A review of problem gambling in forensic populations suggests that one third of criminal offenders meet criteria for problem or pathological gambling. This is the highest rate yet found in any population. Approximately 50% of crime by incarcerated problem and pathological gamblers is reportedly committed to support gambling. The prevalence of gambling within correctional facilities (40%) appears lower than in the general population. However, inmates who do gamble tend to do so regularly, and problem and pathological gamblers are disproportionately represented among this group. Inmate screening for problem gambling and provision of specialized treatment are currently lacking in most correctional facilities. In addition to more screening and treatment, there needs to be greater vigilance in detecting gambling and enforcing its prohibition.T he past 20 years have seen a wide expansion in the availability and acceptability of legalized gambling. As a consequence, more people are participating in gambling and more people are developing gambling-related problems. Past year prevalence rates for problem and pathological gambling ranges from 0.5% to 4.0% depending on 665

1. Physical aggression toward nursing staff by confused elderly residents is a very common and frustrating clinical nursing problem in long-term care facilities. 2. Some physical aggression may be associated with a lack of knowledge about dementia, therefore staff inservice education may be one way of reducing some forms of physical aggression. 3. The authors found a 50% reduction in reported physical aggression from elderly residents after a staff education program on dementia and aggression was implemented.

While researchers have documented the significant issue of moral distress among nurses, few have explored moral distress among mental health nurses. In addition, no research to date has explored nursing students' experiences of moral distress during mental health clinical rotations, despite nursing students typically reporting negative attitudes towards mental health nursing. This manuscript reports on a qualitative study involving seven Canadian baccalaureate nursing students, who reported on their experiences of moral distress during a 13-week clinical rotation on inpatient psychiatric units. Overall, nursing students reported significant moral distress related to the perceived lack of nurses talking meaningfully to patients on the unit, a hierarchical power structure for physicians, a lack of information given to patients about their psychiatric medications, and an inability of their nursing instructors to advocate for ethical change on the units. Several students made a specific connection between their moral distress and not wanting to pursue a career in mental health nursing.

Objective Moral distress is increasingly being recognized as a concern for health care professionals. The purpose of this study was to explore the nature and prevalence of moral distress among nursing staff who care for people living with dementia. Methods This study was focused on nursing staff caring for people with dementia in long-term care and assisted living sites. The Moral Distress in Dementia Care Survey instrument was distributed to 23 sites and nursing staff rated the frequency and severity of situations that were identified as potentially causing moral distress. Results Moral distress is prevalent in the nursing staff who provide dementia care. Nursing staff reported experiencing moral distress at least daily or weekly. Both frequency and severity of moral distress increased with proximity to (amount of time spent at) the bedside. Moral distress had negative psychological and physiological effects on nursing staff, and affected intention to quit.

We sought to estimate the incidence of long-term care (LTC) placement and to identify resident- and facility-level predictors of placement among older residents of designated assisted living (AL) facilities in Alberta, Canada. Included were 1,086 AL residents from 59 facilities. Research nurses completed interRAI-AL resident assessments and interviewed family caregivers and administrators. Predictors of placement were identified with multivariable Cox proportional hazards models. The cumulative incidence of LTC admission was 18.3 per cent by 12 months. Significantly increased risk for placement was evident for older residents and those with poor social relationships, little involvement in activities, cognitive and/or functional impairment, health instability, recent falls and hospitalizations/emergency department visits, and severe bladder incontinence. Residents from larger facilities, with an LPN and/or RN on-site 24/7 and with an affiliated primary care physician, showed lower risk of placement. Our findings highlight clinical and policy areas where targeted interventions may delay LTC admissions.