Thesis (MTech (Nursing))--Cape Peninsula University of Technology, 2008. / Includes bibliographical references (leaves 59-67). Also available online.

Nursing has its own unique contribution to make to diabetes care, but that impact is rarely quantified, measured or conceptualised. The thesis makes this contribution in the form of three published research projects and proposes an adaptation to Abbott’s conceptual framework on the division of expert labour. The first research project demonstrates the value of the hospital based diabetes specialist nurse using a randomised controlled trial; the second delineates the competences of different levels of nurses in diabetes care using a nominal group technique and the third project provides a baseline of the state of nursing in relation to the initiation of insulin therapy using a survey approach. Each project is followed by a personal reflection and discussion of the implications in the light of Abbott’s framework. Abbott’s thesis is that the development of professions is determined by a series of jurisdictional disputes rather than by a grand plan of the professions themselves. While this assertion does not always hold true in diabetes care the studies do concur with Abbott in other ways, particularly that the profession can be taken forward by taking responsibility for appropriate educational preparation, extending the boundaries of knowledge and the nursing role where appropriate. The discussion cautions against setting up professional edifices that become self-serving and stifle development, either by rigid enforcement of competences or by fossilising the nursing contribution to diabetes care. In terms of the care of the person with diabetes, nursing remains most effective within the umbrella of a multi-disciplinary team while demonstrating its own contribution. Nursing should show professionalism by continually striving for excellence, developing new knowledge and pushing role boundaries when it is in the best interests of the patient. The original contribution to knowledge is shown in the research projects’ contribution to the evolution of diabetes nursing in the United Kingdom and the proposal that Abbott’s framework be modified to put more emphasis on the task of work to achieve optimum patient outcomes than on the jostling of professions; acknowledging the growth in multi-disciplinary team-working and rise in the power of organisations at the expense of the power of individual professions since his work was first published.

Aggressive or explosive behaviors in children typically occur within the context of a variety of psychiatric diagnoses and pose additional challenges when children present with histories of abuse. These behaviors are often interpreted as deliberate or noncompliant and management of these extreme behaviors often results in locked seclusion in most inpatient psychiatric settings. Locked seclusion remains controversial at best and raises legal and ethical issues regarding its safe and therapeutic use. <br>This retrospective quantitative study evaluated the effectiveness of the Collaborative Problem-Solving (CPS) approach as a less restrictive behavioral intervention on an inpatient child psychiatric unit with children ages 5-12 years that introduced the CPS approach during a nine month performance improvement project from July 1, 2006 - March 31, 2007. This study sought to determine what variables, if any, impacted the use of locked seclusion before, during, and after CPS implementation and whether children with histories of abuse were placed in locked seclusion at a significantly different rate relative to admissions of children who did not have histories of abuse. Erik Erikson's Theory of Psychosocial Development served as the theoretical framework.<br>The closed medical record review involved 197 admissions and 167 children. All data were analyzed in two parts: the entire nine month period of 197 admissions and by time period, based on when the CPS intervention was introduced and implemented on the unit. <br>Length of stay was the only variable statistically significant during the nine month period (n=197) and third time period of January -March 2007 (n=65) when CPS was fully implemented and assessed. This finding suggests that a child's longer length of stay may have had a relationship with being placed in locked seclusion. When length of stay was controlled as an influence with history of abuse, the variable of interest for this study, children with histories of abuse for the nine month period were not significantly more likely of being placed in locked seclusion than children without histories of abuse; for the third time period, they were found to be almost eight times less likely of being placed in locked seclusion with an odds ratio of 7.81.<br>Although these findings suggest a favorable response to the CPS approach and that behaviors associated with traumatized children were normalized to that of their peer group, the results must be considered with caution. There were many limitations to the initial project and any inferred success with abused children and the CPS approach is based on statistical outcomes only. Other variables not measured or controlled must be considered as potential influences that may have impacted these outcomes. As such, future research evaluating CPS effectiveness with traumatized children is recommended. / School of Nursing; / Nursing / PhD; / Dissertation;

Bakgrund Suicid är ett folkhälsoproblem som förbises av samhället. Suicid står för 25% av dödsorsakerna bland ungdomar. Män begår oftast suicid medan kvinnor främst begår suicidförsök. Ett suicidalt beteende påverkas av flera olika faktorer, såsom tidigare suicidförsök, psykiska sjukdomar, alkohol eller droger, negativa traumatiska livshändelser, ärftliga faktorer och/eller tillgång till suicidala medel. Det ultimata är att förebygga suicid, inte endast vårda och ingripa när det redan hänt. Syfte Studiens syfte var att belysa patienters upplevelser i samband med vård efter ett suicidförsök. Metod Studien är en litteraturbaserad studie med tyngdpunkt i självupplevda berättelser. För dataanalys har en modifierad kvalitativ innehållsanalys använts. Resultat Individernas skildringar resulterade i tre teman; Lidande, Bemötande och vård samt Vårdmiljö. Lidandet utgjorde en central del i de egenupplevda berättelserna, och var kopplade både till individerna själva och till vården. Bemötandet och vården var i många fall bristfällig, då den inte såg till deras behov, och vårdmiljön ansågs ofta som ogynnsam för tillfrisknandet. Slutsats Suicid är ett komplext problem, vilket gör att vården av suicidala patienter blir komplex. Lidandet är en central del hos suicidala patienter. Genom ett holistiskt perspektiv och ett sympatiskt bemötande kan vårdpersonalen minska lidande hos denna patientgrupp. Klinisk betydelse Hälso- och sjukvården har en betydande roll vid vård av suicidala patienter. Den här studien visar att sjukvården behöver ha ett mer holistiskt perspektiv vid vård av suicidala personer. Ett patientperspektiv kan öka förståelsen för dessa personers lidande och upplevelser av vården i samband med ett suicidförsök. / Background Suicide is a public health problem that is often ignored by society. Suicide stands for 25% of the cause of deaths among adolescents and young adults. Males tend to commit suicide whereas females mainly commit suicide attempts. A suicidal behavior is influenced by several factors, like previous attempts, mental illness, alcohol or drugs, negative traumatic occurrences in life, hereditary factors or access to suicidal implements. The most ultimate is to prevent suicide, and not only nurse and intervene when it has already happened. Aim The aim of this study was to illuminate patient experiences connected to health care after a suicide attempt. Method This study is a literature based study, with literature emphasized in self-experienced stories. A modified qualitative content analysis has been used to analyze data. Findings The stories resulted in three themes, Suffering, Treatment and nursing and Health care environment. Suffering was a central part in their stories and was connected to the individuals themselves and to the health care. The treatment and nursing was defective in many cases, because it did not see to their needs, the health care environment was often considered as having an unhealthy impact to recovering. Conclusion Nursing of suicidal patients is a complex problem. Suffering is a fundamental part among suicidal patients. Through a holistic perspective and a sympathetic treatment nursing staff may reduce these patients' suffering. Clinical value Health care has a significant part in nursing suicidal patients. This study shows that health care needs to have a more holistic perspective in the care of suicidal patients. A patient perspective may enhance the understanding for these patients' suffering and experiences connected to a suicide attempt.