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Introduction and Aims. Trauma exposure (including experiencing dysfunctional parenting when a child) and posttraumatic stress disorder (PTSD) frequently coexist with major depressive disorder (MDD) and alcohol use disorders (AUD), with the impact of this comorbidity usually studied as a dual disorder (i.e. PTSD-MDD or PTSD-AUD). This study explores trauma exposure (including to dysfunctional parenting), PTSD symptom severity and PTSD in people seeking treatment for coexisting depressive symptoms and alcohol use problems. Design and Methods. Participants (n = 221) with current depression and alcohol use problems were recruited. Trauma exposure, PTSD symptoms and PTSD were assessed using the Posttraumatic Stress Diagnostic Scale. The Measure of Parenting Style assessed dysfunctional parenting (neglect/over-control/abuse) experienced as a child. Results. Most participants experienced trauma (71.6%, n = 159), with more than one-third reaching DSM-IV criteria for current PTSD (38.0%, n = 84). Unique to this study was that there were no gender differences in rates of trauma exposure, number of traumatic events and PTSD. More severe PTSD symptoms and PTSD were associated with: childhood neglect; earlier depression onset; more severe depression and alcohol problems; and lower general functioning. More severe problems with alcohol were related to Intrusion and Avoidance symptoms, while severe alcohol dependence symptoms were related to hyperarousal. Discussion and Conclusions. PTSD symptoms and PTSD are highly prevalent in those with coexisting depression and alcohol use problems and are associated with a history of childhood neglect and higher levels of comorbidity. Trauma, PTSD symptoms and PTSD should be assessed and addressed among people seeking treatment for coexisting depression and alcohol problems.[Bailey K, Webster R, Baker AL, Kavanagh DJ. Exposure to dysfunctional parenting and trauma events and posttraumatic stress profiles among a treatment sample with coexisting depression and alcohol use problems. Drug Alcohol Rev 2012;31:529–537]

Background: Retention in substance abuse treatment is difficult but essential for positive post-treatment outcomes. Aims: The present study is the first to explore factors related to retention in a long-term specialist residential substance abuse treatment programme for women in Australia. Methods: Archival data (e.g. socio-demographic, substance use, mental health, and length of stay) were collected from a sample of 71 women admitted to the programme between January 1997, and November 2002. Participants were divided into two groups based on their length of stay in the programme: less than 90 days (n = 42) and 90 days or more (n = 29). Results: A substantial proportion of the sample experienced comorbid substance abuse and mental health problems, with 60.6% (n = 43/71) reporting evidence of comorbidity (either a previous psychiatric diagnosis, or having been prescribed psychiatric medications). Overall, only 13% of residents completed the programme. Longer retention was associated with demographic (older ...

The aims of this study were to document long-term patterns of substance use among people with co-existing psychiatric and substance use disorders and to explore differences in psychosocial outcomes for groups with different substance use outcome profiles (persistent hazardous, intermittent hazardous and non-hazardous users). An opportunistic long-term (4 - 6 years) follow-up interview was conducted with participants from a previous study who were recruited during their inpatient admission at a public psychiatric hospital in Newcastle, New South Wales, Australia. Follow-up data were obtained from 47 people from the original study and combined with their existing baseline, 6-month and 12-month data. The follow-up interview included demographic variables and measures of substance use, psychiatric symptomatology and a range of psychosocial variables. Alcohol, cannabis and amphetamines were the most commonly misused substances. Persistent hazardous users experienced poorer outcomes in the domains of social functioning and psychiatric symptomatology, including depression, than intermittently hazardous or non-hazardous users. An unusually high mortality rate of 10% among the males in the original sample (12/120) was an unexpected finding, particularly as this was likely to be an underestimate. Given the differences in outcomes between groups with varied gradations of substance use, a harm minimisation approach for research and practice among people with co-existing psychiatric and substance use disorders is endorsed.

