bluuebunny/crossref_metadata_2025 huggingface dataset:
Depression during the female climacteric period
Authors: Coleman Philip M
Published: March 2003

The paper draws attention to the increased incidence of clinical depression reported during the climacteric period of the female life continuum It seeks to identify factors which may be responsible for this phenomenon, drawing upon research and anecdotal evidence from both the biological and social sciences With this aim, changes during the climacteric period for women are examined within a bio‐psycho‐social framework Nursing care and treatment of those suffering depression within this stage of the middle years are discussed briefly and the influence of personal beliefs, held by both the patient and clinician, emphasized The relevance and importance of these factors when employing the Roy Adaptation model in the care of such clients is also considered In conclusion, the author stresses the need for a holistic approach and highlights the value of Roy's model in care provision for this patient group
Nursing dementing elderly people: ethical issues
Authors: Hillan Edith M
Published: March 2003

It has been estimated that up to 40% of people with moderate to severe dementia live in residential homes or long‐stay hospital wards This paper examines some of the ethical issues that arise in nursing people suffering from dementia within an institutional setting The paper focuses first on the nursing profession and the recently published Strategy for Nursing The fundamental patient/client values within the strategy recognize the uniqueness of the individual and the importance of providing nursing care which is tailored to meet individual needs The next part of the paper will examine the difficulties associated with individualizing care for people suffering from dementia and highlight some of the ethical issues involved in looking after them Finally, some of the general professional issues involved are examined and some tentative suggestions are put forward as to how some of the identified problems might be tackled
Health belief systems in perspective
Authors: Thorne Sally
Published: March 2003

The author adopts a critical stance toward the assumptions, beliefs and behaviours underlying western biomedical tradition as it is enacted within the health care arena, in this paper On the basis of a cross‐cultural comparison of how health belief systems depict the nature of health, the nature of illness and the role of healers, this paper will analyse the degree to which traditions other than western biomedicine seem to influence much of our decision making and behaviour as practitioners and recipients of health care Thus, locating our relationship to biomedical thought within the context of non‐dominant belief systems provides an unusual angle from which to evaluate critically the way we think and behave In concluding that western health beliefs are powerfully influenced by traditions far beyond biomedical ideology, the author raises implications for nursing's future directions as active participants in a global health movement
Patient satisfaction with home‐birth care in The Netherlands
Authors: Kerssens Jan J
Published: March 2003

One of the necessary elements in an obstetric system of home confinements is well‐organized postnatal home care In The Netherlands home care assistants assist midwives during home delivery, they care for the new mother as well as the newborn baby, instruct the family on infant health care and carry out household duties The growing demand for postnatal home care is difficult to meet, this has resulted in a short supply of the most popular day care programme and a level of provision which does not result in adequate services This study acknowledges the patient perspective of maternity home care in order to contribute to its organization The majority (79%) of service centres were willing to participate A total of 1812 (81%) women who recently gave birth to a child responded to a postal questionnaire addressing the quality of care according to five dimensions availability, continuity, interpersonal relationships, outcome and assistant's expertise Almost one‐third of the new mothers rated the availability as inadequate while the assistant's expertise was rated positively Postnatal maternity home care is personalized, small‐scale, and recognizes childbirth as a life event Furthermore, it is relatively inexpensive and contributes to the satisfaction of recipients
Monitoring the pressure sore problem in a teaching hospital
Authors: Dealey Carol
Published: March 2003

During 1989 and 1990 a senes of three prevalence surveys were undertaken in a West Midlands teaching hospital to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure relieving equipment A further survey was undertaken in January 1993 to examine any improvement in pressure sore prevention strategies and in the care of those with established pressure sores All in‐patients were assessed using the Waterlow score Full details of all pressure sores and any pressure relieving equipment in use was recorded The findings were compared with those of the first survey in 1989 The prevalence for 1989 was 8 77%, and this had reduced slightly to 7 9% in 1993 There was no significant difference in these figures However, in 1989 35 patients had 64 pressure sores and in 1993 32 patients had 46 pressure sores There was a significant reduction in the actual numbers of pressure sores There was no significant difference in the grades of sores and the sacrum was the most frequent position in both surveys The survey showed an improvement in the management of established pressure sores There was little change in the patient populations with respect to the degree of risk of pressure sore development Using the Waterlow score, the numbers of patients found to be in the no risk, at risk, high risk and very high risk categories remained remarkably stable These surveys will continue to provide a basis for selecting pressure relieving equipment Measurement of pressure sore incidence is needed in the future to monitor the efficacy of the prevention programme
Unlimited liability? Emotional labour in nursing and social work
Authors: Aldridge Meryl
Published: March 2003

