ACCCN national nursing workforce survey of intensive care units

A descriptive study was designed and implemented by the Australian College of Critical Care Nurses (ACCCN) Workforce Planning Advisory Committee to capture data pertaining to workforce issues of intensive care nurses. All intensive care units (ICUs) within Australia were mailed a self reporting survey. Despite a low response rate (52 per cent) and difficulty reported by respondents in gaining the appropriate data requested, the results revealed an interesting snapshot of the intensive care nursing workforce.
Types of services offered by units varied considerably; paid overtime hours were low (<2 per cent of total hours worked) and use of both part-time and agency staff was also low (10 per cent of total hours worked). Private hospitals utilised a greater proportion of part-time and agency nursing staff than public hospitals (20:10 per cent). The turnover rate for registered nursing staff was estimated at 18 per cent, with education, skill acquisition and improved communication reported as the major incentives used by managers to attract and retain staff. This study demonstrated that valuable data are currently uncaptured and recommends a more refined process of a national database to record and manage this important information for future workforce planning.

Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.

Painful nipples in nursing mothers: fungal or staphylococcal?

Painful nipples, or ‘breast thrush’, in nursing mothers is a well recognised condition. It is a clinical diagnosis characterised by intense nipple pain often radiating into the breast, especially during breastfeeding. Between feeds it may cause a burning sensation and tenderness; breastfeeding may be abandoned because of it.

Therapeutic Discourse and the American Public Philosophy: On American Liberalism's Troubled Relationship with Psychology

I explore the main currents of postwar American liberalism. One, sociological, emerged in response to the danger of mass movements. Articulated primarily by political sociologists and psychologists and ascendant from the mid-fifties till the mid-seventies, it heralded the "end of ideology." It emphasized stability, elitism, positive science and pluralism; it recast normatively sound politics as logrolling and hard bargaining. I argue that these normative features, attractive when considered in isolation, taken together led to a vicious ad hominem style in accounting for views outside the postwar consensus. It used pseudo-scientific literature in labeling populists, Progressives, Taft conservatives, Goldwaterites, the New Left and others "pathological," viz. mentally ill. Hence, "therapeutic discourse." I argue that philosophical liberalism, which reasserts the role of political theory in working out norms and adjudicating disagreement, is a more profitable way of thinking about and defending from critics liberalism. I take the philosopher John Rawls as the tradition's modern representative. This inquiry is important because the themes of sociological liberalism are making a comeback in American public discourse, and with them perhaps the baggage of therapeutic discourse. I present a cautionary tale.

A theoretical discussion about the clinical value of phenomenology for nurses

This article develops a theoretical discussion related to the value of a phenomenological framework in contributing to contemporary nursing knowledge. Nursing is based on the understanding of patients' personal experiences and their responses to their illness. Phenomenological methodology utilizes the patient's own language to reflect meanings embedded in their health experience.