The period following discharge from hospital after an acute myocardial infarction (MI) is associated with vulnerability and psychosocial and physical morbidity for many survivors and their families. It is reported that people experience interpersonal, family and financial problems, self-care obstacles, work and physical difficulties. Culture and ethnicity undeniably influence the illness experience and the process of recovery and adjustment. This study investigated the perceptions of Gujarati survivors of acute MI and their families in Leicester, United Kingdom in the first 12 weeks following discharge in order to develop a profile of their health seeking beliefs and needs. Thirty-one interviews with 19 Gujarati MI survivors and their families (representing approximately 31 hours of dialogue) were analysed using grounded theory. Qualitative data revealed a period of vulnerability not only for survivors but also their families as they processed recent events and faced the future. Data analysis revealed nine interrelated themes describing the post-discharge experience for Gujarati survivors and their families. Data revealed that normal life was often markedly changed by the MI experience. Reflection, contemplation and resignation characterize this period of vulnerability. Overwhelmingly, data analysis revealed that the Gujarati culture, beliefs and customs influenced the recovery experience.

This study was designed to evaluate the effects of a peer support programme on adolescents' knowledge, attitudes and use of alcohol and tobacco. Year 7 students (average age 12 years) from three schools who offered the programme (n = 169) and from three schools without the programme (n = 157) completed a self-report assessment. Perceptions of their parents' and friends' use of alcohol and tobacco and attitudes towards the participants' use of these substances as well as the participants' own attitudes (preferences and norms) and use of the substances were assessed on three occasions; pre-intervention, post-intervention and at 6 months follow-up. There were no significant effects of the programme on participants' knowledge, attitudes and use of alcohol and tobacco. Over time, participants in both groups reported increased enjoyment of alcohol, increased use of alcohol and tobacco and more lenient attitudes towards these substances. In conclusion, the peer support programme failed to show any positive influence on adolescents' knowledge, attitudes and use of alcohol and tobacco.

Background: Although South Asian people are a significant ethnic group at increased risk of coronary heart disease and high mortality rates and experience greater delays with respect to diagnosis, referral and treatment, comparatively little is known about their quality of life during recovery from a myocardial infarction. Objectives: We sought to determine and compare the impact of ethnicity on quality of life after myocardial infarction (MI) in a mixed ethnic population (South Asian and white people) in the UK. Methods: A 2x2 mixed-group design with repeated measures on the second factor. The independent variables were ethnic group (white/South Asian) and time since MI (2 weeks/3 months). The dependent variables were the subscale scores on the Short-Form 36-item health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results: At 2 weeks, significant differences were observed between groups on 5 of the 8 SF-36 subscale domain scores, with the white group reporting higher quality of life. Significant improvement in reported quality of life occurred in both groups over time on all domains of the SF-36, except bodily pain. There was a significantly greater improvement in favour of the white group for the role-physical domain. There was no significant difference between groups in terms of anxiety or depression at 2 weeks. Both groups showed a significant reduction in anxiety and depression by 3 months, but the degree of reduction was not significantly different between them. At 3 months, there was no significant difference between groups in terms of anxiety scores, but the South Asian group scored significantly higher on the depression scale. Conclusions: South Asian people have significantly poorer quality of life than white people after MI. While both groups showed improvement over time, South Asian people reported significantly less improvement in physical role function and were more depressed at 3 months. Identifying the factors accounting for such differences is important to develop models of care for delivering the most effective and culturally-sensitive interventions to this group.

Objective: We sought to identify the psychosocial characteristics of high earthquake exposure subjects that were associated with the development of post-disaster morbidity and with recovery.Method: Data reported are from 515 participants in a longitudinal study of the psychosocial effects of the 1989 Newcastle (Australia) earthquake. Subjects were allocated to three subgroups (low morbidity; recovered; and persistent morbidity) on the basis of their Impact of Event Scale scores across the four phases of the study. Differences between these subgroups were examined on a broad range of variables.Results: Several background, dispositional, coping style and exposure-related factors characterised those who developed psychological morbidity, only a small subset of which differentiated between those who recovered and those with persistent morbidity.Conclusions: Post-earthquake morbidity persists longer in those who are older, have a history of emotional problems, have higher neuroticism, use more neurotic defenses, and report higher levels of post-disaster life events.