At the heart of the‘new nursing’ is an emphasis on developing a close, holistic relationship between nurse and patient Through this not only will healing be facilitated, and patients be encouraged to take responsibility for their own health, but the nurse will be placed firmly at the centre of the network of health professionals Individual practitioners and the profession as a whole will achieve a clearer and more satisfying mission This casting of the nurse as pivotal enabler parallels attempts to systematize social work theory and practice in the 1970s, and many common intellectual sources on relationship‐building are used But what are the supposed characteristics of the ‘good relationship’? The paper argues that, while the new nursing endeavours to emphasize the social context of patients, health and illness, much of the psychotherapeutic literature called in support is essentialist the social world is treated as a hindrance to the goal of‘authenticity’ Thus acquired professional knowledge and skills are devalued Added to the potential of this for personal stress are risks for the profession itself In circumstances of permanent financial pressure, foregrounding hard‐to‐measure criteria of success, like the quality of relationships, is very hazardous
Interpersonal learning in groups: an investigation
Authors: Franks Vicky , Watts Mary , Fabncius Julia
Published: March 2003

The dissatisfaction of patients with communication in health care has largely been addressed by providing more communication skills training Research into why skills training might be ineffective has identified various factors, which include organizational resistance, personal defences against anxiety and a need for personal reflection and support In one college of nurse education small group discussion and reflection had become established practice for students in their first and second clinical experience The groups met once weekly and were facilitated by a nurse teacher Discussion was unstructured and focused on the nurse's interpersonal relationship with his or her patients This project examined one such group and sought to examine the use of small group reflective discussion by nurses about ther patients as a means of improving interpersonal communication The research was conducted over a period of 6 months with nine student nurses meeting once weekly during their first two episodes of clinical experience Kelly's personal construct theory was used and two repertory grids were constructed by the group One grid examined processes and change in intrapersonal construing, and the other grid examined processes and change in construing about certain patients These grids were completed by the students at the beginning and at the termination of the groups Notes were taken after each group meeting, which recorded impressions and processes, these were discussed once weekly with supervision The notes were analysed using a grounded theory methodology The results show some changes in patterns of constructing in relation to self which indicate an increase in anxiety and reluctance to self‐reflect The need for defensive structures in order to facilitate self‐reflection is discussed in the light of the qualitative analysis Finally the value of this type of work is supported by evidence of the group working as a social microcosm The limitations and indications for further research are noted, but this project supports the contention that in order to be truly effective those who come in contact with the emotional needs of patients
Perpetuation of ageist attitudes among present and future health care personnel: implications for elder care
Authors: Lookinland Sandra , Anson Kathy
Published: March 2003

The population of the western world is greying rapidly By the year 2025, people over the age of 65 will make up 20% of the population of the USA By the year 2000, one‐half of elderly people in the United Kingdom (UK) will be over the age of 75 The increasing numbers of elderly people will be spending from 18% (males) to 27% (females) of their added years as impaired, disabled and frail individuals The purposes of this comparative descriptive study were to (a) describe and compare the attitudes of registered nurses (RNs) and health career work study students (HCS) who work with elderly people in the clinical setting, and (b) determine whether relevant demographic variables of the two groups were related to their attitudes A convenience sample of 82 RNs and 68 HGSs were asked to complete Kogan's (1961) Attitudes Toward Old People Scale (KOP) Response to the survey was 91% and 74% for the HCS and RN groups respectively There was a significant difference between the group mean scores with students holding less favourable attitudes toward elderly people on the KOP‐negative scale No significant difference was found on the KOP‐positive scale Point‐bisenal correlations between demographic variables and attitude scores revealed that gender and ethnicity were significantly related to RNs attitudes—males and blacks and Asians expressed more unfavourable attitudes Educational level and primary area of clinical work were significantly associated with students' scores on the KOP‐negative scale, while years of clinical experience was significantly related to KOP‐positive scale scores While both groups held attitudes that were more favourable than unfavourable, RNs and HCSs expressed stereotypical views about old people in general Recommendations for nursing education and nursing service are proposed to prevent the negative impact on future care elderly people that the findings suggest
Women's experiences of rheumatoid arthritis
Authors: Brown Shona , Williams Anne
Published: March 2003

