bluuebunny/crossref_metadata_2025 huggingface dataset:
Microbiological assessment of saliva from children subsequent to atraumatic restorative treatment (ART)
Authors: Carvalho C. K. S. , Bezerra A. C. B.
Published: December 2004

Summary. Aims. The aim of this study was to evaluate mutans streptococci (MS) in the saliva following use of the atraumatic restorative treatment (ART) technique.

Methods. Sixteen 5–7‐year‐old children had restorations using the ART technique and employing FUJI IX glass‐ionomer cement as the restorative material. Decayed tissue was manually excavated without local anaesthesia, being careful to avoid discomfort. Saliva was collected for microbiological assessment using Kit Caritest MS before treatment, one week, four weeks and one year after ART was used. The procedure for saliva collection, incubation, storage, and comparative reading of MS counts followed the manufacturer's instructions. The data were statistically analysed, using non‐parametric tests (Wilcoxon Signed Ranks and Sign Test) at a significance level of 0·05.

Results. The results showed a significant reduction of MS levels in saliva when comparing the results before treatment with those obtained one week (95·95%; P = 0·003), four weeks (93·27%; P = 0·000) and one year (95·56%; P = 0·002) after ART.

Conclusions. It is concluded from the results that the ART technique proved satisfactory and appeared to have produced a significant and sustained reduction in levels of MS. These results need to be confirmed in a larger study.
Oral health status in relation to ethnicity of children in the Municipality of Copenhagen, Denmark
Authors: Sundby A. , Petersen P. E.
Published: December 2004

Summary. Approximately 25% of children under the age of 18 in the Municipality of Copenhagen have a non‐Danish ethnic background, and it is suspected that there may be major inequalities in oral health as a result.

Objectives. The objectives of this study were to describe the occurrence of dental caries in different ethnic minorities, and to analyse whether the dental caries experience of the children may be affected by cultural and behavioural differences.

Materials and methods. The study was conducted in Copenhagen as a cross‐sectional investigation of 794 children, aged 3 and 5 years old (preschool), 7 years old (Grade 1) and 15 years old (Grade 9). Children of Danish, Turkish, Pakistani, Albanian, Somali and Arabian backgrounds were selected by convenience sampling. Epidemiological data were retrieved from the Danish Recording System for the Public Dental Health Services (SCOR) and sociological data were collected by postal questionnaires.

Results. Marked differences in dental caries prevalence were observed when different ethnic minorities were compared to Danish children. These were most prominent for the primary dentition. At age 7, 53% of the Danish and 84% of the Albanian children were affected by dental caries, the mean caries experience was 3·5 dmfs (decayed, missed and filled surfaces) and 13·8 dmfs, respectively. Caries in incisors and/or smooth surfaces was observed in 10% of the Danish children and 48% of the Albanian children. There were cultural differences in dental attendance and self‐care practices of children and parents. These socio‐behavioural factors may help to explain the differences in dental caries prevalence and severity.

Conclusions. Development of appropriate oral health promotion strategies is urgently needed to improve oral health behaviour and attitudes of parents and children of ethnic minorities. Preventive programs should be organized at local community level in close collaboration with key persons of ethnic minority societies.
Targeting of the Year One dental visit for United States children
Authors: Hashim Nainar S. M. , Straffon L. H.
Published: December 2004

Summary. The aim of this review was to evaluate the evidence with regard to the timing of the first dental visit for children in the United States. It was concluded that the Year One dental visit should be performed for all children of low socioeconomic status. However, it should be regarded as an elective procedure for infants of middle‐to‐high socioeconomic status, except for certain selected high dental caries risk subgroups.
Pastoral care and moral government: early nineteenth century nursing and solutions to the Irish question
Authors: Nelson Sioban
Published: December 2004

This paper reexamines the role of the early nineteenth century nurses, conventionally depicted in nursing histories as the well‐meaning but untrained Catholic nursing nuns or, in post‐Reformation Europe, servants and fellow patients. It will be argued here that professional and capable nursing had begun to transform the care of the sick poor and to demonstrate its importance to the success of medical/surgical innovation long before Florence Nightingale and her call to Scutari. Moreover, the case is put that the emergence of nineteenth century forms of care for the sick occurred in response to the pressing problems of population management in Ireland, Great Britain and North America. The pastoral concerns of the first Irish nurses, with their expertise in both the spiritual and material domains, provided the prototype for what was to follow: a spiritual form of life that addressed the governmental concerns of its time. Finally, it is argued that given the overt moral imperatives of nineteenth century nurses of all persuasions, the depiction of nursing history as a crossing from the religious to the secular domain is challenged.
A longitudinal study of feeding difficulty and nursing intervention in elderly patients with dementia
Authors: Watson Roger , Deary Ian J.
Published: December 2004

