bluuebunny/crossref_metadata_2025 huggingface dataset:
Career desirability: young people’s perceptions of nursing as a career
Authors: Hemsley‐Brown Jane , Foskett Nicholas H.
Published: March 2003

Career desirability: young people’s perceptions of nursing as a career

The majority of young people make a career choice without regard for salary, and base their decision on interest and enjoyment or a desire to help people. This paper examines students’ perceptions of nursing as a career at a number of key stages in their education decision‐making, and how this information influences their subsequent career decision either to choose or to reject nursing. Factors relating to image and status are also explored and some comparisons are made between nursing and young people’s own choice of career, to highlight a number of significant issues. The findings indicate that although young people expressed admiration for the work of nurses, this was rarely matched by an envy of nurses, or a desire to become a nurse themselves.
Can nurses learn to let go? Issues arising from an intervention designed to improve patients’ involvement in their own care
Authors: Pill Roisin , Rees M.E. , Stott N.C.H. , Rollnick S.R.
Published: March 2003

Can nurses learn to let go? Issues arising from an intervention designed to improve patients’ involvement in their own care

The aim of the paper was to explore the reasons behind a perplexing observation that an intervention designed to alter professional behaviour in general practice consultations in South Wales was poorly sustained despite initial enthusiasm among the nurses. Nurses’ baseline and continuing responses to the new approach with patients with non‐insulin dependent diabetes are described, drawing on observations and interviews with the 18 practice nurses in the 15 experimental practices.

The nurses fell into two groups: those showing greater understanding of the principles underlying the approach and a more reflective attitude to their work; and those who adapted the simple technology provided to their usual consultation style. This variation was related to their perception of their role and their attitudes to diabetic care, especially the challenge posed by the ‘difficult patient’. They were noticeably less willing to allow the patient freedom to decide what to do once diabetic control was deteriorating according to biochemical measures. It is concluded that the failure of the nurses to sustain behaviour change over time stems from a basic dilemma, namely, what is the extent of my responsibility and how ought I to discharge it? There is scope for more research into professional perspectives on chronic care, the strategies they use to manage patients and to cope with their own feelings, and the implications of these strategies for patients.
Quantitative measurement of caring
Authors: Beck Cheryl Tatano
Published: March 2003

Quantitative measurement of caring

Caring is a difficult, elusive concept not only to define but also to measure. Eleven different quantitative instruments designed to measure caring are reviewed. Out of these 11 caring instruments, seven are Likert scales, two are visual analogue scales, one is a checklist, and one is a Q‐sort. For each of these instruments the following information is provided: description of the tool, such as number of items and length of time to administer; conceptual definition of caring upon which it is based; reported reliability and validity; and the instrument’s use in research studies. Comparison of these instruments revealed that different aspects of caring are measured by these tools such as caring behaviours, satisfaction with caring behaviours, ability to care, and response to caring behaviours. Some caring instruments are designed to be completed by patients only, by nurses only, or by either patients or nurses. Multiple factors need to be taken into consideration by nurse researchers in deciding which instrument to use to measure caring.
Incompatible skills and ideologies: the impediment of gender attributions on nursing research
Authors: Hicks Carolyn
Published: March 2003

Incompatible skills and ideologies: the impediment of gender attributions on nursing research

The evidence‐based care culture requires that ritualistic treatment interventions are subjected to scientific scrutiny, with the ultimate intention that clinical practice should have empirical rather than historical justification. Despite initiatives to increase research output, there is evidence for a continued research/practice rift. One explanation for this that has relevance for the present paper is the perceived conflict between the skills and ideologies associated with clinical nursing and research. More specifically, it would seem that the characteristics demanded by high quality nursing are diametrically opposed to those required by research, such that research activities may be perceived to be inappropriate within the traditional nursing role. Formal gender‐role schemata may also contribute to the theory–practice gap, insofar as nursing embodies qualities that are essentially female‐associated, while research requires attributes associated with masculinity. These conceptualizations are derived from two studies based on central trait theory, which involved participants in making assumptions about a range of qualities of hypothetical candidates for a nursing post, who were described either as a good researcher or a good clinician. The hypothetical candidates in the first study were female, but in the second were male; in both cases the participant raters were female. It is, however, conceivable that rater‐gender impacts upon assumptions of personal and professional attributes of clinical and research nurses. In order to investigate this contention, the present paper manipulated the gender of the raters, whilst replicating the previous studies in every other way. Analysis of the data using a series of 3‐way ANOVAS suggested that there were some significant effects of rater and candidate gender, as well as of clinical/research descriptors, especially in terms of ascribed kindness, compassion, ambition and success. The results are discussed in relation to gender role stereotypes and nursing research.
Professional nurse autonomy: concept analysis and application to nursing education
Authors: Wade Gail Holland
Published: March 2003

