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Biomedical subjects

M Crowe

Publications and source records attributed to M Crowe.

At least 19 recordsLinked to original sources
PubMed2000

Psychiatric diagnosis: some implications for mental health nursing care.

Psychiatric diagnosis: some implications for mental health nursing care This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.

Attitude of Health Personnel↗
PubMed2000

The nurse-patient relationship: a consideration of its discursive context.

This paper is a theoretical exploration of the discursive context that shapes the nurse-patient relationship. It represents a feminist poststructural consideration of the broader institutional and social context that influences the dynamics of that relationship. The characteristics of that relationship can be regarded as performances of subjectivity shaped by managerial, medical and nursing discourses. Both nurse and patient signify particular discursively constituted meanings to each other which shape the relationship. It is proposed that the discourses which inform how each should respond to the other encourage the utilization of disciplinary tactics by the nurse which relay to the patient what is expected of him/her. An effect of these disciplinary procedures is to rein in the caring potential of nursing practices. However, nursing's relationship with women's work and the social history of caring may provide it with a discursive context that recognizes the social significance of this work.

Empathy↗
PubMed1999

Mad talk: attending to the language of distress.

This paper will examine how the narrative of one woman, Madeleine, can be constructed as symptomatic of the diagnosis of schizophrenia, and how it can also be read from other perspectives, particularly a poststructural feminist one. The readings are presented as possibilities for understanding the woman's experiences and the implications of this for mental health nursing practice. A poststructural feminist reading acknowledges the gendered experiences of subjectivity and how those experiences are constructed in language. The purpose of this paper is to identify for mental health nursing practice an approach which recognizes the figurative and literal characteristics of language in order to provide nursing care which positions the individual's experience of mental distress as central. This requires an acknowledgement of Madeleine's path into mental distress rather than simply a categorization of what is observed in a clinical setting. Intervention may need to include a range of strategies: medical and nonmedical, psychotherapeutic and social, physical and environmental. It may also require the provision of sanctuary and security whilst these options are explored.

Attitude to Health↗
PubMed1998

GBV-C/HGV coinfection in HIV-1-positive men: frequent detection of viral RNA in blood plasma but absence from seminal fluid plasma.

Sequential paired samples of blood and seminal fluid were obtained from a cohort of 54 HIV-1-infected homosexual males. The prevalence of GBV-C/HGV RNA in the cell-free fractions of some of these patients was determined using reverse-transcription polymerase chain reaction (RT-PCR). To assess the effects of HIV-1 and HCV infection upon GBV-C/HGV RNA status, blood CD4 cell counts, HCV RNA status, and HIV-1 proviral DNA and viral RNA titres were also determined. GBV-C/HGV RNA was detected in 8/30 (27%) of the blood plasma samples obtained at the start of the study, and was present at a frequency of 14/64 (22%) in all the blood plasma samples tested. By contrast, GBV-C/HGV RNA was not detected in the 26 seminal fluid samples obtained at the start of the study, including 8 samples obtained from patients for which GBV-C/HGV RNA was detected in the corresponding blood sample. Of the samples tested for the presence of both GBV-C/HGV and HCV RNA, there was no evidence of coinfection. Although GBV-C/HGV RNA detection rates were significantly higher in individuals with blood CD4 cell counts greater than 200 cells per microlitre, there were no significant differences in the median blood CD4 cell counts or HIV-1 proviral DNA or viral RNA titres observed between the GBV-C/HGV-positive and -negative individuals. The failure to detect GBV-C/HGV RNA in seminal fluid samples obtained from this cohort would suggest that further studies need to be carried out to determine the roles of sexual transmission and of seminal fluid in GBV-C/HGV infection.

CD4 Lymphocyte Count↗
PubMed1998

Surveillance of an adult intensive care unit for long-term persistence of a multi-resistant strain of Acinetobacter baumannii.

Sporadic infections with Acinetobacter spp., punctuated with prolonged outbreaks of infection involving larger numbers of patients and a particular epidemic strain of Acinetobacter baumannii, have occurred in the adult intensive care unit (ICU) of Nottingham University Hospital since 1985. The aim of this study was to screen patients admitted to the ICU for three or more days during a non-outbreak period in 1994-1995 and to use DNA fingerprinting techniques to compare any isolates of Acinetobacter spp. with isolates obtained from the same ICU during the previous ten years. In the present study, almost 20% of the ICU patients screened during 1994-1995 became colonized with Acinetobacter spp. The commonest species isolated from patients was Acinetobacter baumannii; five different strains were identified by random amplified polymorphic DNA fingerprinting, including the epidemic strain responsible for outbreaks of infection in 1985-1986 and 1992-1993. Environmental sampling yielded Acinetobacter spp. from one or more samples on four occasions; Acinetobacter radioresistens was the commonest species isolated, and Acinetobacter baumannii (not the epidemic strain) was isolated on only one occasion from the environment. The long-term persistence of a potentially epidemic strain in the ICU, even during a non-outbreak period, indicates a need for continued vigilance. Consequently, periodic patient and environmental surveillance, combined with typing of isolates, is recommended for ICUs where significant outbreaks of Acinetobacter infection have occurred in the past.