Structural equation modelling has already been used to study the relationship between feeding difficulty and nursing intervention in elderly people with dementia. Four models were tested and one provided an acceptable fit to the data. However, there were limitations in terms of sample size and the scales used to measure the variables related to feeding difficulty and nursing intervention. In the present study the sample size has been increased and the scaling of variables has been improved and an additional model has been tested. The best fitting model introduces a latent state variable to explain the relationship between feeding difficulty and nursing intervention. In order to study this relationship further several lines of investigation are suggested, including trait validation and state experimentation. These will be explained in the paper.
Illuminating environmental influences on women's caring
Authors: Wuest Judith
Published: December 2004

Current health care reform is resulting in increasing demands on women to care for others. Little is known about the process of women's caring or the effects of caring on women. This feminist grounded theory study resulted in a substantive theory that explains how women manage the problematic aspects of caring and explicates the ways that environment influences women's responses to caring demands. Of particular concern is the evidence that the existing social structure creates and intensifies problems for women caring. The discussion considers the implications of the findings for health policy and nursing practice.
Vulnerability, health and health care
Authors: Rogers Ada C.
Published: December 2004

The concept of vulnerability is an important one for nurses because of its implications for health. The experience of vulnerability creates stress and anxiety which affects physiological, psychological and social functioning. Although everyone is vulnerable at different times in his or her life, some individuals are more likely to develop health problems than others. Vulnerability is affected by personal factors as well as factors within the environment. Trends in society indicate that increasing numbers of vulnerable people will create additional demands on an already over‐burdened health care system. Vulnerability is an area that requires much further research and application.
A critical review of the belief that technology is a neutral object and nurses are its master
Authors: Barnard Alan
Published: December 2004

This paper discusses technology in relation to nursing practice. The purpose of the paper is to introduce to nursing literature a critique of an important and common assumption concerning the relationship between nurses and technology. The discussion centres on the belief that technology is a neutral influence upon the practice of nursing. Technology is argued to be more pervasive an influence upon the politics of practice, the values of individuals, nursing practice and decision making, than many nurses identify. Therefore adequate understanding of the relationship between technology and nursing practice must address the need to be more critical of the belief that technology is a neutral object, and originates from being cognisant of arguments which both support and oppose the assertion.
The biological sciences in nursing: an empirical paper reporting on the applications of physiology to nursing care
Authors: Jordan Sue , Reid Ken
Published: December 2004

This action research study was undertaken to address practical concerns over curriculum development in nursing. The applied physiology component of a post‐registration nursing diploma was evaluated in terms of its impact on patients rather than on the nurses themselves. The reported data were triangulated, all the findings indicated that patient care could be enhanced when nurses applied their knowledge of physiology to practice. Despite its limitations of scale, this study contributes to the curriculum debate in nurse education.
Attitudes towards the relevance of biological, behavioural and social sciences in nursing education
Authors: Thornton Tina
Published: December 2004

This paper explores the perceptions of staff and students regarding the supporting sciences within nursing education and how they feel such content relates to the ‘real world’ of nursing. A qualitative study examining the perceptions of students and teaching staff, particularly the concept of relevance, was conducted to explore factors which impact upon the integration of theory and practice. The teaching approaches used, assessment items selected, and the perceptions held about what nurses actually do all impinge upon what, and how, students learn in subjects which are essentially non‐nursing in their orientation. Through an awareness of factors affecting how students and teaching staff actually approach supporting sciences content, better informed curriculum decisions can be made.
Husserl, phenomenology and nursing
Authors: Paley John
Published: December 2004

Discussions of phenomenological research in nursing consistently appeal to either Husserl or Heidegger in justifying the technical and conceptual resources they deploy. This paper focuses on Husserl, and examines the relationship between his phenomenology and the accounts of it that are to be found in the nursing literature. Three central ideas are given particular attention: the phenomenological reduction, phenomena, and essence. It is argued that nurse researchers largely misunderstand these concepts and that, as a result, their version of Husserl's philosophy bears little resemblance to the original. A further consequence is that the project of identifying the ‘essential structure’ of a phenomenon, typically adopted by the nurse researchers who cite Husserl as an authority, comes close to being unintelligible. It is suggested that, while the methods used in ‘phenomenological’ nursing research may still have some legitimacy, they cannot achieve what they are alleged to achieve, and they should be detached from the framework of Husserlian ideas and terminology which is supposed to justify them.
Practical nurses in elder care and changes in Finnish society – a biographical study
Authors: Paasivaara Leena , Nikkonen Merja , Backman Kaisa , Isola Arja
Published: December 2004

Background.  Substantial changes in the socio‐economic circumstances in Finnish society over the past century have resulted in major changes in the case of older people, and in the status of nursing staff who care for them.

