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Aims and objectives- The aim of this meta-analysis was to identify the factors that related to aggression (verbal abuse, or physical abuse/assault) perpetrated against the nurse or other health professional by patients/relatives or staff. In light of the paucity of systematic reviews on this common issue in nursing, the objective was to present a comprehensive systematic review and meta-analysis of these papers.\ud Background – Aggression towards nurses is common around the world and can be the impetus for nurses leaving the profession or developing anxiety when working in particular settings.\ud Design- Systematic review with meta-analysis\ud Data Sources- The databases of Medline (1966 to 2015), CINAHL (1982 to 2015) and PsychInfo (1920 to 2015).\ud Methods- Meta-analyses were conducted to assess the effect of the factors of gender and context (dichotomised as mental health/psychiatric or non-mental health/psychiatric).\ud Results - A total of 1571 papers were screened by two reviewers. At the final decision 14 were selected for analysis. A higher proportion of female nurses than male nurses were reported to be the victims of verbal abuse, with the difference in proportions being statistically significant. A statistically significant higher proportion of male nurses than female nurses were reported to be the victims of physical abuse. There was a significantly higher proportion of mental health nurses reported experiencing physical abuse as compared to non-mental health nurses.\ud Conclusions – The analysis reveal female nurses have greater odds of verbal abuse than male nurses and male nurses have greater odds of physical abuse than female nurses. Overall mental health nurses had 3 times higher odds of physical assault than other nurses.\ud Relevance to clinical practice- In light of the findings it is recommended organisational support improve in high aggression potential clinical areas and for nursing curriculums to incorporate education about the management of challenging behaviours in undergraduate programs.

This paper examines and offers a critique of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), underlying principles and assumptions, and the nature and consequences of its nosological framework. The reason for this critique is to look at the rationale for some of the diagnostic categories and also why some categories are retained, including some of the long-standing diagnostic groups, such as schizophrenia. It is not the intention here to rehearse the problems of biological psychiatric thinking, nor argue the strengths and weaknesses of the DSM-IV-TR in its definitions and descriptions of particular syndromes and illnesses. The ideas presented here derive from a range of previous research that argued that the DSM-IV-TR colludes in a system of psychiatric care in which all people, by virtue of characteristically human foibles and idiosyncrasies, are potentially classifiable into a variety of diagnostic mental health categories. In the present study, it was argued that because of resource constraints, professional dispute, and public concern, the major criterion for attracting a formal diagnosis is not classifiability according to the DSM-IV-TR, but rather, that of 'social risk', defined in terms of risk to oneself and/or others and embodying obvious social control functions. Here, we expand and develop some of these ideas, and relate them more specifically to insights offered by critical or deconstructive psychology and the development of the forthcoming the DSM-V.

Problem Based Learning (PBL) using minimal guided instruction is used as an educational strategy across a broad variety of disciplines in the tertiary sector. This paper includes some of the strengths and weaknesses of PBL, both in general and in relation to the health care setting, encompassing some of its philosophical underpinnings and its methodological approach. In an effort to explore some of the benefits and problems with PBL in the work setting, this account will comprise a realistic rather than idealistic focus and will include a range of perspectives from both a facilitator and student standpoint. We suggest that PBL is a useful strategy across a comprehensive nursing degree programme (as the ideal) provided the learning programme is supported financially and that its ideal creed which supports a small group approach are adhered to. What we find is that reality is often different, with individual facilitators condensing their PBL programmes to incorporate a modified PBL approach with this personalized approach often taking strength away from the original conceptions of PBL. What we suggest here is that these circumstances constitute a conundrum.

Background: There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice. Methods: This study comprised of two UK and four Australian Schools of Nursing within Universities. A 12 item survey was developed for the purpose of this study and was checked for face validity by experienced mental health nurses. Convenience sampling was used and 395 responses were received. Results: The comprehensive program represented by the Australian sample, revealed a third of respondents indicated that mental health nursing was definitely not a career option, while only 8 % of the UK specialised program reported mental health nursing was not seven for them. In both groups a higher level of motivation to work in mental health emanated from personal experience and/or work experience/exposure to mental health care. Conclusions: A greater focus on clinical exposure in comprehensive programs could enhance professional experience needed to increase student motivations for mental health nursing.

