Nursing care of clients treated with atypical antipsychotics who have a risk of developing metabolic instability and/or type 2 diabetes

Objective : The aim of this article is to present a current discussion related to the nursing care of clients treated with atypical antipsychotic medicines and who have a risk of developing metabolic instability and/or Type 2 diabetes. The importance of such a discussion is to provide both the novice and the experienced nurse with additional knowledge of this current health issue with which to inform their nursing practice.

Discussion : The potential for psychosis to be a chronic condition is very high, and often people require antipsychotic medicine for lengthy periods throughout their lives. Sometimes, treatment is for life. The second generation of antipsychotic medicines was greeted with much enthusiasm since it was better tolerated than the first generation. However, each medication has desired and adverse effects and, when taken for lengthy periods, these effects may produce physical illness. Studies show that the prevalence of Type 2 diabetes and the metabolic syndrome was significantly higher in clients with a chronic psychiatric disorder, particularly schizophrenia.

Conclusions : Metabolic instability, especially weight gain, is associated with some psychotropic medicines. Nursing interventions need to include care assessment, planning, intervention, and evaluation for clients treated with antipsychotic medicines in terms of risk minimization strategies in routine nursing care.

A pilot program of physical activity promotion among clients receiving home and community care

Three Victorian local governments cooperated in a pilot study of physical activity promotion as part of home and community care (HACC) service delivery. Thirty-one people receiving HACC volunteered to participate, including completing the Transtheoretical Stages of Change Exercise Questionnaire and the short-form Stanford Health Assessment Questionnaire (HAQ) just before and at 3 months and 6 months after starting regular self-selected physical activity. Twenty-one participants returned questionnaires at 3 months, and 17 participants returned questionnaires at 6 months. Data were analysed using paired t tests and effect sizes were calculated as mean differences. At 3 months, mean improvements were identified on 6 of the 8 HAQDI (disability index) subscales, and in the overall HAQ-DI score. Improvement in dressing and grooming was preserved at 6 months. At either 3 or 6 months, improvements in dressing and grooming, reach, hygiene, and daily activities, and overall HAQ-DI score exceeded the minimum clinically important difference. No improvements were statistically significant, as is likely in a pilot study with a small sample, however, these results suggest that even very small increases in physical activity may afford clinically meaningful improvements in some areas of physical function required for independent living.

Implementation and evaluation of brief depression and anxiety screening in clients contacting a drug and alcohol service

Introduction and Aims. High prevalence mental health (HPMH) comorbidity is common in clients seeking alcohol and other drug (AOD) treatment yet can remain undetected. Although research has reported on the introduction of screening into AOD services, little research has reported on the processes surrounding the introduction or evaluated its effectiveness.This study reports on the implementation and evaluation of brief anxiety and depression screening within a specialised, publicly funded AOD service in South-East Victoria.
Design and Methods. Study one examined the implementation of standardised HPMH screening with 114 adult clients (Mean age = 35.49, SD = 9.53; 64% male) telephoning an AOD service over a 5 week period. Measures included severity of HPMH problems,AOD use, care plans and referrals. Study two used semistructured interviews with nine staff/managers to evaluate the effectiveness of screening and its impact on service delivery.
Results. Ninety-four per cent of clients were identified at risk of anxiety or depression. Most care plans incorporated counselling, and concurrent referrals commonly involved a general practitioner. Staff and management found systematic screening increased identification and understanding of comorbid issues and enhanced client interaction but impacted on resource requirements.
Discussion and Conclusions. Most AOD treatment seekers were identified HPMH comorbid and care plans generally included counselling.Adjunctive referrals were more common for severely depressed clients. Screening was effective and enhanced client rapport.Evaluations revealed low confidence in treating HPMH issues in-house.Training may increase worker confidence in managing mental health interventions with subclinical cases, enhancing services’ ability to move towards dual diagnosis capability.

