Processes for disciplining nurses for unprofessional conduct of a serious nature : a critique

Aims: This paper critiques the deliberative processes used by the discipline panels of an Australian statutory nurse regulating authority when appraising the alleged unprofessional conduct of nurses and determining appropriate remedies.

Background: Little is known about the nature and effectiveness of the deliberative processes used by nurse regulating authorities (NRAs) disciplinary panels established to appraise and make determinations in response to allegations of unprofessional conduct by nurses.

Methods: A qualitative exploratory descriptive/pragmatic research approach was used. Data were obtained from two case-orientated sampling units: (1) 84 Reasons for Determination made between 1994 and 2000 and (2) a purposeful sample of 12 former and current nurse regulating authority members, nurse regulating authority staff and a nurse regulating authority representative who had experience of disciplinary proceedings and/or who had served on a formal hearing panel. Data were analysed using content and thematic analysis strategies.

Results: Attitudinal considerations (e.g. whether a nurse understood the 'wrongness' of his or her conduct; accepted responsibility for his or her conduct; exhibited contrition/shame during the hearing; was candid in his or her demeanour) emerged as the singularly most significant factor influencing discipline panel determinations. Disciplinary action is taken appropriately against nurses who have committed acts of deliberate malfeasance. NRAs may not, however, be dealing appropriately with nurses when disciplining them for making honest mistakes/genuine practice errors.

Conclusion: Traditional processes used for appraising and disciplining nurses who have made honest mistakes in the course of their work need to be substantially modified as they are at odds with the models of human error management that are currently being advocated and adopted globally to improve patient safety and quality of care in health care domains.

Making sense of law and disorder

This article tells the story of a cross-cultural encounter on a beach at King George's Sound in the south west of Australia in 1826, when Major Edmund Lockyer arrived to establish a British military garrison. The account we have of those early encounters come from the pen of Lockyer, and by taking a close reading of his journal this article attempts to reveal the meanings and context of Aboriginal actions. It also analyses how the Aborigines and the British made sense and subsequently responded to the encounter. Whilst this story is not given iconic status in Australian historiography, it is valuable in opening up a porthole into this contact zone at the moment when precarious relationships were being formed.

Origins of inflated responsibility in obsessive compulsive disorder

The pivotal role of inflated responsibility beliefs in the maintenance and treatment of obsessive-compulsive disorder (OCD) has been clearly demonstrated (Rachman, 1993; Salkovskis, 1998; Shafran, 1997; van Oppen & Arntz, 1994). Yet little is known about the origins of these beliefs, their contribution to a sense of inflated responsibility or the symptoms of OCD, or the contribution of personality to inflated responsibility and to OCD, The aims of this thesis were to investigate a model of the inter-relationships among the personality dimensions of neuroticism and psychoticism, inflated responsibility and OCD, and the origins of inflated responsibility to inflated responsibility and to OCD. In order to achieve these aims, a scale was developed to assess the origins of inflated responsibility based upon the five pathways proposed by Salkovskis, Shafran, Rachman, and Freeston (1999) and the additional domains of guilt, vigilance and thought-action fusion (Shafran, Thordarson, & Rachman, 1996; Shafran, Watkins & Charman, 1996; Tallis, 1994). Eighty-four participants with OCD (age M = 43.36) and 74 control participants (age M =37.14) volunteered to participate in the two studies of this thesis. The aim of Study 1 was to develop and validate a measure of the Origins of Inflated Responsibility (OIR). The results of the first study yielded a 25-ttem scale, the Origins of Inflated Responsibility Questionnaire (OIRQ) with five independent factors: responsibility, strictness, protection from responsibility, critical incidents, and peer blame which demonstrated both internal reliability and temporal stability over a 2-week period. In Study 2, participants also completed the Responsibility Attitudes Scale (Salkovskis, Wroe, Gledhill, Morrison, Forrester, Richards, ct al. (2000) (a measure of inflated responsibility), the Padua Inventory (Sanavio, 1988) (to measure of the symptoms of OCD)y and the Eysenck Personality Inventory-Revised (Eysenck & Eysenck, 1991). Multivariatc Analysis of Variance revealed that the OCD group scored higher on all variables than the control group except for strictness where the groups were not different, and psychoticism where the OCD group scored lower. A series of Multiple Regression analyses revealed that both group and the OIR contributed to inflated responsibility (R2 = .56). When all variables, OIR, inflated responsibility and neuroticism were entered as predictors of OCD, 60% of the variance in OCD was explained however, 49% of the variance was shared by the independent variables suggesting the presence of some underlying construct. Structural Equation Modelling, where all the constructs in the model were examined simultaneously, revealed that neuroticism contributed to the OIR, inflated responsibility and OCD. The OIR were also significant predictors of inflated responsibility and indirectly through inflated responsibility predictive of OCD. The OIR also directly predicted OCD and when the total effects are considered, their contribution was greater than the total effect for inflated responsibility alone. The results of these studies provide good support for the origins of inflated responsibility proposed by Salkovskis et al. (1999), as measured by the OIRQ developed for use in the current thesis. The results also support the contribution of inflated responsibility and neuroticism, as well as the OIR, to OCD, The large amount of variance shared by the OIR, inflated responsibility and neuroticism suggest that there might be some underlying construct, perhaps of a biopsychosocial nature, that requires further investigation for its role in the onset and maintenance of OCD. The clinical relevance of these findings is discussed in terms of early prevention strategies and interventions.