This paper is based on findings drawn from research undertaken within a qualitative framework of analysis The purpose of the research was to explore women's experiences of rheumatoid arthritis Three areas of concern to the women are identified and discussed in the light of relevant literature They are as follows seeking help, searching for meaning and uncertainty about symptoms A major theoretical concern of both authors is to demonstrate the importance of placing patients' personal accounts of their experiences and understandings at the centre of nursing interest and practice It is argued that there is a need to develop research studies of how patients expenence disease, in order to develop a basis for good practice
Hindsight bias in reflective practice: an empirical investigation*
Authors: Jones Peter Reece
Published: March 2003

Reflection is seen as a central component in the education and practice of nurses It is through critical reflection on one's practice that expertise can be assured This faith in the process of reflection has influenced much of pre and post registration nurse education It is only in the past few years that reflection as a technique has being criticized A small‐scale study investigating the phenomenon of hindsight bias and its consequence on the reflective process is described The effects of the hindsight bias is to influence people's recollection of events once they know the final outcome The present study does indicate that nurses are susceptible to such a bias, which would question the validity of reflection as a way to enhance patient care There is an urgent need to clarify the reflective process and then to examine its effect on patient outcomes
Mapping knowledge in chronic illness
Authors: Dluhy Nancy M
Published: March 2003

Theory‐based nursing practice requires a systematically developed, integrated body of information to deal effectively with the complexities of the human condition This philosophical research is founded on a complementary knowledge model, valuing diverse views The burden therefore is on uncovering connections between perspectives A method is proposed and tested for mapping pluralistic knowledge in chronic illness Underlying the method development is the premise that all knowledge can be represented as different combinations of ontology (views of the person) and epistemology (nature and aims of science) Based on a review of over 300 references, six major themes (comprised of 20 conceptual categories) are uncovered in the nursing literature Analysis of the map reveals the influence of trends as well as areas of minimal development (e g holism) A key advantage of mapping is the opportunity to know the data in a large substantive area and to begin to identify potential linkages for cumulation Fatigue, pain, symptom management, day‐to‐day living with illness, and social support are identified as promising areas to begin building a mid‐range theory of chronic illness Developing a cumulative knowledge base narrows the gap between theory and practice
Analysing clinical practice guidelines. A method of documentary analysis
Authors: Appleton Jane V. , Cowley Sarah
Published: March 2003

This paper will describe a method of documentary analysis used in a study examining the validity of clinical guideliness issued to health visitors to assist them in identifying families requiring increased health visitor support. This forms the preliminary work for a wider study examining how health visitors decide to increase support to vulnerable families. Although a number of published research texts dicuss the value of records and documents as important data sources for health service researchers, there is relatively little information avialable about the processes of documentary analysis. This paper offers one method for analysing clinical practice guidelines, it describes the development of a critique and analysis tool and expolres the strengths an weaknesses of this particular analysis instrument.
Liaison mental health nursing: origins, definition and prospects
Authors: Roberts Dave
Published: March 2003

Liaison mental health nursing is an evolving specialist area of mental health nursing in the United Kingdom (UK). It has many similarities with ‘psychiatric consultation liaison nursing’ practiced in the United States of America (USA), but there have been differences in its development. It is well established in general health settings where psychological problems are most apparent, such as accident and emergency services and oncology. However, it lacks clear developed, and how it is currently described. The position of liaison mental health practice within nursing is discussed, and also its relationship to liaison psychiatry. The theoretical base of this specialty may be seen as an integration of biological, psychological and sociological perspectives. There is no current programme of training for liaison mental health nurses, and this is likely to inhibit its recognition as a specialty in the UK. As interest grows in psychosocial aspects of physical health, liaison mental health nursing has the potential to provide a focus for research within nursing. Areas for further development are reviewed, and a research agenda is proposed.
Measuring care: the case of district nursing
Authors: Rapport Frances , Maggs Professor Christopher
Published: March 2003

This paper describes a district nursing study that considered the experiences and responses of primary health care professionals and their patients to changes taking place within the community. As a qualitative study it employed interviews as the main method of data collection and was informed by both ethnography and interpretative phenomenology. Forty‐three study participants were interviewed, eliciting opinion on whether care is more than just a hands‐on activity, whether patient need is being met and to what extent service policy is in tune with care delivery. Describing the views of primary health care professionals and patients in order to illustrate the complexity of the district nursing service and professional roles, the paper finds little shared vision between staff and managers of each other's responsibilities. It concludes that a more holistic approach to understanding professional roles is needed in order to satisfy the differing agendas of managers, staff and patients. It propounds the need for closer collaborative practice between health care professionals, for it finds that they value the ability to communicate as an essential element of their jobs. It reflects that, without such collaboration, it will be difficult for nurses to take a lead position on changes shaping community care.
Teaching elderly patients how to use inhalers. A study to evaluate an education programme on inhaler technique, for elderly patients
Authors: Abley Clare
Published: March 2003