Professional nurse autonomy: concept analysis and application to nursing education

Professional nurse autonomy, an essential attribute of a discipline striving for full professional status, is often confused with personal autonomy, work autonomy or aggregate professional autonomy. Using Walker & Avant’s (1995) model for concept analysis, this paper presents an analysis of professional nurse autonomy. Professional nurse autonomy is defined as belief in the centrality of the client when making responsible discretionary decisions, both independently and interdependently, that reflect advocacy for the client. Critical attributes include caring, affiliative relationships with clients, responsible discretionary decision making, collegial interdependence, and proactive advocacy for clients. Antecedents include educational and personal qualities that promote professional nurse autonomy. Accountability is the primary consequence of professional nurse autonomy. Associated feelings of empowerment link work autonomy and professional autonomy and lead to job satisfaction, commitment to the profession, and the professionalization of nursing. A student‐centred, process‐orientated curricular design provides an environment for learning professional nurse autonomy. To support the development of professional nurse autonomy, the curriculum must emphasize knowledge development, understanding, and clinical decision making.
Experiences of violence in HIV seropositive women in the south‐eastern United States of America
Authors: Sowell Richard , Seals Brenda , Moneyham Linda , Guillory Joyce , Mizuno Yuko
Published: March 2003

Experiences of violence in HIV seropositive women in the south‐eastern United States of America

Women represent one of the fastest growing groups being diagnosed with HIV infection. Because of the circumstances under which they live, women at the highest risk for HIV infection may also be at risk for verbal, physical and sexual violence. The purpose of this study was to examine the frequency and type of violence experienced by women infected with HIV, and describe associations between reported violence, self‐esteem and sense of competence. The study used a descriptive design and was conducted in the south‐eastern United States. The sample consisted of 194 women infected with HIV. Women were primarily single, African‐Americans residing in urban areas with an annual household income of less than $10 000 per year. Participants completed face‐to‐face interviews using a structured questionnaire which included a frequency of violence scale, Rosenberg’s self‐esteem scale, and Pearlin and Schooler’s mastery scale. Approximately 15% of women reported at least one event of physical abuse and 55% at least one event of verbal abuse in the past 6 months. Verbal abuse experienced by women was the strongest net negative predictor of self‐esteem and competence. These findings indicate that HIV‐infected women are at risk for experiencing physical abuse and verbal abuse, and the experience of violence is associated with lower self‐esteem and competence.
Violence in mental health care: the experiences of mental health nurses and psychiatrists
Authors: Nolan Peter , Dallender Janie , Soares Joaquim , Thomsen Sarah , Arnetz Bengt
Published: March 2003

Violence in mental health care: the experiences of mental health nurses and psychiatrists

Violence against mental health service personnel is a serious workplace problem and one that appears to be increasing. This study aimed to ascertain the extent and nature of violence against mental health nurses and psychiatrists, and to identify what support, if any, they received following exposure to violence. Mental health staff working within five West Midlands Trusts in the United Kingdom were surveyed using a postal questionnaire to investigate the extent and nature of violence they encountered in their daily work. There was an overall response rate of 47%, which included a response rate for psychiatrists of 60% (n=74) and for mental health nurses of 45% (n=301). Though both groups experienced violence at work, nurses were found: to have been exposed to violence significantly more during their career; to have been a victim of violence within the previous 12 months of the survey; and to have suffered a violent incident involving physical contact. Whilst a higher proportion of nurses than psychiatrists received some support following a violent incident, a large proportion of both groups did not receive any, although most felt in need of it. The implications of this study for training and management are discussed.
Intensified primary cancer care: a randomized study of home care nurse contacts
Authors: Johansson Birgitta , Berglund Gunilla , Glimelius Bengt , Holmberg Lars , Sjödén Per‐Olow
Published: March 2003