Parent management training, comorbidity, and treatment of children with oppositional defiant disorder

This study found that Parent Management Training was a successful treatment for promary school aged children who were referred to a mental health clinic and diagnosed with Oppositional Defiant Disorder. The positive outcome was not affected by the child having comorbid disorders. These findings have relevance to the clinical field.

Sensitivity to motivational cues in attention-deficit / hyperactivity disorder

This thesis examined a prediction of Reinforcement Sensitivity Theory regarding the association between personality traits and motivated behaviour and, whether reward-and-punishment sensitivity is associated with Attention-deficit / Hyperactivity disorder (ADHD). Results supported the predicted association between personality and motivated behaviour, but not the predicted association between reward-and-punishment sensitivity and ADHD.

The role of alcohol consumption in recovering drug users

This thesis found that alcohol consumption by illicit drig users has not been well researched. A qualitative study found alcohol was used as a substitute and believed to be related to illicit substance use. While the quantitative study generated no overall consensus, the research highlighted the need to conduct additional studies into substance abuse. The portfolio explored the relationship between maltreatment and the development of Reactive Attachment Disorder through four case studies of child clients.

Social skills training and childhood attention deficit hyperactivity disorder (ADHD)

This study implemented social skills training as an adjunctive to psychostimulant medication with a sample of 14 boys with ADHD, compared to a control group of 14 ADHD boys whose treatment consisted of psychostimulant medication only. Results indicated that social skills training provides additive effects on some aspects of social functioning, over and above those of medication only. Findings are discussed in terms of their contributions to the understanding and treatment of the social difficulties in childhood ADHD. Costs and benefits of this approach to treatment are also considered.

A review of cashmere nutrition experiments with suggestions for improving their design and conduct

