Transference in the nurse-patient relationship

The therapeutic relationship has been considered foundational to psychiatric nursing practice since at least the mid-20th century. However, this does not, in itself, guarantee either its continuity or relevance to current practice. Concepts such as the therapeutic relationship require sustained attention, both in theory and in practice, to illustrate ongoing relevance to the discipline. This paper addresses the therapeutic relationship in psychiatric nursing via aspects of psychoanalytic theory, particularly the notion of transference, as theorized by both Freud and Lacan. Two case fragments provide practice material, through which transference in the nurse–patient relationship is explored. The nurse, in the context of his/her relationship with the patient, a sick stranger, offers both a listening and the potential development of transference. This transference can be experienced, in part, as a form of attachment to the nurse, one that is not regarded pejoratively as dependency. There is the potential, within the nurse–patient relationship, for a psychical holding to develop, one from within which both the patient can speak and transference might arise. It is argued that listening to the patient has the potential to assist the patient and, with the development of transference, can provide the context for important work.

Overseas Chinese as expatriate managers in China: is their recruitment a solution to cross-cultural management problems for multinationals operating in China?

This paper examines the issue of diversity in Chinese identity and how it impacts on the operations of multinationals in China who recruit Overseas Chinese to handle cross-cultural issues. China’s rapid economic development and entry into the World Trade Organization in 2001 made her a formidable player in the global economy and direct foreign investment surged. Yet it is acknowledged that for the foreign investor in China, cross-cultural issues create difficulty at every level, from the interpersonal level relating to communication and negotiation, to the organizational level relating to decision making, human resource management practices, corporate legal institutions and liaison with government institutions. Western multinationals have considered the advantages of posting Overseas Chinese from Southeast Asian countries, Taiwan and Hong Kong to their China operations as a solution to cross-cultural management issues. But has this policy been successful? In terms of language expertise this would seem to be a good strategy, yet organizational case material contradicts this in reality. Overseas Chinese, while sharing some elements of Chinese culture with mainland Chinese, the Confucian heritage and other aspects such as language and diet, nevertheless have different world views and values and behave differently from mainland Chinese in areas critical to business management. As a survival strategy, Overseas Chinese have often developed dual identities which operate simultaneously. For political and historical reasons, many of them have had to adapt to the local culture of their country of citizenship or even hide their own ethnicity in order to survive. On the other hand, the mainland Chinese are different in that their behaviour has only had to be Chinese, but overlaid with this has been the experience of participating in a communist political environment for decades, which has left its mark on mainland Chinese culture. On the basis of their different historical experiences, in the current business environment in China, cultural confusion, difficulty and conflict may occur for the Overseas Chinese.

This paper focuses attention on the subtle cultural differences between the Overseas Chinese and mainland Chinese in an organizational context. This problem has yet to be researched in depth within international business and international management studies. It provides evidence that Overseas Chinese are not often favoured by the local Chinese. It gives insights on how to manage the local Chinese for foreign multinationals operating in China.

Extent of heart failure self-care as an endpoint to patient education: a literature review

Background: In western countries the number of chronic heart failure (CHF) management programs has escalated in recent times. One key component of them is to teach self-care behaviours that enable affected individuals to monitor themselves and engage in lifestyles that improve their health status.
Aim: The aim of this article is to describe CHF self-care management and to review the literature which examines the effectiveness of patient education on patients’ performance of self-care behaviours.
Design/method: bibliographical databases were searched for papers published in English between 1982 to 2006. The search used the key words: heart failure, education, self-care and measures. Only randomized controlled trials (RCTs) were selected.
Results: Ten randomized controlled trials were selected that used education as an intervention and, in total, 1064 patients with CHF participated in these studies. The studies were heterogenous as to the sample population, the health outcomes measured, the education interventions, the expertise of the educator, and the length of time that was spent on teaching patients. No consistent patterns of implementation and specific evaluation of its impact were found, although three respective groups of investigators reported signifi cant differences in recurrent hospitalisation rates and mortality rates which were relative to usual care.
Conclusions: Teaching patients appropriate CHF self-care behaviours can significantly improve their health outcomes. Improvements in self-care were demonstrated in seven studies but only three had used validated instruments to measure such changes. This suggests that no firm conclusions can be drawn about changes in self-care practices.

Assessing patient satisfaction with day surgery at a metropolitan public hospital

With the advances in health care technology, many surgical procedures are performed as day surgery cases. The provision of day surgery is considered to be a cost effective method of utilising resources, but it does challenge nurses to provide optimal patient care during the patient's short stay in hospital. Patient satisfaction is considered to be an important indicator of quality nursing care. This paper reports on an investigation aimed at assessing patient satisfaction with day surgery in an Australian metropolitan public hospital. One hundred and seven patients completed a recently developed survey assessing patient satisfaction with day surgery. The response rate was 41%. Waiting times, communication, pain management and discharge planning were major areas of patient dissatisfaction. Directions for improvement in day surgery services are discussed.

Dispersal and recruitment of juvenile Red-capped Robins, Petroica goodenovii

Data on the dispersal and recruitment of juvenile birds following fledging are largely unreported for Australian birds. In this study, we investigated the short-distance dispersal of a sample of colour-banded, juvenile Red-capped Robins, Petroica goodenovii, in Terrick Terrick National Park, Victoria, Australia. Of 67 colour-banded juvenile birds that successfully reached independence during the 2000–01 breeding season, eight were recruited into the study area or adjacent areas for the following breeding season. A ninth bird was resighted in Gunbower State Forest, 36 km from where it was banded. This is the furthest recorded dispersal movement of a Red-capped Robin. Of 59 colour-banded juvenile birds that reached independence during the 2001–02 season, four remained within the study area for the remainder of the breeding season, but these birds were not present in the study area during the following breeding season. Juvenile birds that successfully reached independence and dispersed were heavier as nestlings, when controlled for age and date, than birds that disappeared (assumed dead) before reaching independence. Estimates of Red-capped Robin abundances within Terrick Terrick National Park were greater than those of nearby eucalypt woodlands, suggesting that the White Cypress-pine, Callitris glaucophylla, woodlands within the park offer good-quality habitat for Red-capped Robins and may be saturated with breeding territories. Thus, juveniles may be forced to establish breeding territories far from their natal territories. These results are discussed in relation to avenues for further research on juvenile dispersal in Australian birds and their conservation implications.

