and provide guidelines for professional conduct, but dilemmas continue to exist. The authors indicate this can be attributed to (1) the standards being vague and (2) correctional personnel not understanding or supporting the standards or the psychologist's role as a mental health professional. This article examines these propositions in more detail, using vignettes and discussion, and offers other approaches to resolving the dilemmas and improving the delivery of mental health services to incarcerated individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy and assessment in hospital settings. Ideological and professional conflicts.

The hospital system and the medical setting present a variety of clinical and nonclinical task and role demands that necessarily influence the mental health practitioner's ability to function with patients. The strong potential in the hospital milieu for professional role conflicts is considered, and the paradigmatic clashes between existing medical and psychological approaches are seen as an intrinsic aspect of such professional conflicts. The controversy over the use of the DSM-III is noted, and the potential for the misuse of psychological diagnoses in treatments incongruent with the orientation of the profession is described. The particular complicating effects of the hospital organization on psychotherapy and assessment are discussed, and suggestions for professional boundary definition and maintenance are made. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of nurse practitioners in the acute care setting

A collaborative practice model was initiated in a university hospital to assist resident physicians to coordinate patient care on specialty services. Nurse practitioner (NP) data were collected on daily work activities and categorized as direct care, indirect care, administration, education, and research. Satisfaction surveys were collected from patients, physicians and nursing staff. Data on clinic evaluation and management service provided by the NPs were reported. The study supported the appropriateness of NPs in the acute care setting.     

Psychologists in public inpatient psychiatric settings: Ethical dilemmas.

Psychologists face new ethical dilemmas as their roles expand in public hospital psychiatric units. Clinical and administrative practices indicate psychological values, models, and interventions are useful and effective when serving seriously mentally ill inpatients. Issues addressing the clinical, administrative, and training competence of psychologists in public hospital settings are discussed. It is recommended that national guidelines be developed to be used by state licensing and hospital credentialing boards in verifying preparation for public inpatient psychiatric practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient knowledge and nurse role strain in three hospital settings

The relationship between patient medical and hospital knowledge and nurse role strain is examined within three contrasting types of general hospital. The nature of this relationship was found to differ greatly within each of the three hospitals. Interpretations of these findings focus upon differences in organizational structure and climate, staff orientation, and type of clientele group. These data suggest that cuation should accompany attempts to generalize across different types of hospitals when questions relevant to the patient role are posed.     

Evidence-based strategies improve assessment of pediatric bipolar disorder by community practitioners.

The misdiagnosis of pediatric bipolar disorder (PBD) has become a major public health concern. Would available evidence-based assessment (EBA) strategies help improve diagnostic accuracy and are clinicians willing to consider these strategies in practice? The purpose of the present study was to document the extent to which using an EBA decision tool—a probability nomogram—improves the interpretation of family history and test data by clinicians and to examine the acceptability of the nomogram technique to clinicians. Over 600 clinicians across the U.S. and Canada attending continuing education seminars were trained to use the nomogram. Participants estimated the probability that a youth in a clinical vignette had bipolar disorder, first using clinical judgment and then using the nomogram. Brief training of clinicians (less than 30 minutes) in using the nomogram for assessing PBD improved diagnostic accuracy, consistency, and agreement. The majority of clinicians endorsed using the nomogram in practice. EBA decision aids, such as the nomogram, may lead to a significant decrease in overdiagnosis and help clinicians detect true cases of PBD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Care tracker: a new approach to nursing care in ambulatory settings

It is becoming increasingly clear that mitochondrial Ca2+ uptake from and release into the cytosol has important consequences for neuronal and glial activity. Ca2+ regulates mitochondrial metabolism, and mitochondrial Ca2+ uptake and release modulate physiological and pathophysiological cytosolic responses. In glial cells, inositol 1,4,5-trisphosphate-dependent Ca2+ responses are faithfully translated into elevations in mitochondrial Ca2+ levels, which modifies cytosolic Ca2+ wave propagation and may activate mitochondrial enzymes. The location of mitochondria within neurones may partially determine their role in Ca2+ signalling. Neuronal death due to NMDA-evoked Ca2+ entry can be delayed by an inhibitor of the mitochondrial permeability transition pore, and mitochondrial dysfunction is being increasingly implicated in a number of neurodegenerative conditions. These findings are illustrative of an emerging realization by neuroscientists of the importance of mitochondrial Ca2+ regulation as a modulator of cellular energetics, endoplasmic reticulum Ca2+ release and neurotoxicity.     

An exploration into occupational stress experienced by HIV health care professionals who work within genitourinary medicine settings.

The present study investigates the occupational stress of health care workers involved with HIV care in genitourinary medicine (GUM) outpatient departments. Sixteen nursing and 14 medical staff completed the P. Gray-Toft and J. G. Anderson (1981) occupational stress inventory. This assesses 7 potential sources of stress (death and dying, uncertainty regarding treatment, inadequate preparation, lack of support, conflict with others, conflict with physicians, and workload). The mean scores obtained revealed a preponderance of low-stress scores for both medical and nursing staff. Analyses of variance and covariance further demonstrated that, in general, levels of stress did not differ within or between the occupational groups. However, sources and characteristics of stress were different between nurses and doctors. In this group of health care professionals, their work with HIV-positive patients within the GUM outpatient setting may be instrumental in limiting levels of stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of patient visits to nurse practitioners and physician assistants in hospital outpatient departments

Amprolium was successfully used to induce cerebrocortical necrosis (CCN) in dromedary racing camels, only when they were fed on a barley diet. Camels which were fed on hay ad libitum did not suffer form CCN, although their thiamine pyrophosphate (TPP) reached similar levels as in camels fed on barley. The reason for this phenomenon is discussed. Five camels which suffered from CCN had TPP values of 80-115% and were euthanized on humane grounds when they were in lateral recumbency. Pathohistological investigations revealed a polioencephalomalacia of the dorsal cerebral cortex with oedema and status spongiosus. Cerebral autofluorescence was observed under ultraviolet light. The major clinicopathological changes were a slight anemia and a decreased potassium value whereas glucose, muscle enzymes, leucocyte counts and differential counts were elevated. A TPP effect of 12% was found during this study in healthy dromedary racing camels and symptoms were observed when TPP values reached 80-115%. The test is now being widely used during the camel racing season.