Acinetobacter↗
PubMed1998

Bacteraemia in the adult intensive care unit of a teaching hospital in Nottingham, UK, 1985-1996.

Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the possible risk factors associated with bacteraemia, and outcome. The incidence of bacteraemia and fungaemia increased from 17.7 per 1000 admissions in 1985 to 80.3 in 1996. A total of 315 episodes of bacteraemia and fungaemia were documented over a 12-year period, of which 18% were considered community-acquired and 82% hospital-acquired. Gram-positive and gram-negative bacteria accounted for 46.9% and 31.5% of the episodes, respectively. Polymicrobial infection accounted for 17.8% and fungi for 3.8% of the episodes. Staphylococcus aureus (22.5%), Staphylococcus epidermidis (7.6%), and Streptococcus pneumoniae (7.9%) were the predominant gram-positive bacteria implicated, whereas Escherichia coli (6%), Enterobacter cloacae (7%), Klebsiella aerogenes (3.8%), Pseudomonas aeruginosa (5.1%), and Acinetobacter spp. (3.8%) were the predominant gram-negative bacteria isolated. The two most common sources of infection were the respiratory tract (39.7%) and an intravascular line (24.5%), but in 8.9% of episodes the focus of infection remained unknown. Bacteraemic patients stayed in the unit for a longer period (12 days) than did non-bacteraemic patients (3 days). The overall mortality related to bacteraemia and candidaemia was 44.4%. Surveillance of bacteraemia in the intensive care unit is important in detecting major changes in aetiology, e.g., the increasing incidence of gram-positive bacteraemia, the emergence of methicillin-resistant Staphylococcus aureus in 1995, and the emergence of Enterobacter cloacae. It is of value in determining empirical antimicrobial therapy to treat presumed infection pending a microbiological diagnosis and in directing the development of guidelines for infection prevention, e.g., guidelines for central venous catheter care.

Adolescent↗
PubMed1998

The power of the word: some post-structural considerations of qualitative approaches in nursing research.

This paper takes a post-structural position to discuss some issues related to the use of qualitative research methodologies in nursing research. Two fundamental assumptions which underpin qualitative approaches are explored in relation to how subjectivity is constructed in the process of data collection. These assumptions reveal an ideological position which proposes that reality can be apprehended by capturing the individual's point of view (subjectivity) and that qualitative researchers can directly represent this lived experience in language (linguistic representation). Post-structural approaches challenge these assumptions which are often an uncritically accepted part of the common sense world and therefore taken to be natural. It proposes that these views of subjectivity and language are not natural but rather cultural. There is a recognition of the wider sociopolitical and historical context in which nursing research takes place and a displacement of normative constructions of subjectivity. It provides nursing with the possibility of challenging existing power structures which determine the individual's experiences of health and illness.

Bias↗
PubMed1998

Developing advanced mental health nursing practice: a process of change.

In the current economic climate of restructuring and rationalization it is important for mental health nurses to define their realm of expertise in order to demonstrate professional accountability and to validate their position in relation to unqualified but cheaper caregivers. If mental health nurses are to act in the best interests of patients and the community, they need to challenge current trends in health-care delivery that are preoccupied with economic efficiency and lack of consideration of broader social issues. To substantiate mental health nursing practice and defend against the undermining of clinical expertise by policies and service delivery that advances economic interests, mental health nurses need to corroborate their claims to expertise by articulating a patient-centred rationale for their practice. The ideas presented in this paper have evolved through the development of two postgraduate programmes for advanced mental health nursing practice--one in Australia at Griffith University and the other in New Zealand at the Department of Psychological Medicine, Christchurch School of Medicine.

Clinical Nursing Research↗
PubMed1997

Becoming a registered nurse.

This paper describes research carried out with clinical agencies and former students to ascertain the effectiveness of curriculum design within the third year of a problem-based Bachelor of Nursing programme. It shows that where holistic care, time management, prioritization of care, working as a team member, and sophisticated clinical reasoning were introduced as deliberate strategies in students' learning, the transition to the workplace was more successful.

Clinical Competence↗
PubMed1997

An analysis of the sociopolitical context of mental health nursing practice.