Aim.  The purpose of this study was to describe and analyse the work of practical nurses in elder care through the experiences and life cycles of two practical nurses with a long working experience.

Methods.  The data consisted of oral biographical narratives produced by the two nurses in repeated interviews. The data were analysed using inductive content analysis.

Findings.  The following chronological stages and periods of the work of the informants emerged as the core themes of elder care: (1) Collective institutionalized care in the 1950s−1970s: The lowest caste in training, obedient subordinates, undemanding service and routine work; (2) Elderly orientated institutionalized care in the 1980s and 1990s: From subordination to co‐operation as an experienced nurse, recognizing the specific qualities of the elderly; (3) Prospects of elder care from the 1990s onwards: Returning to custodial care?

Conclusions.  The themes are related to the more general changes that have taken place in Finnish society and health care. The future prospects of practical nurses seem challenging because the principles of social work and health care in Finnish society have shifted from institutionalization towards community care. As a consequence, practical nurses are required to have higher qualifications.
Creativity: a refinement of the concept for nursing practice
Authors: Fasnacht Patsy H.
Published: December 2004

Aims.  This paper seeks to remove some of the ambiguity surrounding the conceptual meaning of creativity using techniques of concept refinement to advance the concept.

Background.  Creativity is an essential component of nursing practice that occurs daily in nurse's interactions with clients, families and other nurses. Failure to acknowledge and encourage creativity in beginning nurses may hinder future development and innovations in nursing practice and in nursing science. In order to promote the development of creativity it is first necessary to clarify and refine the concept as it applies to nursing.

Design/methods.
 A comprehensive review of a variety of computer and online databases resulted in thousands of articles on creativity between the years 1966 and 1999. The final sample (
n
 = 48) was obtained using both stratified random and purposive sampling techniques. A content analysis of the literature was conducted using methods identified by Morse and illustrated in the work of Hupcey
et al . Having determined the concept to be partially mature, the concept was advanced using techniques of concept refinement.

Findings.  Content analysis of the literature yielded three differing definitions for creativity: revelation, birth and reincarnation. Creativity occurs in the presence of intrinsic motivation and a nurturing environment. While value is often used to identify whether a product is creative, the value of the product cannot determine whether the process has occurred. The product produced determines evidence of the process of creativity.

Limitations.
 Limitations of this investigation are the use of secondary sources and the relatively small sample size (
n  = 48).

Conclusions.  Refinement of the concept of creativity indicates that it is a process that may be developed and influenced by the environment and is recognized by the product produced. Further investigation is needed to explore methods and techniques for developing creativity in nursing.
Australian nurses' and midwives' knowledge of computers and their attitudes to using them in their practice
Authors: Webster Joan , Davis James , Holt Victoria , Stallan Glenys , New Karen , Yegdich Tania
Published: December 2004

Background.  The introduction of a new information retrieval system for the use of health service staff at a large tertiary referral hospital provided an excellent opportunity for nurses to make greater use of evidence to inform their practice. However, the extent to which nurses were able to access the resource was unknown.

Aim.  The aim of the study was to obtain this information and to test nurses' knowledge of computers and their attitudes to using them in their practice.

Methods.
 During October 2001 a computer use questionnaire was attached to the pay advice slips of all nursing staff at the Royal Brisbane and Royal Women's Hospital (
n  = 1708). Staff were asked to return their completed questionnaire in a preaddressed return envelope. To encourage this, a prize (a Gold Class cinema pass for two) was offered.

Results.  Of the 1708 questionnaires distributed, 590 were returned, giving a 34·5% response rate. Computer use was influenced by education, nursing seniority, age, and length of time in the service and, to a lesser extent, gender.