Personal experiences of aggression or violence in the workplace lead to serious consequences for nurses, their patients, patient care and the organisation as a whole. While there is a plethora of research on this topic, no review is available that identifies types of aggression encountered, individuals perceived to be most at risk and coping strategies for victims. The aim of this systematic review was to examine occupational anxiety related to actual aggression in the workplace for nurses. Databases (MEDLINE, CINAHL and PsycINFO) were searched, resulting in 1543 titles and abstracts. After removal of duplicates and non-relevant titles, 137 papers were read in full. Physical aggression was found to be most frequent in mental health, nursing homes and emergency departments while verbal aggression was more commonly experienced by general nurses. Nurses exposed to verbal or physical abuse often experienced a negative psychological impact post incident.

Nursing as normative praxis The purpose of this paper is twofold. First, it introduces a variety of concepts of ‘praxis’, and argues in support of those which reflect the normative dimension of the critical social perspective. This begins with the Aristotelian concept, and moves through a variety of sources, including Hannah Arendt and Paulo Freire, but focuses primarily, and uniquely in the nursing literature, upon the work of the Yugoslavian ‘praxis Marxists’. Second, specific ways of conceiving nursing as praxis are outlined, including political, aesthetic and ethical forms which have immediate import for nurses. The paper concludes with brief suggestions as to how these ways of conceiving praxis may be used by nurses to develop a more intimate and productive understanding of their own practices.

Is the complexity of care a paradox? This paper looks at the phenomenon known as care and the medium through which it is expressed — caring. It explores some of the meanings of these terms but focuses particularly on nursing care. Superficially, nurses and society have a broad understanding of what ‘care’ means but common usage of the word belies its complexity. When examined alongside the writings of scholars the inconsistent nature of care and caring emerges. We reflect on the difficulties this presents for both the nurse and the cared for when, on the one hand care is promoted as the essence of nursing, while on the other there is no acceptable definition of care on which to base this claim. Encompassed within our discussion is the underlying theme that although care is an appropriate ideal for nursing it does not capture all of the day-to-day realities and hence it is not an overriding ideal. Care in nursing in this sense is contradictory and we describe it as paradoxical.

The authors examine the topic of humour and argue that humour is needed as one of many skills within the nurse patient relationship. We advance the view that humour has been well researched as an agent of therapeutic value and as a communication tool which helps to relieve stress, but, to date is not used to its fullest potential and tends therefore to be underestimated in both general and psychiatric nursing areas. Humour has benefits for both the nurse and the patient having psychological benefits and a vast array of physiological advantages and is regarded by those who use it as a social lubricant acting as a positive in nurse patient relationships. We also argue that it is essential that nurses know when to use humour as timing and appropriateness is imperative in order for it to be most effective. Humour can be used in all areas of clinical nursing practice and may prove useful in being a reliable predictor over the course of a patient's illness. The use of humour can help improve the nurse-patient relationship by initially breaking the ice between nurse and patient. This alternative mode of delivery can then be foundational to other areas of the nurse patient relationship such as self-disclosure, the enhancement of learning and relieving stress. Furthermore, it helps to facilitate and promote mutual health and well being for both the patient and the nurse. The usage of humour in psychiatric nurse settings is discussed and the benefits to both the patients and their staff are outlined as being of immense therapeutic value. The literature perhaps tends to skirt around these benefits somewhat, as psychiatry and laughter in partnership are not really considered important discursive topics.

It is suggested in this paper that DSM-IV serves to psychiatrise everyday life by deconstructing the traditional distinctions between the mentally disordered and the mentally healthy. It allows for continuing psychiatric expansionism by enabling the nosological territory to expand without limit, invading that behavioural area once differentiated as ‘healthy’ or ‘normal'. According to DSM-IV, all people exhibit more or less psychological and behavioural phenomena which can be taken as indicative of mental disorder. In the face of potentially unlimited application, the decision to apply the term ‘mental disorder’ in any particular case is removed from the realm of nosology and re-located within decisions regarding the security of the social system, manifest as risk posed to the individual and the community. It is suggested that psychiatry has thus become a system of risk management and that DSM-IV colludes in and facilitates that strategy.

This paper argues that conceiving nursing as a form of praxis, encompasses amongst other things, the critical reflection upon one's nursing practice in order to work out and understand internal and external constructions of personal theories. This reflective examination will demonstrate the implicit knowing that nurses develop as a result of their personal, day to day practice. Highlighting this knowing and incorporating the richness of their practice experience becomes the basis for their own personal nursing praxis.