A needs based methodology for classifying construction clients and selecting contractors : comment

This note is a comment on Chinyio, E.A., Olomolaiye, P.O., Kometa, S.T. and Harris, F.C. (1998) A needs based methodology for classifying construction clients and selecting contractors, Construction Management and Economics, 16(1), 91± 8, which describes research aimed at classifying clients by their needs rather than by the traditional public/private/developer approach. The paper also proposes a new method of selecting contractors by matching clients’ needs to contractors’ ability to satisfy them. The note offers constructive criticism of some aspects of the analysis.

Captured by the game : might a focus on the ‘therapeutic relationship’ diminish the attention we give to the client’s intimate network?

A recent project sought to clarify how psychotherapists and mental health workers understand psychosocial health and pathology. In this enquiry, I paid particular attention to the client’s interpersonal networks: did the professionals actively consider, and if so to what extent, ‘intimate social and family relationships’ in constructing their understanding of the presenting problem and in the process they used for goal setting. Twenty-two semi-structured interviews were undertaken, eleven with psychotherapists and eleven with mental health workers. Across both groups, interviewees tended not to see their clients as embedded, relational entities, but primarily, often quite exclusively, as autonomous beings. Second, interviewees accorded a high value to the importance of ‘the therapeutic relationship’. Is it possible that the emphasis practitioners place on ‘the therapeutic relationship’ has the effect of marginalising the attention that is given to the client’s significant-other network

Pathways to non-complex assistive technology for HACC clients in WA : full report

The project aims to identify, evaluate and make recommendations to improve the pathways by which West Australian (WA) Home and Community Care (HACC) clients access daily living equipment. Otherwise known as assistive technology (AT), these devices are largely non-complex and often low cost. Funded by HACC and conducted within the context of the WA Assessment Framework (WAAF), the project seeks to answer the following question:

The vortex of violence : moving beyond the cycle and engaging clients in change

This article introduces the conceptual practice tool of ‘The Vortex of Violence’ and one suggested practice model for utilising the vortex of violence in practice with women who have experienced a domestic violence relationship. The practice tool and model are an expansion of ‘The Cycle of Violence’ that shifts the focus from explanation of the dynamics of abusive relationships to the exploration of the lived experience of women and the development of a personal/therapeutic template for healing and reclaiming of their lives.

Beyond speech alone guidelines for practitioners providing counselling services to clients with disabilities and complex communication needs

Contains guidelines for practitioners providing counselling services to clients with disabilities, and those with complex communication needs.

The role of a community kitchen for clients in a socio-economically disadvantaged neighbourhood

Issue addressed: To investigate the role of a community kitchen for clients living in a socio-economically disadvantaged neighbourhood. Methods: In 2005, semi-structured interviews were conducted with 21 clients attending a community kitchen located in a socio-economically disadvantaged neighbourhood in New South Wales. Participants were asked their reasons for attending the kitchen. Qualitative content analysis was used to categorise verbatim responses to the open-ended questions. Results: The main reasons participants attended the community kitchen were to alleviate food insecurity and the opportunity to interact socially in a safe place, followed by obtaining advice on a broad range of services to address health and social problems. Conclusions: The community kitchen had a positive effect on the lives of socially isolated people who are usually hard to reach, by providing meals, and facilitating social interaction and access to a wide range of services.

The performance of open-end Brazilian fixed income mutual funds for retail clients

From a financial perspective, this dissertation analyzes the Brazilian mutual fund industry performance for an average retail client. The most representative funds for the local population, that are the fixed income open-end ones, will be selected and their performance will be measured aiming to answer if clients of this industry obtained a proper return over their investments in the period between August 2010 and August 2013. A proper return will be understood as the preservation of the purchasing power of the individual´s savings, what is achieved with a positive performance of a mutual fund after discounting taxes, administrative fees and inflation. After obtaining an answer for the previous question, this dissertation will explore a possible alternative solution: Tesouro Direto, that is an example of a financial approach that could foster the disintermediation between savings and investments through electronic channels. New electronic platforms, with a broader scope, could be utilized to increase the efficiency of funding productive investments through better remunerating Brazilian savings. Tesouro Direto may point towards a new paradigm.