Conclusions.  Information from the study has assisted planners and educators to identify clusters of nurses to target for interventions in this area. Results will also be used to assess the success of any interventions.
Interaction between caregivers and families expecting a malformed child
Authors: Maijala Hanna , Åstedt‐Kurki Päivi , Paavilainen Eija , Väisänen Leena
Published: December 2004

Background.Earlier research has shown that the care of families expecting a malformed child should be intensified and that the topic is understudied.

Aim.This study aimed at generating a practical nursing theory of interaction between caregivers and families expecting a malformed child, as experienced by families.

Methods.A grounded theory study was undertaken at a university hospital, Finland. Data consisted of semi‐structured interviews with 29 mothers and fathers, analysed using the constant comparative method.

Findings.The interaction process starts with the confirmation of the diagnosis. It usually comes as a shock to the parents, and gives rise to questions about the nature of the malformation, family members' relationship with themselves, family relationships and relationships with people outside the family. These questions are crucial to the family's coping and form the core of interaction. Families' own coping strategies are either reinforced or undermined by caregivers' actions and are reflected in parents' expectations about caregivers, which in part account for their actions and experiences of interaction. The care system as an interactive environment is part of a process which results in the experiences of being helped or being left without help. The core of the interaction process comprises two dimensions: gaining strength and losing strength in relation to malformation issues.

Conclusions.The findings of the study are consistent with earlier research and complement it by providing a detailed delineation of the interaction from the perspective of the family. They can be used to formulate recommendations for improving caregivers' interactive skills and awareness of the topic through training. The care system should be developed to ensure that families receive psychological support and that the family as a whole receives proper care. Consideration of the viewpoint of siblings is a challenge for further research.
Horizontal violence: experiences of Registered Nurses in their first year of practice
Authors: McKenna Brian G. , Smith Naumai A. , Poole Suzette J. , Coverdale John H.
Published: December 2004

Background. Interpersonal conflict among nurses (traditionally called ‘horizontal violence’ or ‘bullying’) is a significant issue confronting the nursing profession. However, there is a dearth of research focusing on horizontal violence experienced by new graduate nurses.

Aims. In order to assess the priority for preventive intervention programmes, the aims of this study were to determine the prevalence of horizontal violence experienced by nurses in their first year of practice; to describe the characteristics of the most distressing incidents experienced; to determine the consequences, and measure the psychological impact, of such events; and to determine the adequacy of training received to manage horizontal violence.

Method. An anonymous survey was mailed to nurses in New Zealand who had registered in the year prior to November 2000 (n  = 1169) and 551 completed questionnaires were returned (response rate 47%). Information was requested on the type and frequency of interpersonal conflict; a description of the most distressing event experienced; the consequences of the behaviour; and training to manage such events. The Impact of Event Scale was used to measure the level of distress experienced.

Results. Many new graduates experienced horizontal violence across all clinical settings. Absenteeism from work, the high number of respondents who considered leaving nursing, and scores on the Impact of Event Scale all indicated the serious impact of interpersonal conflict. Nearly half of the events described were not reported, only 12% of those who described a distressing incident received formal debriefing, and the majority of respondents had no training to manage the behaviour.

Conclusions. First year of practice is an important confidence‐building phase for nurses and yet many new graduates are exposed to horizontal violence, which may negatively impact on this process. The findings underscore a priority for the development of effective prevention programmes. Adequate reporting mechanisms and supportive services should also be readily available for those exposed to the behaviour.
The concept of readiness to change
Authors: Dalton Cindy C. , Gottlieb Laurie N.
Published: December 2004

Aim. Readiness is associated with change, yet there is little understanding of this construct. The purpose of this study was to examine readiness; its referents, associated factors and the resulting consequences.

Methods. In the course of nursing five clients living with multiple sclerosis over a 7‐month period using a Reflective Practice Model, data were systematically gathered using open‐ended and then more focused questioning. Data collected during 42 client encounters (28 face‐to‐face encounters; 14 telephone contacts) were analysed using Chinn and Kramer's concept analysis technique.

Findings. The concept of readiness was inductively derived. Readiness is both a state and a process. Before clients can create change they need to become ready to change. A number of factors trigger readiness. These include when: (a) clients perceive that a health concern is not going to resolve, (b) a change in a client's physical condition takes on new significance, (c) clients feel better able to manage their stress, (d) clients have sufficient energy, (e) clients perceive that they have adequate support in undertaking change. When one or more of these factors is present clients become ready to consider change. The process of readiness involves recognizing the need to change, weighing the costs and benefits and, when benefits outweigh costs, planning for change. The desire to change and to take action determines clients' degree of readiness. When they experience a high degree of readiness they report less anger, less depression, and view their condition in a more positive light. In contrast, when they experience a low degree of readiness they report feeling depressed, afraid and vulnerable in the face of change.

