Ml Minstrell

Distribution and abundance of roadkill on Tasmanian highways : human management options

An obvious sign of potential human impact on animal populations is roadkill. In Tasmania, this impact is perceived as relatively greater than in other Australian states, and is often noted by visitors and locals alike, such that calls for management action are common in the popular press. The goal of this three-year study was to assess the frequency and distribution of species killed on Tasmanian roads. Seasonal surveys were completed along five major routes, for a total of 154 trips. Over 15 000 km of road were surveyed and 5691 individuals in 54 taxa were recorded for an average roadkill density of 0.372 km-1. Over 50% of encountered roadkill could be identified to species, with common brushtail possums (Trichosurus vulpecula) and Tasmanian pademelon (Thylogale billardierii) the most common species identified, both in overall numbers and frequency of trips encountered. The 10 most common taxa accounted for 99% of the items observed. The seasonal occurrence, relationship with vehicle speed, and clustering in local hotspots for particular taxa all suggest that mitigation measures, such as vehicle speed reduction in specific areas, may be effective in reducing the number of animals killed. Mitigation measures, however, will not apply equally to all species and, in particular, success will depend on changing human behaviours.

The nurse practitioner–client therapeutic encounter: an integrative review of interaction in aged and primary care settings

AIMS To review the key features of the nurse practitioner-client interaction in the thera-peutic encounter to inform the development of nurse practitioner-led memory clinics. BACKGROUND Nurse practitioners spend significant time interacting with clients and their families/caregivers yet there is limited research on this interaction during therapeutic encounters in aged and primary care contexts. DESIGN Integrative review. DATA SOURCES Electronic search of CINAHL, Embase, Medline, PsychINFO, PubMed, Scopus, Web of Science 2004-2013; hand search of the Journal of Advanced Nursing, Journal of the American Academy of Nurse Practitioners and Journal of Clinical Nursing. REVIEW METHODS Integrative literature review using Whittemore and Knafls methodology. RESULTS Ten published studies were included, representing over 900 nurse practitioners and their clients. Three key factors of nurse practitioner-client interaction were identified: nurse practitioner expertise and the influence of the therapeutic encounter context; affirming exchange as a bedrock of communication; and high levels of client engagement. In aged and primary care settings, where the therapeutic encounter requires and allows longer consultations, such as nurse practitioner-led memory clinics, patient-centred approaches can engage clients in consultations using a biopsychosocial framework, resulting in improved client satisfaction and, potentially, increased adherence to treatment plans. Nurse practitioners who are open and respectful, who encourage patients to provide more information about their lives and condition and are perceived by the client to be empathetic, are providing affirmation to the client. CONCLUSION Affirming interactions are a key feature of successful therapeutic encounters when time and context do not allow or warrant the full repertoire of patient-centred communication.

Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles

BACKGROUND Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed. METHODS Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011-2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively. RESULTS One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia. CONCLUSIONS An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.

Aged care nurse practitioners working in general practice.

This study aimed to describe the implementation and challenges for the development of an aged care NP role within general practice. This paper reports on part of a larger study on the role of aged care NPs in primary health care, dementia and mental health services.