Assessment of patient pain in the postoperative context

Because of its subjective nature, the assessment of pain requires the use of comprehensive practices that accurately reflect a patient’s experiences of pain. The purpose of this study was to determine how nurses make decisions in their assessment of patients’ pain in the postoperative clinical setting. An observational design was chosen as the means of examining pain activities in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were selected. Each 2-hour observation period was examined 12 times thus resulting in 74 observations. In total, 316 pain activities were determined. Five themes relating to assessment were identified from the data analysis: simple questioning, use of a pain scale, complex assessment, the lack of pain assessment, and physical examination for pain. The study identified how nurses’ prioritization of work demands created barriers in conducting timely and comprehensive pain assessment decisions.

Vice chancellors for the 21st century? A study of contemporary recruitment and selection practices in Australian universities

This article is based on recent Ph.D research. The practices for appointing Vice Chancellors (VC's) in Australian Universities were examined, together with the changing role of the VC and new demographic patterns in VC backgrounds. A number of other issues were also examined, including the training and preparation of VC's, mentoring and the changing skill base required to be effective in the role. In addition, the paradox was investigated of appointing academics from the ranks of individuals with non-business backgrounds, to run large enterprises which are being compelled to adopt an increasingly business-oriented focus. The methodology employed involved the use of a survey instrument administered to present and former VC's, Chancellors and members of selection panels, supplemented by interviews. Representatives of the Australian Vice Chancellors Committee (AVCC) and consultants operating in the academic field were also interviewed. In addition, extensive use was made of public domain material. The research was mainly qualitative in nature. However, use was also made of descriptive statistics to provide an insight into how higher education in Australia is changing and to analyse survey findings. Some key results of the research are reported, including the importance of informal processes such as networking in the selection of VC's, the key role played by Chancellors, and the continued practice of appointing VC's from within academia rather than the private sector. This is in spite of evidence that the role of the VC has changed to one of strategic planner and business manager rather than the more traditional role, in the context of a rapidly changing external environment. Suggestions are also made for ongoing research in the area.

Age and walking speed effects on muscle recruitment in gait termination

During gait termination at normal walking speed, older adults more frequently employ two-step responses, increasing their stopping distance and stopping time more than younger controls. This study investigated ageing effects on lower limb muscle recruitment patterns during stopping at three walking speeds. Twelve young male (26±3.7 years, range 19–30) and 12 gender-matched older participants (72±4.3 years, range 65–82) terminated walking at normal, medium and maximum speed. A visual stopping stimulus was presented 10 ms following either left or right heel-contact with no stimulus (catch) on 30% of trials. Electromyographic (EMG) activity was recorded from the tibialis anterior (TA), soleus (SOL), biceps femoris (BF), vastus lateralis (VL) and gluteus medius (GM). Older males more frequently (46% of trials) took two-steps to stop than young males (20%). The stance leg muscles responded significantly faster than the swing leg, and with increased speed, fewer swing limb muscles contributed to stopping. Older males were slower to respond with the stance leg, at 215 ms following the stimulus compared with 176 ms for the younger group. They also recruited fewer swing leg muscles with less frequent activation of the soleus and gluteus medius. Failure to activate muscles would provide less extensor torque to maintain the centre of gravity anterior to the forward base of support. This would decrease the total force opposing horizontal velocity in order to bring the body to rest and, as a consequence, encourage an additional step prior to stopping.

Case review: septic shock in the pregnant patient

This case study involves a 36-year-old female at 15 weeks gestation who presented with severe lower abdominal pain post amniocentesis and subsequently deteriorated into a state of septic shock whilst in the ED. The circumstances surrounding this patient's presentation and subsequent clinical course are presented. The assessment and management of septic shock is also described with specific consideration to this patient's pregnant state.

The cost of seasonal respiratory illnesses in Australian children: the dominance of patient and family costs and implications for vaccine use

Respiratory viral infections are one of the next group of diseases likely to be targeted for prevention in childhood by the use of vaccines. To begin collecting necessary epidemiology and cost information about the illnesses caused by these viruses, we conducted a prospective cohort study in 118 Melbourne children between 12 and 71 months of age during winter and spring 2001. We were interested in calculating an average cost per episode of community-managed acute respiratory disease, in identifying the key cost drivers of such illness, and to identify the proportion of costs borne by the patient and family. There were 202 community-managed influenza-like illnesses identified between July and December 2001, generating 89 general practitioner visits, and 42 antibiotic prescriptions. The average cost of community-managed episodes (without hospitalisation) was $241 (95% CI $191 to $291), with the key cost drivers being carer time away from usual activities caring for the ill child (70% of costs), use of non-prescription medications (5.4%), and general practice visits (5.0%). The patient and family met 87per cent of total costs. The lowest average cost occurred in households from the highest income bracket. Acute respiratory illness managed in the community is common, with the responsibility for meeting the cost of episodes predominantly borne by the patient and family in the form of lost productivity. These findings have implications for preventive strategies in children, such as the individual use of, or implementation of public programs using, currently available vaccines against influenza and vaccines under development against other viral respiratory pathogens.