Community treatment orders (CTOs) are legal mechanisms by which an individual with a mental illness and a history of non-compliance and potential for violence can be mandated (against their will) to undergo psychiatric treatment in an outpatient setting. Although CTOs are increasingly being adopted by governments as a means of protecting both mentally ill persons and society itself, their use continues to stimulate considerable debate. While there is some evidence of their potential benefits in promoting treatment compliance and reducing hospital stays, there is concern that they infringe on the mental health client's human rights and freedoms. Consideration of the ethical and practical implications of the use of CTOs must continue. In this paper, some of the most pressing issues are identified and discussed.
Fetal health surveillance is a significant everyday work responsibility for labor and delivery nurses. Here, nursing care is increasingly focused on technological interventions, particularly with the use of continuous electronic fetal monitoring. Using Institutional Ethnography, we explored how nurses conduct this work and uncovered the ruling relations coordinating how nurses “do” fetal health surveillance. Analysis revealed how these powerful ruling relations associated with the biomedical and medical-legal discourses coordinated nurses’ fetal monitoring work. Forms requiring documentation of biophysical data caused nurses to focus on technological interventions with much less attention given to holistic and supportive care measures. In doing so, nurses inadvertently activated and participated in these powerful ruling discourses. The practice of ensuring the safe birth of the baby through advances in technological surveillance and medical interventions took priority over well-established approaches to holistic nursing care.
Patients have expressed difficulty accurately distinguishing registered nurses (RNs) from other hospital personnel because standardized uniforms are no longer worn by RNs. According to American studies, such complaints are widespread; moreover, patients' perceptions of nurse caring and competence and of other traits associated with nurses' professional image have been negatively affected by casual, non-conventional attire. As there are no published Canadian studies, we conducted a pilot study to examine patient perception of the nurse uniform. Adult patients viewed photographs of the same RN dressed in eight different uniforms and rated each uniform according to 10 traits associated with nurses' professional image. The white pantsuit scored higher for professionalism than uniforms with small print, bold print, or solid colour, and most patients preferred that the RN dress in white. Our preliminary findings suggest that RN attire warrants further investigation, and we are planning a large-scale, fully powered study to inform patient-driven change to existing uniform policies.
Background The quality of Registered Nurses’ worklife is impacting nurses’ mental health, and the standard of care received by clients. Contributing factors to nurses’ stress are the trauma of continuous caring for those in great suffering, and adverse working conditions. Objectives i) to explore the prevalence of work-related stress in a provincial sample of Registered Nurses; ii) to compare the levels of compassion satisfaction, burnout and secondary traumatic stress reported by nurses in hospital, community, non-direct care settings, and, iii) to identify factors that predict levels of nursing work stress. Methods A descriptive, predictive study with a self-report survey containing demographic questions and the Professional Quality of Life Scale was emailed to over 3,300 Registered Nurses. The scale measured the prevalence of three worklife indicators, compassion satisfaction, burnout and secondary traumatic stress. Multiple linear regression identified factors that predicted the levels of the three indicators. A subgroup analysis explored the quality of worklife based on three practice environments. Findings Nurses (n = 661) reported moderate compassion satisfaction, burnout, and secondary traumatic stress. The strongest predictor, satisfaction with one's current job, predicted high compassion satisfaction and lower burnout and secondary stress. The subgroup analysis identified hospital nurses as having the most work-related stress and the lowest level of compassion satisfaction. Conclusion Innovative, collaborative action can transform nurses’ practice environments. Organizational support is essential to bring about needed improvements.
There is considerable debate concerning the use of Community Treatment Orders (CTOs) in mental health practice. CTOs mandate individuals with mental illness to engage in community treatment (e.g. medication or other therapy) against their will (CMHA, 1998). The purpose of this presentation is to present the preliminary findings of a study using Institutional Ethnography (IE) that is exploring the consideration and implementation of CTOs in Newfoundland and Labrador, Canada. Interestingly, this province has CTO implementation rates that are far less than the Canadian average. Using IE offers the potential to elucidate the everyday work/life experiences occurring within an institution and to show how they are influenced by institutional social structures and discourses known as ruling relations (Smith, 2005). Participants in this study include clients, family members, and health professionals who have experience with the consideration or use of CTOs in mental health settings. Data collected through interviews and review of institutional documents are examined for evidence of the social web of influence that governs everyday actions. These social and ruling relations are mapped in accordance to their relationship to and influence over one another. The results obtained are of considerable interest to practitioners, advocacy groups, families, and individuals with mental health concerns. In bringing these social patterns and structures to light, there is hope that the resulting awareness will foster a greater willingness for individuals involved with CTOs and the mental health system to engage with one another on a more meaningful level.
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