Abstract: The author explores possible approaches to the ethical dilemma confronting nurses of critically ill premature infants with an uncertain or futile outcome despite aggressive neonatal intensive care. A case history illustrates the issues. The morality of nursing decisions based on deontological and utilitarian principles is examined, as are the concepts of beneficence and non-maleficence. A fusion of virtue ethics and the ethic of care is suggested as appropriate for ethical decision-making in the neonatal intensive care environment.

Abstract: A survey of Registered Nurse to assess educational needs in areas of 1. Drug dosage calculations. 2. Strength and dilution of solutions. 3. Calculation of Intravenous Drug Times

Abstract: This article examines the environmental stressors that cause occupational stress for many nurses, particularly the health reforms and the Employment Contracts Act (ECA). The concept of stress is reviewed and theories of occupational stress are described, including the demand-control theory and the transactional model. Nurses are advised to become aware of occupational stress in their workplaces, citing a study by the author showing high levels of stress among hospital nurses.

Abstract: The author examines the impact of poor housing on health, and looks at how the situation can be improved. Ways that nurses can work towards improving housing standards and thus health are discussed.

Abstract: The purpose of this paper was to observe the effectiveness of continuous intravenous narcotic infusions as a means of pain relief in the first 48 hours post operatively. 12 patients who had experienced major thoracic or abdominal surgery participated in the study. Pain was assessed at rest and on activity on visual analogues at 5 specific times daily for up to 48 hours post operatively. Data was also collected from a structured interview within the first 48 hours and a retrospective interview when the infusion was discontinued. Results indicated- 1. Very little correlation of changes in pain relief dose to the assessment of pain intensity. 2. Documentation and assessment was not always thoroughly completed. 3. Inadequate treatment of pain post operatively was evident especially on activity. It should be emphasised that pain management could be improved through a focus in interdisciplinary consultation, continuing in service education on pain management and accountability in procedure.

Abstract: The authors review the literature on the residual effects of Guillain-Barre Syndrome (GBS), which can include fatigue, foot drop or numbness, reduced mobility and nerve tingling. In GBS the peripheral nerves are attacked by the body's defence system, an auto-immune attack, and as a result, the myelin sheath and axons of nerves are impaired. The pathophysiology of the illness and long term effects are presented, and implications for nursing care and rehabilitation are discussed. Two case studies are included which illustrate coping with the long-term effects of GBS, the effect of GBS residuals on extreme fatigue and depression.

Abstract: The author reviews the controversial treatment of electroconvulsive therapy (ECT) which has re-emerged as a safe and effective treatment for major depressive disorders. She first addresses the popular conceptions of ECT, which are based on early misuse of the treatment when it was delivered unmodified, or forcefully and without anaesthetic. She then uses a case study to illustrate the benefits of ECT for catatonia and catatonic states. Diagnostic criteria for catatonia include motoric immobility, excessive motor activity, extreme negativism or mutism, peculiarities of voluntary movement, and echolalia or echopraxia. The treatment of a patient is detailed, and the role of the ECT nurse is outlined. The ECT nurse is a co-ordinator, an educator, liaises with other services and families, and is a point of contact about ECT within the mental health service generally and in the ECT unit in particular. The case study showed successful use of ECT. A series of eight ECT treatments were administered to the catatonic patient, after which he was discharged home with minor depression and showing signs of enjoying life once again.

Abstract: In this article the authors introduce an alternative way that nurses can be with families, using a relational process that can enhance nurses' responses when working with those transitioning to parenthood. Seasons of Life, a framework adapted from the Maori health model He Korowai Oranga, emerged from practice to offer a compassionate and encouraging stance, while at the same time respecting each family's realities and wishes. The model allows the exploration of the transition to parenthood within a wellness model, and takes a strengths-based approach to emotional distress. This approach provides a sense of “normality”, rather than of pathology, for the emotions experienced by new parents. The specific issues men may face are discussed, where despite recent culture change that allows men a more nurturing parental role, there is still no clear understanding of how men articulate their sense of pleasure or distress at this time. Practitioners are encouraged to examine their own assumptions, values and beliefs, and utilise tools such as reflective listening, respect, insight and understanding. The most significant aspect of relationship between nurse and parents is not the outcome, but how nurses engage with families. Examples from practice will demonstrate some of the differing ways this relational process framework has been effective.