Conclusion. Nursing has an important role to play in creating conditions to support change. To fulfil this role, nurses need to be able to assess readiness for change and the factors that enable it and then to intervene in ways that facilitate readiness.
Translation and restandardization of an instrument: the Early Infant Temperament Questionnaire
Authors: Hall Elisabeth O.C. , Wilson Margaret E. , Frankenfield Joanne A.
Published: December 2004

Aims of the study.  To test the psychometric properties of a Danish translation of the Early Infant Temperament Questionnaire (EITQ) and to establish standards for scoring the questionnaire.

Rationale.  The general aim was to create a translation that remained close to the original version, was meaningful for the Danish participants, and had acceptable psychometric properties.

Background.  Patterns of temperament can be discerned early in life and tend to persist over time and across situations. For the past 50 years, temperament has been studied by theorists, clinicians and nurse clinicians to predict behaviour, discover interventions that prevent serious behaviour disturbances, and help parents understand the implications of their child's temperament. Thomas and Chess's conceptualization of temperament in nine categories was the framework for the development of the English‐language EITQ.

Research methods.  The translation followed a stepwise process of translation, back translation and consensus. A convenience sample of 204 Danish mothers with 1–4‐month old infants completed the translated questionnaire and a demographic questionnaire in 1999.

Results.  Alpha coefficients for the nine subscales ranged from 0·59 to 0·82. All alpha coefficients were comparable to or higher than those reported on the original United States standardization study. There were statistically significant differences between reported United States mean scores and those in the Danish sample.

Discussion.  The psychometric properties of the Danish translation are equal to or better than those reported for the United States study. Differences in mean scores or most subscales point to the need to create Danish profiles for scoring.

Conclusions.  The Danish version of the EITQ has acceptable reliability and is ready for use in Denmark.
Seeking advice from NHS direct on common childhood complaints: does it matter who answers the phone?
Authors: Monaghan Rosey , Clifford Collette , McDonald Paul
Published: December 2004

Background.  National Health Services (NHS) Direct is a national nurse‐led, call‐centre based, telephone triage, health information and advice service in the United Kingdom (UK). Forty percent of calls to NHS Direct are about children. There is a need to identify whether there is a difference in the time taken for nurses to triage calls about children.

Aim.  The aim of the study was to determine if the call length and outcomes of Registered Sick Children's Nurses and Registered Nurses were different when triaging children who presented with ‘rash’ or ‘fever’ by telephone.

Sample.  This study was carried out at NHS Direct, West Midlands, and involved analysis of 1281 calls taken by 22 nurses.

Methods.  This study examined the frequency of referral by the two nurse groups to five triage outcome groups. Information about the calls was extracted from routinely collected data generated by the computerized clinical decision support software. The data were used for secondary analysis.

Data analysis.
 The data were analysed using Statistics Package for Social Sciences version 10 and nonparametric Mann–Whitney
U ‐tests were performed to compare call lengths of the two groups. The chi‐square test was used to analyse differences in frequency of triage to outcome groups.

Results.
 The mean call length of the Registered Sick Children's Nurses was statistically significantly shorter than that of the Registered Nurses (
P  < 0·001). With the exception of referral for a routine appointment with a general medical practitioner, both Registered Sick Children's Nurses and Registered Nurses referred to other triage outcomes groups with equal frequency.

Limitations.  Inaccuracy of call length measurement of less than 1 minute and more than 20 minutes was because of the limitations of the data extraction software. This system‐led definition and measured length of a call limits both the analysis and conclusions that could be drawn about the content of NHS Direct nurse consultation.

Conclusions.  Registered Sick Children's Nurses take less time than Registered Nurses to triage calls about children presenting with ‘rash’ or ‘fever’. Further investigation is required into the content and consultation process of the nurses, and also the safety and appropriateness of referral.
Evaluation of students' satisfaction with nursing education in Norway
Authors: Espeland Valbjørg , Indrehus Oddny
Published: December 2004

Background. The use of standardized questionnaires for measuring student satisfaction in higher education is motivated by theories predicting a close relationship between students' satisfaction and learning outcomes. The reliability and validity of the Course Experience Questionnaire as an indicator of teaching performance have been established by factor analysis in earlier studies from several countries. The Nursing Clinical Facilitators Questionnaire has been used for measuring satisfaction with clinical practice.