Elderly patients often receive little or no teaching on the use of their inhalers. This study evaluated a patient teaching programme, designed specifically for elderly people. The sample (n = 27) was taken from patients who were prescribed inhalers and had been admitted to the elderly care wards of an acute provider unit. Individual inhaler technique was assessed, using a simple checklist, both before and after teaching and total scores calculated. Each subject received one to one teaching sessions by a registered nurse on four consecutive occasions that inhaled medication was due, together with an information sheet on inhaler technique. Total scores showed significant improvement; however, improvement on any one action was not found to be significant. Thus patient teaching leads to a significant improvement in inhaler technique; however, further research is necessary to determine whether this improvement is sustained over time. Recommendations for practice are made.
Recovering from the death of a spouse
Authors: Hyrkäs Kristiina , Kaunonen Marja , Paunonen Marita
Published: March 2003

Within the context of an international comparative grief project, the goal of this study has been to compare the grief reactions of grieving Finnish women and men who had lost their spouse within a period of either less than or more than 2 years prior the study. The sample consisted of women (n = 242) and men (n = 76) who had lost a spouse between the ages of 25 and 65 years at the time of their death. Two instruments were used in data collection: a sociodemographic instrument and the Hogan Grief Reactions Checklist, developed in the USA. In comparing the different dimensions of grief in the subgroups divided by the bereavement time, there were significant differences in the grief reactions. Despair and disorganization diminished over time. Panic behaviour and detachment dimensions also showed differences although they were not statistically significant. The widowers who lost their spouse more than 2 years prior to the study displayed their feelings of blame and anger more than the widows. Results showed that if the death had occurred less than 2 years prior to the study there were no differences between the groups.
Conceptualizing advanced nursing practice: curriculum issues to consider in the educational preparation of advanced practice nurses in the UK
Authors: Woods Leslie Peter
Published: March 2003

The findings from a Florence Nightingale Scholarship to the USA and Canada, investigating the educational preparation of advanced practice nurses, are reported. The author considers a number of issues facing curriculum designers who might wish to develop clinically based advanced practice nurse programmes in the UK. Utilizing the experiential nature of personal visits, along with the available literature, the strategy adopted by some American and Canadian universities is highlighted to exemplify curriculum issues likely to be encountered in the UK. A definition of advanced nursing practice is provided as a foundation for discussion on curricular construction. This is followed by a discussion on advanced role nomenclature and components and characteristics of the ‘nurse practitioner’, ‘clinical nurse specialist’, ‘nurse consultant’ and ‘nurse clinician’, in order to clarify terminology and disentangle different advanced practice roles. The issues examined include the academic level of advanced practice nurse programmes; the determination of curricular content based on both a ‘generalist’ and ‘specialist’ model of practice; factors considered when exploring advanced practice competencies; and the resource implications for delivering opposing curriculum models. The paper suggests that there is a unique opportunity for advanced practice nursing to establish a key collaborative relationship in the delivery of health care, based on a nursing model, graduate study and the integration of key nursing and related concepts into clinical practice.
A historical study of men in nursing
Authors: Mackintosh Carolyn
Published: March 2003

This study outlines a brief history of men as nurses in the United Kingdom. It uses a variety of historical sources, primary archival, oral history and secondary sources to retell the history of nursing with emphasis on the frequently neglected place of men within it. History appears to indicate that men have had a place in nursing for as long as records are available, but their contribution has been perceived as negligible, largely because of the dominant influence that the 19th century female nursing movement has had on the occupation's historical ideology. The study indicates that men have an equally valid historical role within nursing, and that this should be acknowledged when considering male nurses' position within the nursing profession.
Natural therapeutic holding: a non‐aversive alternative to the use of control and restraint in the management of violence for people with learning disabilities
Authors: Stirling Christopher , McHugh Albert
Published: March 2003