The scientific literature contains divergent views about the effects of nutrition on cashmere. The consequences of ignoring nutrition will be an increase in the number of goats suffering lower production, increased welfare risks and premature mortality. This review evaluated published reports to identify current knowledge and best practice in regard to the design and management of cashmere nutrition experiments. The ability of experiments to distinguish between treatments was evaluated based on their statistical evidence. Many experiments had serious deficiencies in their design, conduct and reporting. Six of 16 papers did not provide statistical information that would enable a reader to verify differences between treatments. For most experiments to detect nutrition affects at P < 0.05, they required a difference between treatments of 0.2–0.8 μm in cashmere mean fibre diameter and 15–42 g in clean cashmere production. Government Research Institutes research was characterised by more experienced authors conducting longer (P < 0.05) and larger (P < 0.05) experiments than those conducted by Universities. Much of the “debate” regarding the affects of nutrition on cashmere production arises from the misinterpretation of both experiments that did not detect statistically significant effects and of experiments that did detect statistically significant effects. Based on a comparison between experiments reporting responses to nutrition with those reporting no response, 13 design and management features were identified that are related to the ability of experiments to detect significant treatment affects. Methods must be adopted to reduce the variance in cashmere production within treatments, by using sufficient animals per treatment, and having replication to provide sufficient degrees of freedom to reduce error terms in analysis. The power of experimental designs should be evaluated before experiments commence. Cashmere production records from a previous full production year could be used as co-variants during statistical analyses but this requires that potential experimental goats are managed in one flock, without variations resulting from different grazing, reproduction or other management for a year prior to an experiment. It is preferable to use more productive and older goats, and goats that are used to handling, and to the conditions and feed to be used. Allocation of animals to treatments must take into account live weight. Nutrition treatments need to be sufficiently different to produce different growth curves. An appropriate control is needed such as live weight maintenance. Evidence of both nutrition intake and growth curves must be published with cashmere production data so the claims made can be verified by the actual responses. As cashmere production is an order of magnitude less than fibre production of Merino sheep or Angora goats and is more difficult to measure, the requirements for measurement, sampling and testing cashmere fleeces are summarised. The use of mid side cashmere patches to determine cashmere growth and quality is seriously biased and must be avoided, preferably by shearing goats prior to and at the end of experiments. In order to obtain higher fleece growth responses and improve the ability of experiments to detect treatment effects it is preferable to start cashmere growth experiments by midsummer and conduct experiments for at least 4 months. These requirements make it difficult for many university students to plan, undertake and complete long-term cashmere nutrition experiments without considerable management support. It is not possible for experiments to disprove the Null hypothesis regarding the effects of nutrition on cashmere production as they can only report a failure to detect treatment effects. Researchers and journals need to be more rigorous in providing statistical information including: degrees of freedom for error terms, treatment variances, standard error of differences or similar to enable readers to compare treatment effects. Publications that do not provide sufficient statistical information should be disregarded from future discussions. Claims that an experiment shows no responses to nutrition should be subject to rigorous examination using the issues identified in this review.

Internet-based treatment for panic disorder : does frequency of therapist contact make a difference?

Internet-based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty-seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8-week Internet-based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e-mails per week) or infrequent (one e-mail per week) support from a psychologist. Posttreatment, intention-to-treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panicrelated cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end-state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet-based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost-effective than previously reported.

Lithium-doped plastic crystal electrolytes exhibiting fast ion conduction for secondary batteries

Rechargeable lithium batteries have long been considered an attractive alternative power source for a wide variety of applications. Safety and stability1 concerns associated with solvent-based electrolytes has necessitated the use of lithium intercalation materials (rather than lithium metal) as anodes, which decreases the energy storage capacity per unit mass. The use of solid lithium ion conductors - based on glasses, ceramics or polymers - as the electrolyte would potentially improve the stability of a lithium metal anode while alleviating the safety concerns. Glasses and ceramics conduct via a fast ion mechanism, in which the lithium ions move within an essentially static framework. In contrast, the motion of ions in polymer systems is similar to that in solvent-based electrolytes - motion is mediated by the dynamics of the host polymer, thereby restricting the conductivity to relatively low values. Moreover, in the polymer systems, the motion of the lithium ions provides only a small fraction of the overall conductivity2, which results in severe concentration gradients during cell operation, causing premature failure3. Here we describe a class of materials, prepared by doping lithium ions into a plastic crystalline matrix, that exhibit fast lithium ion motion due to rotational disorder and the existence of vacancies in the lattice. The combination of possible structural variations of the plastic crystal matrix and conductivities as high as 2 3 1024 S cm21 at 60 8C make these materials very attractive for secondary battery applications.