Intensified primary cancer care: a randomized study of home care nurse contacts

Newly diagnosed cancer patients (n=527) were randomised to intensified primary care or a control group. Intensified primary care comprised routines to improve general practitioners’ and home care nurses’ possibilities to support and monitor patients, i.e. increased information from specialist care, education and supervision in cancer care. The aims of this paper are to evaluate the effects of intensified primary care on cancer patients’ home care nurse contacts, and to study if patients’ use of home care services 6 months after diagnosis can be predicted. The intervention resulted in a marked increase of follow‐up contacts. About 90% of intensified primary care patients reported such contacts, compared to 26% of control patients. The results indicate that standard care does not routinely include follow‐up contacts, not even for the oldest (80+ years) or those with advanced disease. Only 27% and 36% of these groups of control patients reported follow‐ups. Logistic regression analysis identified intensified primary care as the strongest predictor for reporting a continuing contact 6 months after diagnosis. Intensified primary care patients were 14 times more likely than controls to report a such contact. The strongest predictor of a continuing contact in the intensified primary care group was high age. Patients with advanced disease were more likely than patients with non‐advanced disease to report a continuing contact, and living in a rural district was positively associated with reporting a contact. A majority of the patients (70%) assessed the time for the first contact as the ‘right time’ and estimated that the nurse gave expected support to a very large or large extent (67%). The results suggest that routines like those implemented through intensified primary care may be an effective strategy to increase the accessibility and continuity of care, especially for elderly people and for patients with a need for long‐term contacts.
Initiating research with doubly vulnerable populations
Authors: Moore Linda Weaver , Miller Margaret
Published: March 2003

Initiating research with doubly vulnerable populations

Some research questions can only be answered by members of a vulnerable group. Frequently members of these groups are doubly vulnerable as they experience more than one factor that diminishes their autonomy. Initiating research with doubly vulnerable persons presents unique and often difficult challenges. Because of these challenges, many researchers purposefully exclude doubly vulnerable groups from research endeavours. Thus, the health care needs and concerns of individuals considered doubly vulnerable are often not addressed in the scientific literature. This article presents two challenges frequently encountered when initiating research with doubly vulnerable populations: resolving pre‐investigation issues and gaining access to vulnerable populations. Ethically sound strategies for confronting these challenges are discussed. Researchers’ experiences with doubly vulnerable populations are also incorporated. Only when doubly vulnerable groups receive the appropriate research attention are the standards of their care and their quality of life enhanced.
Practitioner‐centred research: an evaluation of the implementation of the bedside hand‐over
Authors: Webster Jonathan
Published: March 2003

Practitioner‐centred research: an evaluation of the implementation of the bedside hand‐over

A practitioner‐based enquiry (PBE) or ‘practitioner‐centred‐research’ ( Rolfe 1998), was undertaken using action research to examine the concept of ‘nursing hand‐over’. The move away from the traditional style of hand‐over (which involved either one or two people verbally relaying ‘all’ information to those nurses coming onto duty) to a hand‐over that is based at the bedside with the patient and involves the patient and only those nurses accountable for that individual’s care, was the focus of the study reported here. The study was carried out on a medical ward for people aged 65 and over and aimed to identify whether after 6 months (post‐implementation of the new style of hand‐over) all staff felt that key issues identified in a 3‐month evaluation based primarily on quantitive data collection, had been addressed by using an action research methodology. Although reference will be made to the 3‐month evaluation as it formed a vital part of the process of assessing the change to practice, the focus of the analysis will be the evaluation that took place after 6 months. The key objective was to assess the effectiveness of the planned implementation of hand‐over at the bedside and the subsequent change to current nursing practice.
‘Having a say’: negotiation in fourth‐ generation evaluation
Authors: Koch Tina
Published: March 2003

‘Having a say’: negotiation in fourth‐generation evaluation

In this paper, research guided by the principles of fourth‐generation evaluation, which has negotiation as its centre, will be scrutinized. The role of stakeholders will be discussed with reference to negotiation issues. Throughout this discussion, observations will be based on the actual process of conducting three project evaluations in this tradition. Attention will be drawn to the consequences of negotiating at an uneven table.
Are patients who self‐administer their medicines in hospital more satisfied with their care?
Authors: Deeks Philip A. , Byatt Kay
Published: March 2003

Are patients who self‐administer their medicines in hospital more satisfied with their care?

Patient self‐administration of medicines in hospital prior to discharge is being seen increasingly as good practice by health professionals. Previous studies have looked for increased compliance and knowledge or asked whether patients liked self‐administration and have not clearly demonstrated the benefits. This study surveys patients’ views on self‐administration and on their care. In particular it looks at the discharge process and the way information was given to the patient on discharge. Questionnaires were distributed to 309 patients being discharged from general medical wards of a teaching hospital in Central England to be completed by the patients after their discharge from hospital. Of these, 202 were returned to a separate university department for analysis. Although this study has been undertaken on only two wards, the survey has potential for large scale use. Findings which were consistent with previous work were that a great majority of patients who had self‐administered their medicines would like to again, whilst those who had not had that opportunity were less likely to choose to self‐administer in the future. However, this study found that a majority of patients under 60‐years‐old would choose to self‐administer their medicines in hospital even if they had not been given the opportunity to do so recently. It was also found that patients who had administered their own medicines in hospital were more likely to report their overall care as excellent and were more satisfied with the discharge process than patients who had not.
What do people need psychiatric and mental health nurses for?
Authors: Jackson Sue , Stevenson Chris
Published: March 2003

What do people need psychiatric and mental health nurses for?