Psychoform dissociation has been researched more than somatoform dissociation. The Somatoform Dissociation Questionnaire (SDQ-20), a commonly used adult measure of somatoform dissociation, is increasingly being used with adolescents internationally. We compared psychoform and somatoform dissociation in a mixed clinical adolescent sample. A total of 71 adolescents (12-18 years old) attending Australian community mental health and counseling services completed the SDQ-20 and the Adolescent Dissociative Experiences Scale, a commonly used measure of adolescent psychoform dissociation. The participants' treating clinicians provided participants' demographic details and mental health diagnoses. We found that 41% of participants reported high levels of psychoform dissociation and 21% reported high levels of somatoform dissociation. Both dissociation types were positively correlated. Neither was significantly related to participants' age, gender, or mental health diagnoses. Participants with more than 1 Axis I mental health diagnosis had higher levels of somatoform dissociation than participants with only 1 or no Axis I mental health diagnosis. This study is the first to examine somatoform dissociation in Australian adolescents and enables initial international comparisons.

This paper summarises the major findings from the Quake Impact Study (QIS), a four-phase longitudinal project that was conducted in the aftermath of the 1989 Newcastle (Australia) earthquake. A total of 3,484 subjects participated in at least one component of the QIS, comprising a stratified sample of 3,007 drawn from community electoral rolls and 477 from specially targeted supplementary samples (the injured, the displaced, the owners of damaged businesses, and the helpers). Subjects' initial earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured at each phase using the General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES). Selected findings and key conclusions are presented for each of six areas of investigation: service utilisation during the first 6 months post-disaster; patterns of earthquake experience and short-term (6-month) psychosocial outcome; earthquake exposure and medium term (2-year) psychosocial outcome; vulnerability factors and medium-term psychosocial outcome; specific community groups at increased risk (e.g., the elderly and immigrants from non-English-speaking backgrounds); the effects of stress debriefing for helpers. Threshold morbidity (i.e., likely caseness) rates are also presented for a broad range of subgroups. In addition to presenting an overview of the QIS, this paper synthesises the major findings and discusses their implications for future disaster management and research from a mental health perspective.

Background. This paper examines the contributions of dispositional and non-dispositional factors to post-disaster psychological morbidity. Data reported are from the 845 participants in the longitudinal component of the Quake Impact Study.Methods. The phase 1 survey was used to construct dimensional indices of threat and disruption exposure. Subsequently, a range of dispositional characteristics were measured, including neuroticism, personal hopefulness and defence style. The main morbidity measures were the General Health Questionnaire (GHQ-12) and Impact of Event Scale (IES).Results. Dispositional characteristics were the best predictors of psychological morbidity throughout the 2 years post-disaster, contributing substantially more to the variance in morbidity (12–39%) than did initial exposure (5–12%), but the extent of their contribution was greater for general (GHQ-12) than for post-traumatic (IES) morbidity. Among the non-dispositional factors, avoidance coping contributed equally to general and post-traumatic morbidity (pr = 0·24). Life events since the earthquake (pr = 0·18), poor social relationships (pr =−0·25) and ongoing earthquake-related disruptions (pr = 0·22) also contributed to general morbidity, while only the latter contributed significantly to post-traumatic morbidity (pr = 0·15).Conclusions. Medium-term post-earthquake morbidity appears to be a function of multiple factors whose contributions vary depending on the type of morbidity experienced and include trait vulnerability, the nature and degree of initial exposure, avoidance coping and the nature and severity of subsequent events.

The psychosocial effects of an earthquake which occurred in Newcastle, Australia in 1989 are the focus of the Quake Impact Study, a four-phase community survey conducted over 2 years. Comparisons were made between adults aged less than 65 years (N= 2371) and those aged 65 years and older (N = 636). Results revealed that older subjects reported fewer threat and disruption experiences and used fewer general and disaster-related support services. However, older subjects reported higher overall levels of post-traumatic stress symptoms on the Impact of Event Scale (IES) compared with younger subjects. On both the IES and a general measure of morbidity (General Health Questionnaire: GHQ-12) the effects of earthquake exposure were more marked among the elderly. Within the older group, subjects who had high levels of post-traumatic stress symptoms (IES > 25, N = 117) were more likely to be female, report higher levels of exposure and use behavioural and avoidance coping styles. Although psychological distress declined with time, post-traumatic stress symptoms remained higher for the high exposure group throughout the study. We conclude that older people may be more at risk for experiencing post-traumatic stress reactions despite having fewer disaster-related experiences. They may also underutilize support services following a disaster. Older women in particular and people with an avoidance coping style appear to be most vulnerable.