For at least the last 10 years, control and restraint (C&R) has gained increased popularity amongst nurses as a safe, professional and legal means to manage violence in health care settings. However, during this period there has been an increased momentum to find non‐aversive management strategies for people with learning disabilities and there has been frequent debate on the abolition of practices which do not achieve this. More recently, the main criticisms of C&R have been the professional and ethical objections that the techniques used inflict some degree of pain or discomfort to the client, and the fact that it remains a reactive strategy with no theoretical framework for professional practice. On this basis, alternatives should be sought which seek to address these issues. This paper outlines the development of natural therapeutic holding, an approach which is non‐aversive and which provides a theoretical structure for professionals to base their practice on in order to develop clear therapeutic goals for the client. Initial findings within a small community residential service for people with learning disabilities indicate that natural therapeutic holding was a preferred method of intervention strategy by staff, proving as effective as C&R in the management of violent incidents, with interventions being much shorter in duration and non‐aversive in nature.
The emergency nurse practitioner role in major accident and emergency departments: professional issues and the research agenda
Authors: Tye Christopher C.
Published: March 2003

The emergency nurse practitioner (ENP) is a rapidly developing role within emergency health care provision in the United Kingdom (UK). This paper explores some of the available literature concerning the development of the role in the context of major accident and emergency departments. The professional and legal implications of this shift in role boundaries are discussed. The current inconsistencies in educational provision and the potential consequences for practice in this area, are highlighted. The relative plethora of rigorous evaluation studies of ENP role effectiveness in North America, is contrasted with the current paucity of empirical data available in the UK. A number of methodological issues concerning the evaluation of ENP services are identified. The need for research in this area, alongside a programme of continuing local audit to guide and inform evidence‐based practice, is emphasized.
Relational capacity: the foundation for interpersonal nursing practice
Authors: Hartrick Gwen
Published: March 2003

Nurses have the opportunity to make a profound difference in peoples' health and healing experiences. However, our emphasis and reliance on mechanistic models of relating often results in our failure to realize this opportunity. This paper challenges the appropriateness of mechanistic models of human relating that focus on behavioural communication skills, and suggests an alternate approach that emphasizes the enhancement of relational capacity. Five relational capacities are described including: initiative, authenticity, and responsiveness; mutuality and synchrony; honouring complexity and ambiguity; intentionality in relating; and re‐imagining.
Computers in midwifery practice: a view from the labour ward
Authors: Hillan Edith M. , McGuire Margaret M. , Cooper Mark
Published: March 2003

Concern continues to exist about the lack of integration of research into clinical practice. One of the reasons which has been suggested for this, is that practitioners may either not know about, or understand, the research findings. The availability of a database which contains systematic reviews of research such as the Cochrane Pregnancy and Childbirth Database, should go some way to overcome such obstacles associated with the implementation of research into practice. As part of a national audit on Caesarean section, a computer with the Cochrane Database was installed in the labour ward of each consultant maternity unit in Scotland. The purpose of this study was to determine if midwives working in labour wards make use of this accessible source of research findings to inform their practice. Anecdotal evidence suggested that although midwives were keen to use the databases, they did not have the requisite computer skills to do so. This study examined the computer literacy of midwives and their perceived educational needs. A questionnaire was distributed to all labour ward midwives in 22 consultant maternity hospitals in Scotland (n=850). This questionnaire considered issues such as the preparation of midwives to use computers, midwives’ perceptions and use of computers and their perceived educational needs. The response rate was 74%. Following analysis of the questionnaire labour ward managers were interviewed by telephone to ascertain their views regarding the Cochrane Database and their perception of its effectiveness. The results highlighted that only 27% of midwives claimed to use the Cochrane Database on a regular basis. Overall midwives had a positive attitude towards information technology but claimed they did not have the requisite computer skills to use these tools. Managers agreed that there was a need for further instruction and support for midwives. The findings of this study have important implications for the future professional preparation and continuing education of midwives.
Relaxation techniques for acute pain management: a systematic review
Authors: Seers Kate , Carroll Dawn
Published: March 2003

This review aims to document the effectiveness of relaxation techniques, when used alone for the management of acute pain, after surgery and during procedures. A systematic review of randomized controlled trials (RCTs) was undertaken. Seven studies involving 362 patients were eligible for this review. One hundred and fifty patients received active relaxation as the sole intervention. Reports were sought by searching MEDLINE, psycLIT, CINAHL, and the Oxford Pain Relief Database. The outcome measures used were pain and psychological factors. A meta‐analysis was not possible, due to lack of primary data. Three of the seven studies demonstrated significantly less pain sensation and or pain distress in those who had relaxation. Four studies did not detect any difference. There was some weak evidence to support the use of relaxation in acute pain. However, this was not conclusive and many of both the positive and the negative studies suffered from methodological inadequacies. Well designed and executed randomized controlled trials are needed before the clinical use of relaxation in acute pain management can be firmly underpinned by good quality research evidence. Until this evidence is available we recommend that the clinical use of relaxation in acute pain settings is carefully evaluated and not used as the main treatment for the management of acute pain.
Investigating psychosocial aspects of participation in early anti‐cancer drug trials: towards a choice of methodology
Authors: Cox Karen
Published: March 2003