The study reported here aimed to describe, by consulting with psychiatric practitioners of different disciplines, what people in contact with mental health services need nurses for, in terms of core nursing activity. Yet, recent trends have also been towards consumer‐led definitions of good practice. The views of service and ex‐service users can contribute much to an exploration of the role of psychiatric and mental health nurses and these perspectives were incorporated into the study. Given the lack of existing theory, a qualitative, grounded theory methodology was selected. In order to generate data rich enough for the analysis, focus groups of psychiatric nurses, social workers, service users, psychiatrists, carers and professions allied to medicine were sampled (13 groups, n=92) on the basis of the themes emerging from the data. Using critical incident technique (
Flanagan 1954), the groups were invited to give examples of effective and ineffective nursing interventions, in relation to specific patient needs. The taped material was transcribed and analysed with the help of a computer package (QSR NUD.IST). This led to the selection of a core category, ‘knowing you, knowing me’, which described service users’ and professionals’ expectations that nurses are best placed to second guess the needs of patients and present themselves accordingly. Thus, nurses were expected, moment by moment, to know whether to be the patient’s friend, a friendly professional, or take a more distant professional stance. The continuum entails different levels of knowledge and power, different language forms and different approaches to structuring time. Nurses themselves are most likely to prefer a position of friendly professional, from which they can move to a more intimate or distant role. Further study is needed to explore how nurses predict patients’ expectations of them using a symbolic interactionist framework.
Psychiatric nurses’ thoughts and feelings about restraint use: a decision dilemma
Authors: Marangos‐Frost Sandy , Wells Donna
Published: March 2003

Psychiatric nurses’ thoughts and feelings about restraint use: a decision dilemma

Patients continue to be physically restrained in psychiatric in‐patient units. Studies concerned with staff‐related variables have suggested that the emotional reactions of professionals to violent or potentially violent patients may influence their use of restrictive measures. However, no research existed that described psychiatric nurses’ thoughts and feelings while they were involved in restraint situations nor what effects their thoughts and feelings had on their decision to restrain. Therefore, an ethnographic qualitative study was conducted in order to describe systematically nurses’ thoughts and feelings toward restraint use in the in‐patient psychiatric setting. The conceptual approach guiding the study was Etzioni’s (1992) theoretical work on the role of normative‐affective factors in decision making. Following ethical approval of the study, ethnographic interviews were conducted with six nurses from an in‐patient psychiatric unit who had participated in a situation involving the physical restraint of a patient. The analysis of the nurses’ thoughts and feelings revealed that the restraint situation represented a decision dilemma for them. This overall finding was supported by four themes: (1) the framing of the situation: the potential for imminent harm; (2) the unsuccessful search for alternatives to physical restraints; (3) the conflicted nurse; and (4) the contextual conditions of restraint. The results indicated that restraint use is more complex than is currently conveyed in the literature in that normative‐affective factors influenced nurses’ restraint decisions. The findings advance our understanding of why restraints continue to be used in psychiatric units. Further research is necessary to examine the findings in other settings and with a larger and more diverse population in order to draw definitive conclusions about the continued use of physical restraints in the care of patients on psychiatric units in hospitals.
The minimization to clients of screen‐detected breast cancer: a qualitative analysis
Authors: Farmer Alison J.
Published: March 2003

The minimization to clients of screen‐detected breast cancer: a qualitative analysis

Previous research has shown a low incidence of psychological morbidity in women with screen‐detected breast cancer when compared to women with symptomatic breast cancer. Farmer et al. suggested that this might be due to the way the diagnosis of breast cancer is given to women with screen‐detected disease. In order to test this hypothesis a detailed, in‐depth, qualitative study was undertaken. The sample consisted of women with symptomatic breast cancer (n=5), women with screen‐detected invasive breast cancer (n=6) and women with screen‐detected in‐situ breast cancer (n=5). The ‘bad news consultations’ with the surgeons, and subsequent meetings with the breast care nurses (BCN), were tape recorded. The women were also interviewed in their own homes within 7 days. The results suggested that the women with screen‐detected breast cancer received more reassurance than the women with symptomatic breast cancer and that the benefits of breast screening were emphasized by the surgeons and the BCNs. This led to minimization of the significance of screen‐detected disease. Women were found to draw on a new conceptual model of early curable breast cancer which appears to be associated with a low incidence of psychological morbidity.
Advanced nursing practice: the case of nurse practitioners in three Australian states
Authors: Offredy Maxine
Published: March 2003