SYNOPSISA stratified random sample of 3007 Australian adults completed a screening questionnaire 6 months after the 1989 Newcastle earthquake. Information was obtained on initial earthquake experiences and reactions, use of specific services, social support, coping strategies and psychological morbidity. This questionnaire was the first phase of the Quake Impact Study, a longitudinal project investigating the psychosocial impact of the earthquake. Two weighted indices of exposure were developed: a threat index, which measured exposure to injury or the possibility of injury; and a disruption index, which measured experiences of property damage, displacement and other losses. Levels of exposure to threat and disruption events were significant predictors of morbidity on both the General Health Questionnaire and Impact of Event Scale, as were coping style and gender. Effects of exposure to threat and disruption were largely additive, with higher exposure being associated with greater use of support services, higher perceived stressfulness and more severe psychological morbidity. Use of avoidance as a coping strategy, female gender, lower social support and being older were also associated with higher post-disaster psychological distress. It was estimated that 14·8% of the population was exposed to high levels of threat or disruption, of whom approximately 25% experienced moderate to severe psychological distress as a direct result of the disaster. It was further estimated that 18·3% of those exposed to high levels of threat were at risk of developing post-traumatic stress disorder, representing approximately 2% of the city's adult population.

The telephone is an effective means of communication and its use is growing as a means of offering members of the public access to health-care agencies for advice and support. Acute hospital beds are at a premium and as lengths of stay in hospital continue to fall there is an increasing need for effective discharge planning and post-discharge support. Eighty-five patients (58 men and 27 women) were interviewed over the telephone 1 week after discharge from a medical ward. Over half of the patients reported health problems and one-fifth reported social problems. Almost half of the patients sought advice. Telephone follow-up would appear to be a useful means of monitoring a patient's progress and providing an opportunity for patients seeking, or nurses offering, advice and support.

Five hundred and seven 14-to-16-year-old students gave self-report responses to a substance use questionnaire. The questionnaire assessed adolescents' use, preferences, and norms and also their perceptions of their parents' and peers' use and norms in relation to alcohol, tobacco, and tea/coffee. Path analysis revealed that adolescents' internalization of parental and peer pressures is a stronger predictor of substance use than are direct effects. Internalized effects occur by means of preferences rather than norms, and peer pressure is predominantly through modeling behavior, whereas parental influence is through perceived normative standards. Peers' influence is stronger in relation to tobacco use, parental influence is stronger in relation to tea/coffee use, and both are equally important in relation to alcohol use. These findings are discussed in relation to preventive strategies.

Background: The aim of this study was to examine the role of pre-trauma, traumatic event, and peri-traumatic psychological characteristics on post-motor vehicle accident (MVA) Posttraumatic Stress Disorder (PTSD) and depression. Methods: The sample comprised 333 (54% female) hospital accident and emergency attendees who completed a self-report postal screening survey approximately 1-month post-accident and 128 (62% female) participants who completed a follow-up survey at 3-months. Results: Path analysis (Model 1) showed that dissociation partially mediated the relationship between past emotional problems and initial post-MVA distress, as well as between fear of dying and levels of distress. Level of alertness and perceived accident severity had no direct effects on post-MVA distress. However, higher levels of exposure contributed to distress predominantly in the presence of high levels of fear and subsequent dissociative experiences. When ongoing PTSD and depression symptoms were included (Model 2), feeling depressed/sad at 1-month was the strongest predictor of both PTSD and depression symptom severity at 3-months post-MVA, explaining 53% and 40% of the variance, respectively. Dissociation remained an important mediating variable at both time points. Conclusions: These models show the influence of previous emotional vulnerability factors and the important mediating role of peri-traumatic experiences (in the presence of fear due to increased levels of accident severity) on post-MVA morbidity. Additionally, MVA survivors who report feeling depressed/sad 1-month after their accident are at greater risk of developing both PTSD and depression. Depression and Anxiety 28:218–226, 2011. © 2011 Wiley-Liss, Inc.

