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The recent emphasis on community care for those with mental illness has changed working patterns and modified inter-professional role boundaries within multi-disciplinary teams. Clients with serious mental illness are usually prescribed medications, which have a wide range of side effects. However, it is uncertain who is responsible for monitoring clients for the side effects of their medications, ensuring clients' and carers' understandings of their prescribed medications and optimizing compliance with medication. This paper discusses the findings of the first phase of an ongoing study designed to assess the role of community mental health nurses (CMHNs) in managing clients' medication and the provision of appropriate continuing professional education. Our respondents were 14 CMHNs, seven of whom were preparing to undertake a pharmacology module as part of a higher education diploma, and seven who were to act as comparators. Data from questionnaires, interviews and clinical observations were triangulated. All respondents felt that issues surrounding clients' medication were not accorded a sufficiently high profile and that it was, in part, their responsibility to expand their roles to meet these unmet needs of clients. Administering and managing clients' medications were considered to be the main area of 'occupational territory' which distinguished CMHNs from social workers. However, the nurses felt that their practice was limited by lack of appropriate educational preparation. [ABSTRACT FROM AUTHOR]

Moral certainty and uncertainty have a profound impact on nurses' ethical choices. In order to describe these concepts, the author examined long-term care nurses' convictions about the issue of withholding or withdrawing artificial nutrition and hydration from elders. A convenience sample of 25 BSN and MSN-prepared long-term care nurses were interviewed and asked to describe their experiences with this issue. A qualitative analysis utilizing Colaizzi's (1978) methodology was performed. Five categories of conviction emerged from the data. These five categories included absolute moral conviction, strong moral conviction, moderate moral conviction, moral uncertainty with conviction and moral uncertainty. Eighty-four per cent of the sample was convinced that tube feeding was not always in the resident's best interest. Sixteen per cent of the sample were uncertain, but were convinced that the resident should not suffer. A pattern emerged from the interview results and the answers to three additional questions. The pattern suggests that the more experience a nurse has with nontreatment the more likely she or he is to agree with it. In this paper. the five categories of conviction are compared and contrasted, the pattern of conviction described, and the implications of the findings for nursing discussed. [ABSTRACT FROM AUTHOR]