This paper will explore the delivery of mental health nursing care within a neo-liberal model of mental health care delivery in New Zealand. Mental health nursing as a socially constructed activity occurs within a particular political context, which determines its role and function. This environment determines the nature of the nurse-patient relationship which is integral to the role of mental health nurses. Critical analysis of the New Zealand Government's neo-liberal health policies will be conducted to explore their effect on mental health care delivery and the nurse-patient relationship. Some of the ideologies and values maintained by current dominant discourses within nursing and the State are discussed. To establish therapeutic partnerships with service-users, mental health nurses are urged to critically analyse their practice and the context in which it occurs.

Delivery of Health Care↗
PubMed1996

Clinical features and antibiotic treatment of septic arthritis and osteomyelitis due to Yersinia enterocolitica.

Yersinia enterocolitica bone and joint infections are rare. Over a period of 7 months four patients with deep-seated skeletal infections due to Y. enterocolitica were seen at the University Hospital, Nottingham. Sites of infection included the knee (one patient) the hip (one) and the spine (two). None of the patients had major underlying disease or risk factors for developing invasive Y. enterocolitica infection. The organisms were sensitive to the second- and third-generation cephalosporins, gentamicin and fluoroquinolones. A literature search covering the period 1970-1994 revealed 20 other cases of skeletal infections due to Y. enterocolitica; there was no uniformity in the choice of antimicrobial agent for treating these infections. Oral ciprofloxacin was used as the principal antimicrobial agent in the patients described here and therapeutic success was achieved in three of these patients. Ciprofloxacin should be considered as first line therapy for invasive infections due to Y enterocolitica.

Administration, Oral↗
PubMed1996

Establishing a therapeutic milieu with adolescents.

Adolescents with acute psychiatric illness need an environment that emphasizes containment, structure, support, involvement and validation. Within such an environment therapeutic relations based on collaboration can be developed. However, these relations require nursing actions that facilitate adolescents' acceptance of containment, their ability to form attachments and development of achievement. The proposed collaborative approach for nursing care positions the adolescent as an active participant in the treatment process. The collaborative approach encourages a sense of responsibility for self and enhances the adolescent's skills to cope with situations and relations that pose difficulties through the development of self-awareness and problem-solving abilities.

Adolescent↗
PubMed1996

Cutting up: signifying the unspeakable.

This article uses a feminist framework to explore women's self-injurious behaviour in response to abuse. It deals specifically with 'cutting up' as a response to physical or sexual abuse. The position pursued regards the body as an inscriptive surface that provides an interface between subject/object and explores how women may lack a means by which to signify to others what their experience means to them. The language available to women does not always provide an adequate means of self-expression. This inadequacy of language often leaves women with no option but the use of non-verbal corporeal inscription. It is proposed in this paper that 'cutting up' is a means of establishing a sense of self while perpetuating a sense of the body as a site for abuse. Discursive constructions of femininity and mental illness perpetuate both the abuse and what is being signified by the act of 'cutting up'. It is argued that this framework for understanding self-injurious behaviours will provide the mental health nurse with an approach to nursing interventions that acknowledges the woman's needs, while at the same time offering the opportunity to signify distress in a manner that does not perpetuate the body's role as an object of abuse.

Child↗
PubMed1995

Clinical and epidemiological features of an outbreak of acinetobacter infection in an intensive therapy unit.

Sporadic examples of infection with multi-resistant Acinetobacter spp. have occurred in Nottingham hospitals since at least 1977, punctuated by more prolonged outbreaks involving larger numbers of patients, particularly those confined to the intensive therapy unit (ITU) with severe underlying disease. In the most recent outbreak, 11 patients were infected with multi-resistant Acinetobacter strains and 26 patients were colonised. Four of the infected patients died directly or indirectly from infection with multi-resistant Acinetobacter spp., either while in the ITU or after discharge to a general ward. The mean interval from admission to the first isolation of a multi-resistant Acinetobacter strain was 6.7 and 12.1 days in the infected and colonised groups, respectively. Multi-resistant Acinetobacter strains were isolated most frequently from the respiratory tract, and eight patients had probable or suspected pneumonia caused by a multi-resistant Acinetobacter sp. All infected patients were treated with imipenem, with or without an aminoglycoside, except one patient who died before a diagnosis of acinetobacter infection was confirmed. Multi-resistant Acinetobacter spp. were isolated from various environmental sites in the ITU, and patient and environmental isolates were found to be related closely by biotyping, antibiograms, pulsed-field gel electrophoresis of chromosomal fingerprints and ribotyping. The outbreak was controlled ultimately by transfer of infected or colonised patients to an isolation cubicle, cohort nursing, emphasis on the importance of hand washing before and after patient contact and when handling case notes, and the use of disposable aprons and gowns during patient contact.(ABSTRACT TRUNCATED AT 250 WORDS)

Acinetobacter↗