Summary •Forty patients (21 men and 19 women) unexpectedly informed that they were to be admitted to hospital were interviewed about their reactions from the time they knew of the imminent admission up until the admission itself. The interviews were carried out shortly after admission to a medical ward. •Patients' reactions were numerous and diverse. The most common reaction was relief at being admitted. Other reactions were related to anticipating the hospital experience, feelings about their predicament, and concern about life beyond their stay in hospital. •Men and women expressed a similar number of reactions, but those who had previously been in hospital expressed fewer reactions than those who had not. •The findings are discussed and the implications for practice are considered.

There can be little doubt that changes in the National Health Service (NHS) heralded by the 1989 Government White Paper, Working for Patients, have significant implications for nurse education. Not least will be the need for Colleges and Schools of Nursing to present a high profile in terms of the services they offer. This paper explores the concept of marketing and its increasing importance to nurse education. It examines Giles' three propositions in relation to marketing, and suggests that these may be applied successfully to organisations providing a service, as well as those producing material goods. It looks at how and why marketing is necessary to nurse education, and suggests that marketing is an essential tool in assisting the School to achieve its objectives. Marketing strategies are discussed in detail, looking first at methods of research, then at the processes used to sell the courses being offered. These include the techniques of developing the offering, marketing the offering, facilitation, valuation and finally, promotional communication. The paper concludes by summarising the reasons why marketing techniques will be essential to the future success of nurse education, at a time when it is so vital to ensure that a well qualified nursing workforce is prepared to meet the challenges of the future.

The Posttraumatic Cognitions Inventory (PTCI) assesses cognitions hypothesised to be associated with poor recovery from traumatic experiences and the maintenance of PTSD. The validity of the PTCI has received good support but doubts have been raised about its Self-BLAME subscale. The main aim of the present study was to test the ability of the PTCI subscales to discriminate between traumatised individuals with and without PTSD and to predict posttraumatic symptom severity. Participants (N=63) who had experienced a traumatic event were recruited via the media and completed the PTCI and self-report measures of PTSD and depression symptoms. Full criteria for a diagnosis of PTSD were met by 37 but not by the other 26. There were significant differences between these two groups on the total PTCI score and the Negative Cognitions About SELF and the Negative Cognitions About the WORLD subscales, but not on the Self-BLAME subscale. The two groups were discriminated by the PTCI subscales with 65% accuracy and the multiple correlation (R=.68) between the subscales and posttraumatic symptom severity was highly significant. However, in these analyses, higher scores on the Self-BLAME subscale were associated with less risk of a diagnosis of PTSD and with less posttraumatic symptomatology. Possible interpretations of these results, in terms of statistical suppressor effects and the protective role of behavioural self-blame, are discussed.

The aim of this study was to identify whether a brief motivational interviewing and cognitive-behavioural-based alcohol intervention group (AIG) programme is feasible with young people at risk of developing a problem with alcohol, and to assess the short-term effectiveness of the intervention. Participants were assigned randomly to receive a group intervention of four sessions duration (n=17; AIG) or no treatment (n=17, control group). Participants were volunteers recruited from a youth centre on the Central Coast of New South Wales, Australia, comprising youths aged 12-19 years who were interested in participating in the study. The Readiness to Change Questionnaire, items from the AUDIT, the DAP Quick Screen and a knowledge questionnaire were administered at pretreatment, post-treatment and at 1- and 2-month follow-ups. Participants in the AIG programme showed an increase in readiness to reduce their alcohol consumption. They also reduced their frequency of drinking at post-treatment and the first follow-up assessment, while the control group reported increases at the second follow-up assessment. The control group also increased their hazardous drinking and frequency of binge drinking compared to the AIG. The intervention appeared to improve the AIG participants' knowledge about alcohol and its effects. The results provide preliminary evidence for the effectiveness of the AIG programme in training young people to set limits on alcohol consumption, increase awareness of safe drinking levels and the effects of alcohol abuse. This pilot study also showed that young people who are identified as being 'at risk' of developing alcohol abuse, and who are also ambivalent about changing drinking behaviours, can be recruited and retained in a treatment programme.