This paper presents the methodological approach and research methods chosen to explore psychosocial aspects of participation in early anti‐cancer drug trials from the perspective of those actually involved. The paper describes how an appropriate methodology, or principles of reasoning behind the choice of research methods, emerged. The choice of methodology was based on three elements: first, an understanding of the competing philosophies about how research can be approached and conducted; second, the author’s view of the subject area; and third, a consideration of previous research approaches which have investigated psychosocial aspects of cancer clinical trials. A qualitative methodology situated within an interpretative paradigm was eventually chosen as the most appropriate means of exploring trial participants’ experiences and the aim and objectives of the research were developed within this methodological framework.
The impact of management of change projects on practice: a description of the contribution that one educational programme made to the quality of health care
Authors: Allan Douglas , Cornes Desmond
Published: March 2003

This paper is based on the authors’ experience of teaching and supervising the first intake of the management unit of the diploma for charge nurses offered by the Department of Professional Development and Training, Glasgow College of Nursing and Midwifery, Glasgow, Scotland. The students on this course undertake a project comprising of a documented research‐based action plan aimed at the achievement of a selected topic for change directly linked with their practice. All the students except one were G grade charge nurses from a wide variety of clinical backgrounds. This paper will briefly consider the work of Barriball et al. who suggest categories of outcomes of continuing professional education. This is contrasted with Scheller, who highlights three problems when attempting to measure the impact of continuing education on practice. Despite these problems, it is beneficial to attempt to consider the impact of continuing professional education on practice. The work of Francke et al. will be featured in which they ascertain the determinants of changes in nurses’ behaviour after continuing professional education. The authors believe that the management of change project, undertaken by the students, enhances the possibility that knowledge gained from the management unit will impact on their practice. Two examples of students’ projects will be used to support the paper. The first concerns changing to a 12‐hour shift pattern in an intensive care setting and the second relates to the implementation of the named nurse system.
Establishing an international network on nurses’ clinical reasoning
Authors: Greenwood Jennifer
Published: March 2003

A recent review of the relevant literature indicates that different approaches to the exploration of nurses’ clinical reasoning are being adopted in North America, Australia and the United Kingdom. These differing approaches, which tend to cluster chronologically and which include decision analysis, information processing and skills acquisition theory and their limitations will be outlined; it will be argued that it is through their conflation that nurses’ collective understanding of nurses’ clinical reasoning is deepened. The author is attempting to develop an international network of nurse scholars interested in clinical reasoning with the aim of achieving this. The purposes of this network will be to facilitate international collaboration to expedite both the growth of knowledge related to nurses’ clinical reasoning and the development of programs of international comparative research related to it. The setting up of this network and progress to date is described.
Nursing’s metaparadigm concepts: disimpacting the debates
Authors: Thorne Sally , Canam Connie , Dahinten Susan , Hall Wendy , Henderson Angela , Kirkham Sheryl Reimer
Published: March 2003

Theoretical advances in nursing have been complicated by polarization and extreme positions regarding nursing’s approach to its main metaparadigm concepts: person, health, environment and nursing. In this paper, the authors deconstruct some of the central arguments that are used to further this polarization. Using a critical interpretive approach, they explain some of the logical implications imposed by various extreme positions for the larger project of nursing’s health and social mandate, and consider the effects of such polarization. On the basis of an appreciation of the serious difficulties inherent in certain philosophical and theoretical positions currently evident within nursing’s literature, the authors argue for a less extreme and more integrated reference point for nursing’s theory and practice.
The new ward manager: an evaluation of the changing role of the charge nurse
Authors: Willmot Madeleine
Published: March 2003