HOLMES G.A. & WARELOW P.J. (1997) Journal of Advanced Nursing 25, 463-470Culture, needs and nursing: a critical theory approachThis paper will bring the critique of culture, notably that undertaken by theFrankfurt School of Critical Social Science, to bear on the problem of needs, andexpose its significance for the practice and discipline of nursing. The paperbegins by reviewing ways in which the idea of 'needs' has been depicted innursing literatiure, and it is suggested that this depiction is inadequate infundamental ways. The critique of existing culture is then outlined and theimplications for nursing are suggested in terms ofthe dissolution of hegemonicpractices and the development of a concept of need built around the notion of'praxis'.THEORIES OF HUMAN NEEDNeeds can be viewed as theoretical constructs constitut-ing general principles of human existence. Some theoryof human needs drives every political ideology and, wesuggest, much of our theory and practice of nursing. Notonly are needs at the heart of political policies and prac-tices, they are even taken by some commentators to betheir legitimating feature. Thus, Bay (1977 p. 1) suggeststhat 'human need priorities must be the ultimate basis fordistinguishing legitimate from illegitimate public poli-cies'. Most political theorists have shied away fromacknowledging this because of the ambiguous positionneeds theory occupies in relation to the 'is-ought'distinction.This is the distinction, elaborated by the 18th centuryScottish philosopher David Hume, hetween propositionsframed in terms of actual existing conditions and thoseframed in terms of ideas or concepts (Hume 1911).Radicals seeking a transformative unification of theorywith practice (i.e. praxis), however, have found it a valu-able normative basis for their theories and between them,Marx, Maslow, Marcuse, Fromm and Adomo have domi-nated the development of needs theory (Marcuse 1964,Adomo 1967, Fitzgerald 1977a, Heller 1974, Comierton1980, Nelson & Grossberg 1988, Berman 1989, Milner1991, Polity Reader 1994). For Marx, the ideal society isone which fulfils the real and authentic needs of thepeople; for Maslow and Fromm these needs are a matterof empirical identification and validation, whilst forMarcuse the prevalence of 'false needs', inflated and sup-plied by capitalist consumerism, forms a central plank inhis critiqu of modem culture.Needs theory may be regarded as underpinning politicalideologies, but tbe relationship is a dialectical, comp-lementary one, so that political ideology is also implicitin any given theory of needs. Furtbermore, it is clear thatexpressed or perceived needs, and those needs for whichpeople seek satisfaction, are also shaped by dominantpolitical ideologies and social practices.If there is a theory of human needs underlying everypolitical position on social welfare issues, how much morethis must be tbe case if those issues involve health care.It is not surprising that the social welfare literature offersa wealth of elaborate accounts of human needs to thosewho seek an informed position. There is little vnthin thenursing literature, however, for those who wish to under-stand nursing as an aspect of welfare provision, or whowant to better understand the role of needs in thephenomena and practice of nursing.© 1997 Blackwell Science Ltd

This paper will examine the claim that caring is an appropriate ethical ideal for nursing. Initially it will examine nursing's philosophy of care and caring, highlighting some areas of difficulty and dissatisfaction articulated by many of its contemporary theorists. Evaluation of the notion of caring as an appropriate ethical ideal for nursing will be balanced against those in opposition, and in this process their critique will be discussed. This discussion will focus on areas such as virtue virtue ethics, moral responsibility, feminine values, mothering and the debate between male and female caring. Different forms of caring will be evaluated and balanced against different forms of nursing. The paper will then suggest that current views which hold aloft nursing as a bedmate of caring may be detrimental to both the cared-for and the carer, advocating in the process a move toward change.

This paper will examine the paradox of power differentials in multidisciplinary teams. The paper begins by offering multidisciplinary teams as an egalitarian enterprise in which all disciplines are included for their particular expertise in relation to patient care. By reviewing ways in which multidisciplinary teams are constructed it will be shown that in nursing discourse these teams are portrayed rhetorically in an idealized rather than realistic way and that there is clearly a power differential between disciplines. The examination highlights the socialized and stereotypical role adopted by the nurse and other disciplines within multidisciplinary teams, so that they fit the social role/rules allotted to them. Investigation of these roles suggest that masculine ideology has prevailed whereby the doctor assumes (without question) the role of team leader. The paper then moves to suggest dissatisfaction with this and that change is underway.