South Asian people living in the United Kingdom are at increased risk of coronary heart disease, have higher mortality rates and are less likely to be treated when compared to the white population. There is, however, little information about the experiences and needs of this group after discharge from hospital.To explore the experiences and needs of Gujarati Hindu patients and their partners in the first month after a myocardial infarction.Using a qualitative research approach, semi-structured interviews were conducted by a Gujarati-speaking researcher with 35 patients and their partners at home during early convalescence.A number of categories emerged from the data which pertained to a lack of information and advice, poor performance of activity, little lifestyle adjustment, poor expectations, lack of future plans, strong family support, dissatisfaction with the family doctor, and a significant belief in fate.Experiences and health care needs of Gujarati Hindu patients with myocardial infarction appear different to those of non-Asians. Cardiac aftercare and rehabilitation services should take account of such information

Background. A sample of 1089 Australian adults was selected for the longitudinal component of the Quake Impact Study, a 2-year, four-phase investigation of the psychosocial effects of the 1989 Newcastle earthquake. Of these, 845 (78%) completed a survey 6 months post-disaster as well as one or more of the three follow-up surveys.Methods. The phase 1 survey was used to construct dimensional indices of self-reported exposure to threat the disruption and also to classify subjects by their membership of five ‘at risk’ groups (the injured; the displaced; owners of damaged small businesses; helpers in threat and non-threat situations). Psychological morbidity was assessed at each phase using the 12-item General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES).Results. Psychological morbidity declined over time but tended to stabilize at about 12 months post-disaster for general morbidity (GHQ-12) and at about 18 months for trauma-related (IES) morbidity. Initial exposure to threat and/or disruption were significant predictors of psychological morbidity throughout the study and had superior predictive power to membership of the targeted ‘at risk’ groups. The degree of ongoing disruption and other life events since the earthquake were also significant predictors of morbidity. The injured reported the highest levels of distress, but there was a relative absence of morbidity among the helpers.Conclusions. Future disaster research should carefully assess the threat and disruption experiences of the survivors at the time of the event and monitor ongoing disruptions in the aftermath in order to target interventions more effectively.

The purpose of this study was to explore any patterns that may be evident in the experiences of 20 patients and their partners 1 month after a first heart attack. An interpretive research approach was used to illuminate the illness experience of patients and its impact on their partners. Semi-structured interviews were conducted with the participants, and qualitative analysis of the data revealed six major categories. These were: expectations about advice and information; feelings about the future; reactions of the partner; playing down the significance of the heart attack; wanting to get back to normal; and the effect on the couple's relationship. These findings are discussed in relation to the theoretical literature and other empirical research. The results of this study may provide pointers to the implications for practice of nurses, particularly on ways to improve support for patients and their partners during early convalescence.

The psychosocial effects of the 1989 Newcastle earthquake on 250 immigrants from non-English-speaking backgrounds (NESB) were compared with a matched sample of 250 Australian-born subjects. The NESB subjects had higher levels of both general (General Health Questionnaire-12) and event-related (Impact of Event Scale) psychological morbidity. Furthermore, NESB females had the highest levels of distress, particularly those who were older on arrival in Australia and those who experienced high levels of disruption. The results suggest that NESB immigrants, particularly women, appear to be more at risk for developing psychological distress following a natural disaster. However, level of exposure and an avoidance coping style contributed more substantially to psychological distress than ethnicity.

In 100 patients admitted to a coronary care unit with a history of chest pain thought to be due to myocardial infarction, the intensity of pain was independently rated by the patient and the primary nurse caring for the patient soon after admission. Pain intensity was assessed using a visual analogue scale designed to yield a score of 0-100. 10 experienced coronary care nurses who had participated in a short programme of pain assessment and management were included in the study. A strong positive correlation between the patients' and nurses' ratings was found. Possible explanations for these findings are discussed.

Five hundred and seven students 14- to 16-years-old gave self-report responses to a substance use questionnaire, the Norwicki-Strickland Locus of Control Scale, and The Piers-Harris Children's Self-Concept Scale. Path analysis revealed that the influence of peers' and parents' use and norms on adolescents' alcohol and tobacco use is mediated by personality, age, sex, and social status effects. Adolescents with external locus of control or low self-esteem "behavior" were more influenced by their peers to smoke. Younger students and girls were more influenced by parental norms than were older students and boys, but only for alcohol and not for tobacco use. Other findings were that girls were not as strongly influenced by their own norms and that girls and low social status adolescents were more influenced by their friend's smoking and drinking. The peers' findings are discussed in relation to substance prevention strategies.

