Abstract: Aim: To determine the feasibility of establishing a nurse practitioner-led, family focused, primary health care clinic within a primary school environment as an alternate or complementary way of addressing the health needs of 'at risk' children and families to the services already provided by the public health nurse.Method: Utilising needs analysis method, data was collected from three sources – known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the public health nurse in order to determine if a public health nurse would be the most appropriate person to lead a primary health care clinic, and the practicalities of establishing a clinic including services participants would expect a clinic to provide. Analysis was descriptive and exploratory.Results: A wide range of health needs were identified from both the demographic data and from participant interviews. Findings also showed that participant's understanding of the role of the public health nurse was not great and that community expectations were such that for a public health nurse to lead a primary health care clinic further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner-led clinic resulted in the preparation of a community-developed model that would serve to address the health needs of children and families in the area the study was undertaken.Conclusion: Overall findings indicated that the establishment of a nurse practitioner-led, family focused, primary health care clinic in a primary school environment is feasible. While a public health nurse may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required. It is likely that a similar model would also be successful in other communities in New Zealand, however the health needs identified in this study are specific to the community studied. Further community needs assessments would need to be completed to ensure health services target health needs specific to the communities involved.

Abstract: Eighty alcohol and/or drug dependent women who were consecutive admissions to an outpatient alcohol and drug service were interviewed with the aim of gathering information regarding childhood adversity, psychiatric comorbidity and alcohol and drug history, including extent of treatment and alcohol and drug related criminality. A secondary aim of the study was to investigate associations between both the multiplicity of alcohol and drug dependence diagnosis and the presence of psychiatric comorbidity in relation to exposure to childhood adversity, including sexual, physical and emotional abuse.The data demonstrate that the study sample was a relatively severe group of alcohol and drug dependent women. A sizeable percentage came from backgrounds characterised by parental separation, conflict and alcohol and drug problems. Many were regularly exposed to physical abuse perpetrated by both parents or main parental figures and over two-thirds were exposed to some form of sexual abuse within their first 15 years. Sixty percent had been dependent on more than one psychoactive substance, with half having undergone previous alcohol and drug treatment. The women also presented with substantial histories of criminal convictions, with a quarter having served a prison sentence. The results indicate the presence of extensive psychiatric comorbidity in the sample. Two-thirds of the women met current DSM-IV criteria forat least one of the following Axis I disorders: major depressive syndrome, social phobia or bulimia nervosa, while nearly half had antisocial personality disorder. More importantly, significant associations were found regarding the presence of psychiatric comorbidity in relation to four measures of severe childhood adversity, i.e. childhood sexual, physical and emotional abuse and parental problems. Multiplicity of alcohol and drug dependence diagnosis was associated with severe emotional abuse, severe parental problems andpsychiatric comorbidity. Emotional abuse during childhood was the most pervasive indicator of comorbidity and multiplicity of alcohol and/or drug dependence. The main implication for clinical practice arising from the results of this study is the need for the development of a broader approach to alcohol and drug service provision. In order to achieve positive treatment outcomes, alcohol and drug service may need to routinely screen and plan treatment for unresolved childhood trauma, psychiatric disorder and other problems related to alcohol and drug use in all clients presenting for alcohol and drug treatment

Abstract: In New Zealand, there is a festering debate over a theory-practice gap in nursing. Joint appointments present as a potential solution to this issue. Joint appointments refer to a variety of arrangements whereby concurrent employment occurs within an educational institution and a clinical setting.Advantages for the appointees include job satisfaction, and professional growth. Clinical credibility for nurse educators enables improved facilitation of student learning. In clinical areas, benefits in patient care are associated with the marrying of academic rigor with clinical practice. Some appointees input into staff development, act as consultants on nursing issues and undertake research. Disadvantages in the concept focus on role conflict (incongruity between the roles) and role ambiguity (lack of clarity concerning expectations). Success of the ventures depends upon the personal attributes of appointees; realistic expectations; flexibility to allow the concept to evolve; and support from colleagues and management.This research describes a case study of a joint appointment between a nurse lecturer and a senior staff nurse in an acute forensic psychiatry unit. Advantages, disadvantages and reasons for success are discussed in relation to the literature findings. The discussion focuses on the need to develop research methodology to further clarify potential benefits and advantages