Aims. The aims of this study were (1) to find out how satisfied nursing students in their last semester were with their clinical practice and the nursing programme as a whole, and (2) to measure the reliability and validity of the two standardized questionnaires.

Methods. The data were collected using the two standard questionnaires, combined with some background items, in a survey design. Exploratory factor analysis was performed.

Findings. A total of 276 nursing students from three university colleges in Western Norway answered the questionnaire in 1999/2000. The scores indicated slight overall dissatisfaction with the nursing programme, but general satisfaction with clinical practice. Furthermore, 70% of the students who expressed dissatisfaction with the quality of the nursing programme were nevertheless satisfied with clinical practice. The broad constituent structure of the Course Experience Questionnaire was replicated, with some deviation for the appropriate assessment scale. The Nursing Clinical Facilitators Questionnaire turned out to have two subscales, representing supportive and challenging behaviour, with satisfactory internal reliability.

Conclusion. Annual evaluations using the two standardized questionnaires may result in greater focus being given to students' satisfaction with the nursing programmes and clinical practice in Norwegian nursing education departments. Comparative studies with the same instruments in other countries would also be of interest.
Narrating practice: reflective accounts and the textual construction of reality
Authors: Taylor Carolyn
Published: December 2004

Background. Two approaches dominate current thinking in health and welfare: evidence‐based practice and reflective practice. Whilst there is debate about the merits of evidence‐based practice, reflective practice is generally accepted with critical debate as an important educational tool. Where critique does exist it tends to adopt a Foucauldian approach, focusing on the surveillance and self‐regulatory aspects of reflective practice.

Aim. This article acknowledges the critical purchase on the concept of reflective practice offered by Foucauldian approaches but argues that microsociological and discourse analytic approaches can further illuminate the subject and thus serve as a complement to them.

Methods. The claims of proponents of reflective practice are explored, in opposition to the technical–rational approach of evidence‐based practice.

Findings. Reflective practice tends to adopt a naive or romantic realist position and fails to acknowledge the ways in which reflective accounts construct the world of practice.

Conclusions. Microsociological approaches can help us to understand reflective accounts as examples of case‐talk, constructed in a narrative form in the same way as case records and presentations.
Health correlates of autonomy, control and professional relationships in the nursing work environment
Authors: Budge Claire , Carryer Jennifer , Wood Sue
Published: December 2004

Background. Internationally, nursing is facing a variety of challenges including changes in health systems, an ageing workforce and escalating shortages of Registered Nurses. New Zealand is no exception. Here as elsewhere these challenges are taking their toll on the resources and demands of hospital environments, on the health and well‐being of nurses themselves and most certainly on the people for whom they care. In the United States of America (USA), three aspects of the nursing work environment – autonomy, control and nurse–physician relations – have been identified as linked to staff retention, levels of staff burnout and needlestick injury, as well as to a range of patient outcomes.

Aim. To examine the New Zealand nursing situation and to see whether aspects of the work environment are associated with health status.

Methods. A total of 225 Registered Nurses in a general hospital completed the Revised Nursing Work Index (NWI‐R) and Medical Outcomes Study (MOS) 36‐Item Short‐Form Health Survey (SF‐36).

Results. Ratings indicated that the New Zealand hospital environment was characterized by less autonomy and control and better nurse–physician relations than in USA hospitals. Results of correlations demonstrated that more positive ratings of the three workplace attributes were associated with better health status amongst the nurses. The results of regression analyses were indicative either of a confounding relationship or of a mediating relationship such that nurses' relations with physicians, administration and other departments mediate the associations between autonomy, control and health status.

Conclusions. The study offers an insight into a New Zealand hospital environment and suggests the importance of good relationships with physicians and other departments for the health of nurses.
Consumer feedback on nursing care and discharge planning
Authors: Cleary Michelle , Horsfall Jan , Hunt Glenn E.
Published: December 2004

Background. Gaining consumer feedback about nursing care and discharge planning is especially important given the changes that have occurred in acute inpatient mental health facilities. Consumers can best define the quality of the service they receive and surveys are considered to be good sources of information about nursing care and discharge planning.

Aim. The aims of this study were to clarify consumer discharge needs, ascertain consumer perceptions of helpful practice, identify areas that require improvement, identify resources consumers deem important, ascertain satisfaction with specific aspects of services, and obtain baseline data to improve future discharge planning.