A screening questionnaire was distributed to 5,000 adult members of the community six months after the 1989 Newcastle earthquake, with a response rate of 63 per cent (n = 3,007). The mean age of respondents was 46.7 years and 58 per cent were female. Subjects' earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured using the General Health Questionnaire and the Impact of Event Scale. Subjects were asked to indicate which of a range of general and disaster-related support services they had used in dealing with the stressful effects of the earthquake. It was estimated that 21.3 per cent of the adult population used general and/or disaster-related support services. Users of these services reported greater exposure to threat and/or disruption and had higher levels of psychological distress than nonusers. However, a high level of use of general services and reliance on medical services were related more to psychological morbidity than degree of exposure to earthquake-related events. Overall, the Newcastle community's needs for assistance in the aftermath of the earthquake were effectively absorbed by the existing support services and the resources marshalled to supplement those services. Individuals and organisations mobilised following natural disasters need to be strengthened by enhancing the capacity of support service workers to identify and manage psychological distress in their clients.

Rosemary Webster describes an initiative taken in Mersey Region to ensure all nurses understand the importance of standard setting. The initiative, prompted by a number of factors, saw the establishment of a steering group whose Statement of Purpose outlined a framework for standard setting in each district. As a result, nurses are now playing a leading role in this increasingly important aspect of health care.

This study describes the development of a classification system for the clarification, understanding and measurement of nurses' work methods. The theoretical basis of the classification system is described. The system offered distinguishes between three common work methods: primary, team and task nursing; the strength of opportunity for nurse-patient interaction in each method being determined as either ‘strong', ‘moderate' or ‘weak', according to how effectively they are practised. Preliminary testing of the system on 32 wards in 13 hospitals is described. It is concluded that further testing and possible refinement is required for validation of the system.

Self-ratings of satisfaction were studied over 6 months in 60 male first-time myocardial infarction patients and their wives. Couples were randomly assigned to either a treatment group, where they received a simple programme of education and psychological support in addition to routine care, or to a control group, where they received routine care only. All patients completed visual analogue scales measuring satisfaction regarding their general health, life in general, care and information received. All wives completed visual analogue scales measuring satisfaction regarding information received and care the patient received. Patients and wives in the treatment group reported statistically significantly more satisfaction than those in the control group. This effect was sustained for 6 months after counselling.

Although sleep has been identified as an activity generally considered necessary for normal functioning, the nursing literature on the subject is relatively scanty. This paper is an attempt to review sleep and its relationship to nursing practice. A discussion of nursing interventions that are likely to ensure that adequate sleep is maintained is included.

Project 2000 signals a new era for the nursing profession; the changes inherent in it will affect all nurses in all aspects of nursing. Crucial to its success will be the way in which the change process is managed. Change is rarely welcomed, and the natural tendency is to resist it. It is perhaps significant that in a recent final examination paper, a student wrote confidently that all nurses in the clinical area were against Project 2000.

Intensive care nurses face many different kinds of problems in addition to clinical ones. Some are technical problems to do with equipment or procedures. Some are ‘people problems’ to do with personal feelings about work situations, or difficulties in management, organisation or work relationships. Sometimes it is only by sharing these problems and facing the challenge with others that solutions can be found, or at least more constructive ways ofseeking them. So it is proposed to provide a means ofcommunication through the journal. Items may be published anonymously but the name and address of the author must be sent with the manuscripts. Each issue of the journal will contain accounts of such problems (if you send them in of course!), with good solutions you have found, if any. Please send brief accounts of problems you have encountered which may also face other intensive care nurses or be ofinterest to them, and any good solutions or ways of coping which you have discovered. These may vary from a few lines about technical or procedural problems or up to 1500 words describing situational problems. Responses to problems published are welcome. Please send these to: Mr David Thompson, Charge Nurse, Coronary Care Unit, The General Hospital, Leicester LE5 4PW. The first contribution to this series is Rosemary Webster’s thoughtful account of her problems in coping with death, an area many people find difficult.