Advanced nursing practice: the case of nurse practitioners in three Australian states

This paper provides insight into the work of nurse practitioners in three Australian states. Using a case study approach, the aim of the study is to give an account of some of the types of cases/patients who consult with the nurse practitioners in the states visited and to offer insight into one of the policy changes required to support the introduction of the nurse practitioner role. A snowball sampling technique was used to obtain the sample population of both 10 nurse practitioners and other health care personnel. Semi‐structured interviews were conducted with the 39 respondents in both samples. The analysis of the 10 nurse practitioner interviews reported here shows that these nurses undertook a wide range of roles. The results of the semi‐structured interviews with the nurse practitioners are described using four of the 10 interviews and reporting them as case studies. The results highlighted the need to address legislation issues and to prepare nurses adequately for their clinical setting and address the difficulties of continuing education of rural nurses.
Drawing up and administering intramuscular injections: a review of the literature
Authors: Rodger Michael A. , King Lindy
Published: March 2003

Drawing up and administering intramuscular injections: a review of the literature

Intramuscular (IM) injections have been an integral part of drug administration in nursing practice for almost half a century. However, there are some conflicting practices which warrant investigation to determine their effectiveness in this aspect of patient care. To this end, this paper presents the results of a literature review which was carried out in order to establish current understanding of present day knowledge, procedures and guidelines for the administration of IM injections. Areas addressed within this review include injection sites used, injuries associated with IM injections, issues surrounding needle selection and volume administered through IM injections, injection techniques and nursing skills associated with IM injections. Synthesis of the research reviewed allows the development of research‐based guidelines for this skill. These guidelines offer a framework for nurses who wish to provide practice in line with current research into the process of drawing up and administration of intramuscular injections.
Barriers to using research evidence in nursing practice
Authors: Retsas Andrew
Published: March 2003

Barriers to using research evidence in nursing practice

The nursing profession has long recognized the importance of research as an essential basis for its development. More recently, the movement supporting evidence‐based practice has brought this point into focus. However, relatively little research has been conducted to identify factors that interfere with the ability of nurses to base their practice on research evidence. Using factor analysis procedures, barriers to the use of research evidence in practice which were perceived to be present by 400 registered nurses working in an Australian hospital, were grouped under four main factors. These were accessibility of research findings, anticipated outcomes of using research, organizational support to use research and support from others to use research. The most important factor was perceived to be organizational support, particularly in relation to providing time to use and conduct research.
Characteristics of severely mentally ill patients in and out of contact with community mental health services
Authors: Barr Wally
Published: March 2003

Characteristics of severely mentally ill patients in and out of contact with community mental health services

Community mental health nurses have been criticized for failing to prioritize work with people with a severe or enduring mental illness, many of whom have no contact with specialist mental health services and rely entirely on their general practitioner and primary care team. It is important to ensure that those in contact with specialist services actually need this level of input but, conversely, that those in contact with only primary care receive a service that is equipped to meet their needs. This study examines the differences between these two groups of patients. A sample of 253 community‐based patients with a severe or enduring mental illness was divided into those with mental health service contact and those without. Differences in the demographic characteristics of the two groups were assessed and further, more detailed, comparisons were made with a sub‐sample of 49 individuals randomly drawn from this larger sample. Instruments adopted for these purposes comprised the Camberwell Assessment of Need and the Life Fulfilment Scale. It was found that patients with a psychotic disorder were more likely than those with neurosis to be in contact with mental health services and patients with schizophrenia were significantly more likely to be on the active caseload of a community mental health nurse than those from all other diagnostic groups. However, patients’ levels of need, unmet need and quality of life did not differ in relation to their service contact. Whilst the study provides limited evidence that community mental health nurses are targeting people with the most serious disorders, questions remain about the large proportion not receiving specialist care. Because primary care plays a significant role in the care of severely mentally ill people living in the community, the further mental health training of general practitioners and practice nurses is becoming increasingly important.
The evolving educational needs of nurses caring for the older adult: a literature review
Authors: Joy  , Carter  , Smith
Published: March 2003

The evolving educational needs of nurses caring for the older adult: a literature review