Method. Satisfaction‐with‐services and discharge questionnaires were completed by clients (39 and 45, respectively) prior to discharge from three acute inpatient mental health units over a 2‐month period.

Findings. Findings indicated that clients were most satisfied with the respect they received from staff, attention staff gave to concerns and worries, quality of service provided by nurses, way treatment met client needs and overall stay in hospital. The majority of respondents (95%) indicated that their discharge arrangements were explained to them and 90% were satisfied with these. Whilst over two‐thirds indicated that the information provided in hospital to assist with discharge had been helpful, they highlighted some areas for service improvement. Resources to prepare them better for discharge included increased contact with consumer consultants and more information about mental health problems, medication and relapse prevention.

Conclusion. This study constitutes another small step towards decreasing the gap between consumer expectations and actual treatment by asking consumers about their perceptions of discharge planning. The findings provide the basis for the development of more appropriate strategies to improve the continuity of services between hospital and community mental health settings.
From alienation to familiarity: experiences of mothers and fathers of preterm infants
Authors: Jackson Karin , Ternestedt Britt‐Marie , Schollin Jens
Published: December 2004

Background.  The birth of a preterm infant has a long‐term impact on both parents. Mothers report more stress and poor adjustment compared with fathers. Influencing factors, such as family situation and health status of the child, can support or weaken the coping ability of the parents. Studies on experiences of fathers are sparse.

Aim.  The aim of this research was to study how mothers and fathers of preterm infants describe their experiences of parenthood during the infant's first 18 months of life.

Methods.  Seven consecutively selected sets of parents of preterm infants born at ≤34 weeks of gestation with no serious congenital defects were interviewed 1–2 weeks after the infant's birth and at 2, 6 and 18 months of age, and the findings were analysed using a phenomenological method.

Findings.  Internalization of parenthood was described as a time‐dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity. Within the syntheses, similarities in how mothers and fathers described their parental roles involved concern for the child, insecurity, adjustment and relationship with the child. Regarding differences, mothers experienced having more responsibility and control of the care and a need to be confirmed as a mother, while fathers described confidence in leaving the care to the staff and wanted to find a balance between work and family life. Important turning points in parenthood experiences often occurred when the infant could be removed from the incubator, discharged from the ward, and when the infant looked normal compared to full‐term infants.

Conclusions.  The structure of the phenomenon of parenthood was formed by the integration of the syntheses of alienation, responsibility, confidence and familiarity. The structure seems to be based on the parents’ expectations of the parental role, the infant's health condition and the health care environment. These interacting factors are influenced by cultural beliefs.
Autonomy and integrity: upholding older adult patients’ dignity
Authors: Randers Ingrid , Mattiasson Anne‐Cathrine
Published: December 2004

Aim. The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real‐life care situations.

Method. The data reported here are from a 6‐ and 12‐month follow‐up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals’ caring behaviour in everyday situations was observed from the point of view of patients’ autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data.

Findings. The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients’ ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients’ very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously.

Conclusion. The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients’ dignity is to be maintained. This implies that when patients’ autonomy is supported their integrity is protected and, consequently, their dignity upheld.
Fatigue in patients with chronic obstructive pulmonary disease
Authors: Theander Kersti , Unosson Mitra
Published: December 2004

Background.  Fatigue is a frequently occurring symptom in patients with chronic obstructive pulmonary disease (COPD). Despite this, relatively few studies have objectively assessed patients’ perceptions of fatigue and the impact of perceived fatigue on their everyday lives.

Objective.  The purpose of this study was to describe the prevalence, duration and severity of fatigue among patients with COPD and the impact of perceived fatigue on cognitive, physical and psychosocial functioning in comparison with controls.

Method.  The Fatigue Impact Scale, including physical, psychosocial and cognitive dimension and structured questions about the frequency, duration, and severity of fatigue was mailed to 44 outpatients with COPD and 88 randomly selected age‐ and sex‐matched controls. In total 36 patients and 37 controls completed the questionnaire.

Results.  Almost half of the patients (47·2%), reported fatigue every day during the preceding month compared with 13·5% of the control group (P < 0·001). The duration of fatigue was more than 6 hours in 52·7% of the patients and 44·4% reported that fatigue was either the worst or one of the worst symptoms they had, compared with 18·9% (P < 0·001) and 10·8% (P < 0·01) in the control group. The patients reported a significantly greater impact of fatigue on cognitive, physical and psychosocial functioning compared with the control group (P < 0·001).