Changes in health service policy and in the structure of nursing have made charge nurses into ward managers with the autonomy and power to improve the quality and effectiveness of patient care. In a climate where clinical effectiveness and quality of care are seen as central to the provision of appropriate health care, this study explores the experiences of one National Health Service trust in implementing this change in the charge nurse’s role, and in doing so highlights the importance of effective change management. Nurse managers were interviewed and all ward‐based G grade (range A‐I) charge nurses within the trust were sent a questionnaire to ascertain: the level of satisfaction with the way the changes had been introduced; whether they were in favour of the changes; and if they had sufficient time, knowledge, resources, preparation and support to enable them to undertake their new role. A random sample of charge nurses were also interviewed. It was found that the majority of charge nurses (61%) were in favour of the development of their role, believing it to be both inevitable and necessary. However, many felt that the change process had been managed ineffectively. There had been insufficient consultation during the change process, preparation and support were perceived as inadequate, the roles of the various protagonists were often unclear, and the lack of supernumerary status led to role conflict and confusion. As a consequence the new ward managers were often unable to fulfil the true potential of this demanding but exciting role.
The qualitative‐quantitative debate: moving from positivism and confrontation to post‐positivism and reconciliation
Authors: Clark Alexander M.
Published: March 2003

Critiques of logical positivism form the foundation for a significant number of nursing research papers, with the philosophy being inappropriately deemed synonymous with empirical method. Frequently, proposing an alternative method to those identified with the quantitative paradigm, these critiques are based on a poor foundation. This paper highlights an alternative philosophy to positivism which can also underpin empirical inquiry, that of post‐positivism. Post‐positivism is contrasted with positivism, which is presented as an outmoded and rejected philosophy which should cease to significantly shape inquiry. Though some acknowledgement of post‐positivism has occurred in the nursing literature, this has yet to permeate into mainstream nursing research. Many still base their arguments on a positivistic view of science. Through achievement of a better understanding of post‐positivism and greater focus on explicating the philosophical assumptions underpinning all research methods, the distinctions that have long been perceived to exist between qualitative and quantitative methodologies can be confined to the past. Rather methods will be selected solely on the nature of research questions.
Preserving writing in doctoral education: exploring the concernful practices of schooling learning teaching
Authors: Diekelmann Nancy , Magnussen Ironside Pamela
Published: March 2003

Preserving writing in doctoral education: exploring the concernful practices of schooling learning teaching¶Many contemporary scholars have challenged the current culture of graduate education and have suggested a need to reform nursing scholarship. The purpose of this study was to describe and analyse the common practices and shared lived experiences of nurses who are students or teachers in doctoral education. Participants recruited from across the United States included 15 nurses, five of whom were current faculty members in doctoral programmes in nursing and 10 who were currently enrolled as students in doctoral programmes. Data collected from extended, non‐structured interviews were analysed hermeneutically using the interpretive phenomenology of Heidegger and Gadamer as the philosophical background. The results of this study reveal that the practices of scholarship, reading, writing, thinking and dialogue are inseparable and belong together. Analysing and describing how the practices of scholarship belong together will contribute to extending an understanding of how the practices of writing can be preserved in contemporary doctoral education. ‘Preserving’ refers to how teachers and students perpetuate and sustain these practices in ways that are meaningful and transformative and in ways that are oppressive. This study explores the experiences that are central to becoming a scholar and suggests how their meaningfulness can be sustained and extended into the next millennium.
A Chinese cultural perspective of nursing care behaviours in an acute setting
Authors: Holroyd Eleanor , Yue‐kuen Cheung , Sau‐wai Cheung , Fung‐shan Luk , Wai‐wan Wong
Published: March 2003

A Chinese cultural perspective of nursing care behaviours in an acute setting¶ This study carried out in Hong Kong, identified 29 Chinese patients’ perceptions of the importance of nursing care behaviours in an acute setting using a Chinese language translated version of the CARE‐Q instrument. Patients ranked items concerned with ‘giving the patients’ treatments and medication on time’ as the most important and ‘sits down with the patient’ as the least important. Comparisons are made with the results from other cultures and specific Chinese cultural interpretations are drawn to provide direction for nursing care of Chinese patients in Hong Kong and worldwide.
Focus on community: directions for nursing knowledge development
Authors: Kulbok Pamela A. , Gates Marie F. , Vicenzi Angela E. , Schultz Phyllis R.
Published: March 2003

Focus on community: directions for nursing knowledge development

Nurses are challenged to advance the theoretical foundations of community practice. This paper offers ideas on what has been done and what needs to be done to meet this challenge. Within a community health nursing perspective, the paper defines community, proposes an integrated knowledge development framework that focuses on community, analyses contemporary theoretical and philosophical foundations of community in nursing, considers three world‐views in which nursing can be framed, and examines parameters for knowledge development for the future.
Mental health nursing policy — an exploratory qualitative study of managers’ opinions
Authors: Shears Malcolm , Coleman Mick
Published: March 2003