Debate about nursing curricula has been on the forefront of industry and academia in Australia particularly since the shift from the ‘apprenticeship style’ of training for nurses to a university-based, comprehensive, bachelor's degree. There is the suggestion that university-based courses are rather inflexible and take for granted that the provision of mental health nursing across what is an essentially general course will ultimately attract the numbers of quality staff members required to fill speciality positions in mental health. Recent literature advocates for a direct entry undergraduate mental health programme in Australia, similar to that in the UK. This is suggested as one of many strategies to address the growing disparity between the demand and the supply for effective mental health treatment and care. The support of preceptor staff in the clinical field in terms of workloads, supervision and professional development are also identified as areas for attention. Another strategy that this paper addresses is the increased support of student preceptors in the areas of workload, supervision and professional development, whereas they forge organizational links between the tertiary sector and industry to facilitate enhanced communication channels between the theoretical curriculum (the theory) and the clinical sites (the practice). Additionally, increasing the mental health content in current curricula to a level that reflects hospital-based and community mental health needs is also required.

Caring is neither simply a set of attitudes or theories, nor does it comprise all that nurses do. Nursing care is determined by the way nurses use knowledge and skills to appreciate the uniqueness of the person they are caring for (changing the care noun into a caring verb). The purpose of this article is to present a range of contemporary nurse theorists' ideas on caring and to examine these ideas using the backdrop of nursing as practiced in both Australia and Canada to demonstrate a range of national and international similarities and theoretical beliefs. Caring relationships set up the conditions of trust that enable the one receiving the care to accept the help offered, underpinning the nurse-patient relationship or the therapeutic relationship. Caring is always specific and relational such as that found in the nurse-patient relationship. We believe that caring theory has much to offer nursing practice worldwide. Caring must be considered in the caring context because the nature of the caring relationship is central to most nursing interventions. Nurses need to be able to actually practice caring rather than just theorize about it-using caring theories to inform their practice.

This paper will develop a discussion about caring as a modern mental health nurse. We argue that the demands of mental health nursing today extend beyond the more traditional skills of care and caring. We believe that in order to meet mental health needs in the 21st century that caring should be extended to encompass the additional expertise of emotional intelligence and resilience. Emotional intelligence, resilience, and resilient behaviours have the potential to assist individuals to transcend negative experiences and transform these experiences into positive self-enhancing ones. This has implications for improved consumer outcomes through role-modelling and educational processes, but also may hold implications in supporting a strong workforce in mental health.

The potential for resilient behaviors and emotional intelligence involves an interplay between the individual and his or her broader environment. Studies that have examined resilience explore factors or characteristics that assist individuals to thrive from and in adversity. These protective factors are part of an individual’s general makeup. Some of these factors are considered genetic, such as a personality that is outgoing and social; however, many protective behaviors can be learned. Coping in the face of adversity involves emotional intelligence and resilience, both of which can be developed through support and education. In this context, fostering resilience and emotional intelligence has the potential to improve clinical outcomes for mental health consumers.

One of the authors of this paper, Carla Diedrich, had a personal experience of suicide in her family. She wants to both share the experience and allow the circumstances to be directive and informative for individuals who have had similar experiences with suicide and for those working in a clinical capacity. In this sense, the work belongs to Carla and her family and has been significant, almost cathartic, in helping her especially deal with this difficult set of personal circumstances.

This paper looks at the concept of care in nursing and considers the ever-changing focus relative to the meaning of the term care and how this care is delivered by nursing staff. In the process of looking at these issues it examines the theoretical and practical issues and how these factors have changed considerably over the last twenty-five years. This examination touches upon some of the intermingled and not mutually exclusive issues which surround care and caring such as technology, stress and burnout, bureaucracy, fiscal policy, the humanness of the nurse and the ever changing nature of care delivery. Many readers will be able to relate to the issues discussed and understand how some of these factors tend to get in the way of one another and affect good patient care and outcomes.

This paper will examine and discuss some of the strengths and weaknesses of conceiving nursing as a form of praxis, encompassing within this, the idea that in order to conceive nursing as a form of praxis, reflection has to be considered a key component. It will be argued that praxis can (and should) become a practical process and that, when applied to one's own nursing practice, changes, reshapes and allows one to discover new meanings (or, draws out the meanings which were always there). Clearly there are many different forms, understandings and applications of the term praxis and this paper will examine some of the tensions and the nexus that exist. These claims will be supported by using personal-professional journal extracts as a catalyst, showing that there is potential for closing the theory-practice gap through more in-depth reflection, and that this examination using reflective techniques will demonstrate that nurses, by using this process develop their own implicit personal nursing theories. Using one's colleagues as a critical resource allows what might be described as ongoing reflection to occur, where critical friends in both theoretical and practice worlds act as a dialectical catalyst for growth and change, moving toward closing the theory-practice gap.