Recent changes in long‐term care policies in the United Kingdom have resulted in many more older patients/clients, previously nursed in long‐term hospital facilities, now being cared for in the community. This change has had a significant impact on nurses, forcing many to make the transition from working in hospital to within the community. This transition calls for appropriate professional educational preparation to enable these nurses to undertake their new roles effectively. The literature search that forms the basis for this paper revealed relatively little material focusing specifically on the educational needs of such nurses in transition. However, literature that addresses the needs of nurses caring for the older individual in the acute setting, and in the community environment, was found and is explored.
Factors related to stress and coping among Chinese nurses in Hong Kong
Authors: Callaghan Patrick , Tak‐Ying Shiu Ann , Wyatt Peggy A.
Published: March 2003

Factors related to stress and coping among Chinese nurses in Hong Kong

Few empirical studies have investigated the issues linked to Hong Kong nurses work‐related health. The present study investigated factors related to stress and coping among Chinese nurses in Hong Kong. The researchers employed a cross‐sectional survey and made within‐group comparisons of nurses’ stress and coping. Using stratified random sampling the researchers selected nurses from the mailing list of a local professional organization. One hundred and sixty‐eight (33·6%) nurses responded. Nurses reported lower stress levels than other workers assessed with the same measure. Paediatric nurses reported the highest stress levels. Nurses at the lower grades reported higher stress levels than nurses at the higher grades. Single nurses had marginally higher stress scores than married nurses and females had slightly higher stress scores than males. However, none of these results were statistically significant. The respondents’ major sources of stress were related to nursing issues like too much work, interpersonal relationships, and dealing with hospital administration. The respondents coped with their stresses by seeking support from friends and colleagues, using different cognitive strategies and through leisure activities. There was a statistically significant link between the respondents’ stress and sickness levels. The results raise issues about the nature of nurses’ working experiences.
Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner
Authors: Twinn Sheila , Cheng Frances
Published: March 2003

Increasing uptake rates of cervical cancer screening amongst Hong Kong Chinese women: the role of the practitioner

Women’s attendance for regular cervical screening has been identified as a significant factor in the prevention of cervical cancer. Evidence suggests, however, that both extrinsic and intrinsic factors influence women’s attendance patterns for screening. Extrinsic factors, in particular the practitioner undertaking the screening procedure, have been shown to influence women’s return rates for further screening. In Hong Kong, where uptake rates amongst Chinese women remain comparatively low, a study was undertaken to examine Chinese women’s experiences and perceptions of cervical screening undertaken by either a female doctor or nurse. A multiple case study design using both qualitative and quantitative methods of data collection was employed. This paper reports the findings from the qualitative data obtained from 52 women participating in 12 focus group interviews held in the two case studies. Thematic analysis of the data demonstrated the importance of the caring nature, communication skills, experience and expertise of the practitioner to women’s attendance pattern for screening. The experience and expertise of the practitioner, described by women as teaching, minimizing pain and discomfort and being considerate, were considered more influential to uptake rates than the professional discipline of the practitioner. Findings such as these indicate the importance of the influence of the practitioner in determining uptake rates for cervical screening amongst this population group.
Discourse analysis of an ‘observation levels’ nursing policy
Authors: Horsfall Jan , Cleary Michelle
Published: March 2003

Discourse analysis of an ‘observation levels’ nursing policy

The practice of special observation (or constant observation) is widely used in inpatient psychiatric facilities for the care of people who are suicidal. In this study, the policy of special observation was examined using a discourse analysis method to discern prevailing ideas and practices highlighted within the policy. After reading, studying and analysing the special observation nursing policy, the authors briefly describe the document and outline the terms and phrases prevalent within the document. These recurrent ideas are then organized into five categories: professional responsibilities, suicidality, the patient’s immediate context, the patient’s observable behaviour and the nursing checklist. In discussion of the policy document, the invisibility of the authors, target audience and patients is noted. The authors attempt to elicit evidence for the therapeutic nurse–patient relationship in the document. In the analysis of patient, nurse and doctor roles and responsibilities, it is evident that the policy document reinforces the traditional medical hierarchy of power relations. Some assumptions that underpin the document are postulated. Questions regarding the nature of risk assessment and the evidence base for the medical prescription of special observation are raised. As well as ideas and themes evident in the document, the absence of some relevant issues is explored. While the need for succinctness and clarity in policy documents is acknowledged, the fact that patient rights, therapeutic processes and ethical dilemmas are absent is deemed significant.
Nursing student–patient relationship: a review of the literature from 1984 to 1998
Authors: Suikkala Arja , Leino‐Kilpi Helena
Published: March 2003

Nursing student–patient relationship: a review of the literature from 1984 to 1998

Aim and background. The aim of this review is to examine the research of the nursing student–patient relationship for planning an empirical study in this area.