Mental health nursing policy — an exploratory qualitative study of managers’ opinions

During the 1990s, much of the legislation and policy that pertains to mental health services has sought to direct them towards a virtually exclusive concern with the seriously mentally ill, typified by the following recommendation from a recent Department of Health review of mental health nursing that stated: ‘The essential focus for the work of mental health nurses lies in working with people with serious or enduring mental illness’. On the other hand, pressure from the primary health care sector suggests the need for services to be provided for the less seriously mentally ill, particularly through the auspices of general practice fundholders. Following a review of the literature, a small‐scale, exploratory study was initiated to seek answers to the following research question: How is the policy focus urging reorientation to the severely mentally ill viewed by nurse managers who have a responsibility through Mental Health Resource Centres and Community Mental Health Teams, to provide mental health services? The study was based within a Welsh National Health Service (NHS) Trust that employed six nurse managers of Community Mental Health Teams (CMHTs). Four of the managers additionally had responsibility for Community Mental Health Resource Centres (CMHRCs). Of the population of six managers, four composed the sample for the investigation. A qualitative research approach was employed, utilizing semistructured interviews as the data collection tool. Analysis of the data revealed that managers were finding creative solutions in order to meet the conflicting demands placed upon them. The research findings also indicated that many of the obstacles to providing a needs‐led service were structural in origin, and could be resolved by central strategic intervention.
Self‐transformation as a factor in the self‐esteem and well‐being of breast cancer survivors
Authors: Carpenter Janet S. , Brockopp Dorothy Y. , Andrykowski Michael A.
Published: March 2003

Self‐transformation as a factor in the self‐esteem and well‐being of breast cancer survivors

Diagnosis with a life‐threatening illness can lead to many changes in one’s self. These changes, called self‐transformation, are not well understood. The present study used triangulation of methods and measures to (i) describe individual differences in self‐transformation among breast cancer survivors, (ii) examine factors associated with self‐transformation in breast cancer survivors, and (iii) examine the relationships between self‐transformation and self‐esteem and well‐being in breast cancer survivors and age‐matched comparison women without cancer. Cancer survivors (n = 60) participated in structured interviews and both survivors and comparison women (n = 60) completed a set of questionnaires. Narrative analysis revealed three categories of transformation among breast cancer survivors: positive transformation, minimal transformation and feeling stuck. These groups differed by age, marital status and income, but not by disease or treatment variables. Breast cancer survivors in the positive transformation group had significantly higher self‐esteem and well‐being in comparison with (i) survivors grouped as feeling stuck and (ii) age‐matched counterparts without cancer. Cancer survivors who reported feeling stuck had significantly lower self‐esteem and well‐being than the other groups of survivors and lower well‐being in comparison with healthy women of the same age. Findings provide support for the concept of self‐transformation and a new understanding of disease, demographic and treatment factors associated with the concept. Findings also suggest that self‐transformation may be a factor in the self‐esteem and well‐being of breast cancer survivors.
The cost and value of pre‐registration clinical placements for Project 2000 students
Authors: Jones Myfanwy Lloyd , Akehurst Ron
Published: March 2003

The cost and value of pre‐registration clinical placements for Project 2000 students

The research outlined in this article was commissioned by the Sheffield and North Trent College of Nursing and Midwifery to explore the cost implications of pre‐registration clinical placements in the context of Project 2000. The authors outline the methodology and findings of an exercise designed to collect relevant cost information which was not readily available. On the basis of these findings, they suggest that: at 1995/1996 pay and prices, clinical placements cost the education provider approximately £890 per student per annum; in terms of real resources, the value to service providers of the service contribution made by second‐ and third‐year nursing and midwifery students on ward‐based placements outweighs the value of the time spent by qualified staff on their supervision and education. Once the funding assumptions underlying the introduction of Project 2000 have been taken into account, second‐ and third‐year nursing and midwifery students benefit the service provider by on average £3·46 for every hour they spend in an unrostered ward‐based placement. The service contribution made by students in community‐based clinical placements cannot free staff time in the same way as on the wards and, because qualified staff in these areas are generally more highly graded, the value of the time they spend on the supervision and education of students on placement is higher than in ward‐based placements. Second‐ and third‐year students therefore appear to cost the service provider on average £0·48 for each hour they spend in a community‐based placement. It was not possible to determine whether this cost translates into a reduction in patient contacts.