This paper presents the findings from a study undertaken to describe nursing practice in one dual diagnosis (DD; coexisting mental illness and intellectual disability) inpatient unit in New Zealand. A focused ethnographic approach (using fieldwork observations, a review of documents, and five semistructured interviews) was used to gather data. A model of culture was used to analyze data to allow a description of DD nursing practice. Additionally, this framework allowed for an exploration of the artefacts, values, and assumptions that underpin these practices. Three key themes emerged from the data: keeping everyone safe, managing the complexities in assessment, and narrating their work. Together, these themes indicate that in the absence of a defined model of DD nursing, practice is based on an institutional psychiatric model. We argue that DD nursing models need to be made explicit in order to advance nursing in this area.
The 'no-suicide contract' is a frequently utilized tool in both the assessment and dispersal of suicidal patients. However, little attention has been given to questioning whether suicidal persons are able to give informed consent to enter such a contract. This article utilizes both the existing literature on no-suicide contracts and the results of recent research into the effects of this tool, to examine whether its use is consistent with the legal and ethical doctrine of informed consent. Particular attention is given to issues of competence, fullness of information, voluntariness and paternalistic intervention when no-suicide contracts are used. This analysis finds the tool to be problematic and suggests that individual patients' ability to give informed consent about a no-suicide contract needs to be carefully considered by clinicians.
No-suicide contracts" (NSCs) are commonly used in community crisis situations. Eight patients and nine nurses were interviewed to explore both how NSCs affect clinical outcomes and how suicidal persons experience their usage. The results suggest that suicide management decisions may be negatively affected and that some patients find the use of the tool to be unhelpful. While further research is needed, the results of this study suggest that careful consideration be given before NSCs are used in community crisis situations. [Brief Treatment and Crisis Intervention 3:241-246 (2002)]
'No suicide contracts' (NSCs) are a tool commonly used by nurses in community crisis situations. At times this tool is utilized because the clinician believes that it is beneficial. However, there are other occasions when NSCs are introduced in a manner that runs counter to the clinical judgement of the crisis nurse. This paper discusses the results of a qualitative study that addressed the question of why nurses use NSCs in such situations, rather than relying on their own expertise. This analysis suggests that underlying concerns of clinicians can determentally affect decision-making in such circumstances, and recommends that rather than subjugating nursing expertise, underlying issues be addressed directly.
Prevalence and perceived importance of inherited disorders influences how clinicians advise their clients. Respondents to this survey provided a number of mechanisms by which inherited disorders may be managed and these could form the basis of future discussions within the profession.
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