Methods. A literature search was made focusing on relationship from student and patient perspectives. The sample included 104 articles from 1984 to 1998. The articles were analysed using an inductive analysis of the literature.

Results. The review shows that there has been an increasing research interest in the issue since the 1980s, with the main focus on nursing students. Most of the studies were of a descriptive nature, using both qualitative and quantitative approaches. It seems that the relationship with a patient is an important part of a meaningful learning process, teaching nursing students about the patient’s individualised care and promoting their personal and professional growth, confidence and self‐esteem. Patients are willing to participate in students’ learning process and they tend to benefit from therapeutic and social interaction with students. Instruction has the effect of changing students’ attitudes and improving their interaction skills, but it does not affect their feelings of anxiety in novel situations.

Conclusions. In future empirical research should be based more firmly on theory‐based illuminations of the student‐patient relationship.
Observing washing and dressing of stroke patients: nursing intervention compared with occupational therapists. What is the difference?
Authors: Booth Joanne , Davidson Ian , Winstanley Julie , Waters Karen
Published: March 2003

Observing washing and dressing of stroke patients: nursing intervention compared with occupational therapists. What is the difference?

This study sought to compare the interventions of qualified nurses with those of occupational therapists during morning care with the same population of stroke patients. Nonparticipant structured observation was used to identify the activities and interventions carried out by each of the two groups in a naturalistic care setting. Approval for the study was granted by the local ethics committee. In order to allow comparison between pairs, staff–patient interactions during morning care (n=10) were observed by a single researcher, firstly, with an occupational therapist and within 3 days of this, with a nurse. Twenty observation sessions were recorded in total during which time the activities, contacts and interactions were coded and recorded at 20‐second intervals on a standard proforma. Analysis was undertaken using the Statistical Package for Social Sciences (SPSS) for windows. The results showed that occupational therapists used ‘prompting and instructing’ commands more than nurses and used facilitation techniques significantly more (P=0·0283). ‘Supervision’ interactions were preferred by nurses with 42·1% of their time spent performing this activity compared with 25·1% for occupational therapists. These results are limited to the group under observation. It is suggested that the reasons for the observed differences in intervention styles used by occupational therapists and nurses may be attributed to the approach taken to the assessment and treatment of stroke patients. This difference might be attributed to a lack of preparation for specialist neurological/neurovascular practices of nurses working in the field of stroke rehabilitation.
The use of metaphor in district nursing: maintaining a balance
Authors: Goodman Claire
Published: March 2003

The use of metaphor in district nursing: maintaining a balance

Aim of the study. To explore with practitioners and others, their priorities for and definitions of district nursing.

Background/Rationale. This paper discusses whether the use of metaphor in nursing literature and research can offer particular insights about the situation and experiences of nurses.

Design/Methods. A case study approach was used to examine district nursing during a time of policy change. The study was undertaken in two stages using a range of qualitative methods of enquiry. Participants of the study were district nurses, General Practitioners (GP) and Community Nursing managers.

Results/Findings. Qualitative data from interviews and periods of observation revealed that district nurses, and to a lesser extent General Practitioners and nurse managers used a shared group of metaphors to try and capture district nursing work. The paper suggest that this recurring group of metaphors demonstrated coherence between the language used, observed practice and accounts of how district nurses worked which provided useful insights for district nursing. The metaphoric language revealed both negative and positive dimensions of district nursing work. It illuminated the context dependent nature of district nursing work and the conflicting interests they had to accommodate. It also revealed the emotional work, skills and strategies district nurses employed in order to achieve their work.

Conclusions. The paper concludes that an examination of metaphoric language offers an opportunity to examine what otherwise would be tacit or even misunderstood in nursing work.
Postnatal depression – biological or cultural? A comparative study of postnatal women in the UK and Taiwan
Authors: Huang Yu‐Chu , Mathers Nigel
Published: March 2003

Postnatal depression – biological or cultural? A comparative study of postnatal women in the UK and Taiwan

Aim.  The aim of the study was to compare the factors which are associated with postnatal depression in the UK (United Kingdom) and Taiwan.

Background/Rationale.  A comparative study of postnatal women in the UK and Taiwan was undertaken to investigate postnatal care and the prevalence of postnatal depression.

Design/Methods.  The Edinburgh Postnatal Depression Scale (EPDS) was used to determine the prevalence of postnatal depression. A semistructured interview and validated questionnaire were used to collect data on maternal satisfaction with postnatal care and the factors associated with postnatal depression. A one in three random sample of women from two community midwife teams in Sheffield, UK and three public health stations in Keelung, Taiwan took part in the study.

