The Canadian nurse
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About 20 per cent of pregnant women experience antenatal depression (AD), which not only has deleterious effects on the woman and her baby but also increases the risk of developing postpartum depression. Nurses who understand the prevalence, signs and symptoms, and risk factors associated with AD can help to identify it and prevent the sequelae. The signs and symptoms of depression in pregnancy do not differ from depression at at any other time. ⋯ Most of the standard treatments for depression can be used in pregnant women, with the exception of some antidepressant medications. Supportive therapies--exercise, adequate nutrition, adequate sleep, and support from family and friends--are also indicated. Screening of women with known risk factors is crucial, but the authors suggest that the high overall prevalence of depressive symptoms during pregnancy indicates a need for universal screening.
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The authors use a case study to illustrate the risks of delirium in older adult patients and discuss ways to prevent, identify and manage its occurrence. An estimated 60 to 80 per cent of hospitalized frail older adults experience at least one preventable episode of delirium, often leading to prolonged hospitalization, functional decline, increased morbidity and eventual nursing home placement or death. Delirium is a medical emergency, characterized by acute onset and a fluctuating course that is demonstrated by abrupt changes in mental status and function. ⋯ Although delirium is amenable to expert nursing care, it is unrecognized or misdiagnosed in up to 70 per cent of older patients. Delirium results from the interplay of multiple forces associated with illness in the older adult, including drugs, substance abuse, metabolic disturbances, nutritional deficiencies, fluid disturbances, acute trauma or illness, infection and impaired physical or functional ability A proactive strategy for delirium prevention and treatment targets defined risk factors and the management of physiologic factors that precipitate delirium. It includes assessment, therapeutic environmental modification, standardized protocols for physiological interventions and staff education.
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Safe, effective and ethical nurse staffing requires that there is a sufficient number and appropriate use and mix of competent nurses available to care for patients. Because of its close connections with patient safety, nurse staffing has become an important concern for governments, health-care providers and the public. ⋯ The report findings were discussed at a roundtable of decision-makers and experts, and these deliberations and the literature evidence were used to create the final synthesis. The authors present one of the key recommendations for nurse staffing that arose from the synthesis.
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In 2003, the Canadian Association of Advanced Practice Nurses (CAAPN), with an educational grant from Purdue Pharma Canada, conducted a web-based survey to examine the pain management practices of advanced practice nurses (APNs). The survey objectives were to explore the role of APNs with respect to the treatment of pain, to determine the extent of their influence over treatment outcomes of patients with pain and to ascertain their level of knowledge of controlled-release pain medication. ⋯ Other results support the current literature that identifies lack of knowledge, education and experience as barriers to pain management practice, influencing the decision to prescribe pain medication. APNs need the tools to develop and implement effective pain management plans for their patients.
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Barriers to implementing research in clinical nursing practice have long been a concern, both to the nursing profession and to managers involved in the delivery of optimal, evidence-based and cost-effective patient care. In this article, American, Australian and Canadian studies of nurses' perceptions of these barriers are reviewed. The author then presents the findings of her study of perceptions of the barriers to research implementation in a sample of 25 nursing professionals in Ontario. ⋯ Participants rated setting characteristics as the most important barrier to research utilization. They rated nurse characteristics as relatively less important, although the results did raise a question about nurses' possible externalization or abdication of responsibility. The author makes a number of recommendations to address these perceived barriers.