Results/Findings.
 Fifty (94% response rate) women from Sheffield and 101 (83% response rate) women from Keelung, who were at low risk for maternal or foetal problems during labour and the postnatal period, agreed to participate. The prevalence of postnatal depression in the British and Taiwanese women was almost equal; 18% in the UK and 19% in Taiwan. In Taiwan, the prevalence of postnatal depression had a negative association with relationship with partner (Spearman correlation=–0·34, P < 0·001) and self‐confidence (Spearman correlation=–0·28, P < 0·01, Spearman correlation). In addition Taiwanese women who felt more anxious after birth (10·9 ± 7·9, P < 0·001, t‐test) had a higher chance of postnatal depression. In the UK, there was a significant negative association between adaptation to the new role of motherhood and score on the EPDS (Spearman correlation=–0·47, P < 0·001). The overall scores for maternal satisfaction were 28·1 and 24·3 in the UK and Taiwan, respectively (P < 0·001, t‐test). British women reported a better quality of care during the postnatal period in terms of emotional support and physical care.

Conclusions.  The findings of this study suggest that further cross cultural investigation could shed light on the relative balance of biological and cultural factors which may be associated with the onset of postnatal depression. As the prevalence of postnatal depression is similar in both cultures despite large differences in culture and postnatal care systems, some support is given to a hypothesis that postnatal depression has at least some biological determinants as well as cultural/social ones.
A literature review on the concept of intimacy in nursing
Authors: Williams Angela
Published: March 2003

A literature review on the concept of intimacy in nursing

Aim. This paper explores the concept of intimacy in nursing.

Rationale. Intimacy is an increasingly important concept in nursing and feature of the nurse–patient relationship, which is perceived to be intrinsic to the proposed therapeutic potential of nursing. The introduction to the paper highlights the theoretical enthusiasm and endorsement of intimacy, the apparent lack of conceptual clarity from a nursing perspective and little published research investigating intimacy in practice.

Method. Literature is reviewed from nursing and a variety of health–related disciplines.

Findings. The paper traces the historical background of the nurse–patient relationship and intimacy and highlights the change in value from detachment and distancing to intimacy, commitment and involvement. The nature of intimacy is examined and a concept analysis based on literature from psychology and psychiatric medicine is critically analysed. Intimacy is suggested to have psychological, emotional and physical aspects, which are explored. An ethnographic research study on intimacy in nursing is reviewed, which also recognizes physical and emotional dimensions of the concept and the importance of sufficient resources to allow the close relationships advocated. Attention is drawn to the constraints on intimacy imposed by the current market–led health service. Literature and research on the implications and consequences of intimacy for the nurse are discussed. These report practical difficulties of maintaining close relationships with individual patients and the potential for over‐involvement and emotional labour.

Conclusion. The paper concludes with the increasing importance attached to intimacy in nursing and its complex, ill‐defined nature. This serves to highlight the importance of research aimed at exploring and clarifying intimacy and further illustrating the therapeutic potential of nursing.
A descriptive study of meaning of illness in chronic renal disease
Authors: Caress Ann‐Louise , Luker Karen A. , Owens R. Glynn
Published: March 2003

A descriptive study of meaning of illness in chronic renal disease

Aim. To explore the subjective meaning of illness in a sample of renal patients.

Background. Patients’ illness representations, such as the meaning they attach to illness, may affect their coping and adaptation. Improved understanding in this area may therefore benefit patient care. Meaning of illness has not previously been explored in renal disease.

Design and methods. Cross‐sectional survey (n=405) in a single regional renal unit in the North of England. Ethical approval was obtained and patients gave written consent. The instrument used was an eight‐item schema, based on the work of Lipowski (1970, Psychiatry in Medicine1, 91–102). Field notes regarding rationale for choice were recorded concurrently, then content analysed to enable identification of themes. The chi‐square test (significance level P < 0·05) was used to analyse differences in selected meaning in older and younger patients; males and females; and patient groups (predialysis, haemodialysis and transplant).

Findings. ‘Challenge’ was selected by most patients (n=253, 62·5%), with similar results in all three patient groups. Slightly more older than younger patients selected ‘challenge’, although the difference was not statistically significant and older patients more commonly had a fatalistic interpretation of the option. More men selected ‘challenge’ than women. Those selecting ‘challenge’ and ‘value’ appeared to have a more positive outlook than other patients.

Conclusions. Patients had identifiable meanings for their illness, and these may be associated with their response to renal disease. The schema appeared to be comprehensive, but is in need of further refinement. Consideration of the possible influence of social desirability is necessary.