Conclusion.  These findings indicate that fatigue is a highly prevalent symptom, which impacts on patients’ functional condition and needs to be professionally assessed and managed.
Fatigue, psychological distress, coping and quality of life in patients with uterine cancer
Authors: Ahlberg Karin , Ekman Tor , Wallgren Arne , Gaston‐Johansson Fannie
Published: December 2004

Background. Cancer‐related fatigue (CRF) is a subjectively experienced symptom that is multidimensional and multifactorial. Patients with cancer have identified fatigue as one of the major troubling symptoms and the primary cause of distress in their lives.

Aims. The major aim of the study was to examine how patients diagnosed with uterine cancer describe their experience of fatigue, psychological distress, coping resources and quality of life. A secondary aim was to describe the relationship between selected variables.

Method. A descriptive and correlational design was used and the study was conducted at a university hospital in Sweden. The study population consisted of women, diagnosed with uterine cancer, who where scheduled to receive curative external radiation therapy. Sixty women participated in the study and data were collected through self‐report instruments. Demographic and clinical data were extracted from patient records. The data were collected during year 2000–2002. The Conceptual Model of Symptom Management was used as a framework to guide the study.

Findings. Patients experienced a low grade of fatigue and psychological distress, but their functional status and global quality of life was high. Significant correlations were found between general fatigue and anxiety and also between general fatigue and depression. There was a significant negative correlation between general fatigue and coping resources. Depression explained 44% of the variance in general fatigue.

Conclusions. The findings provide knowledge about predictors of CRF in women with uterine cancer, and can serve as a basis for future longitudinal studies in which different prophylactic strategies against therapy‐related fatigue are prospectively studied.
Negotiating multiple roles: link teachers in clinical nursing practice
Authors: Ramage Charlotte
Published: December 2004

Background.  The background to this study was a concern about the teacher's role in clinical practice. Experience suggested that teachers believed that their role in practice was important but that there were significant forces which impeded their ability to move with ease between education and practice. A discrepancy between previous research findings and theoretical discussions, and the reality experienced by teachers, led to the adoption of grounded theory as a way of exploring uncertainties in the situation.

Method.  Data were gathered over a period of 7 years and involved 28 in‐depth interviews with nurses with a range of educational roles, employed in educational institutions and practice settings in inner city and provincial areas in the South of England.

Findings.  The data revealed four categories, ‘gaining access’, ‘negotiating credibility’, ‘being effective’ and the core category ‘negotiating multiple roles’. The core category is addressed in this article. Experiences of moving from a position of clinical practitioner to link teacher involved: ‘disassembling the self’ through leaving behind old identities; ‘reconstructing the self’ through clarifying new ways of being; and, finally, ‘realizing the self’ through reciprocal interpersonal activity with students, educational and nursing colleagues.

Conclusions.  It is inevitable that an individual with a remit for change entering an established social group will experience difficulties in establishing their role. It is also clear that an individual who changes their role within a group to reflect behaviours not congruent with the primary activity in that setting will experience dimensions of social exclusion. Further work needs to address how educational roles can make a significant impact on the everyday lives of students and nurses working in practice. The findings of this study are as relevant for the new roles of practice educator, clinical facilitator and practice placement co‐ordinator as they are for link teachers and lecturer practitioners. Several suggestions are made to improve links with practice.
Ethical practice in nursing: working the in‐betweens
Authors: Varcoe Colleen , Doane Gweneth , Pauly Bernadette , Rodney Paddy , Storch Janet L. , Mahoney Karen , McPherson Gladys , Brown Helen , Starzomski Rosalie
Published: December 2004

Background. While contemporary ethical theory is of tremendous value to nursing, the extent to which such theory has been informed by the concerns and practices of nurses has been limited.

Purpose. With a view to complementing extant ethical theory, a study was undertaken to explore, from the perspective of nurses, the meaning of ethics and the enactment of ethical practice in nursing.

Design and methods. Located in the interpretive/constructivist paradigm, using an emergent design, this inquiry employed focus groups to collect the data. Eighty‐seven nurses from a wide range of practice settings were interviewed in 19 focus groups of three to nine nurses each.

Findings. The nurses described ethics in their practice as both a way of being and a process of enactment. They described drawing on a wide range of sources of moral knowledge in a dynamic process of developing awareness of themselves as moral agents. Enacting moral agency involved working in a shifting moral context, and working in‐between their own values and those of the organizations in which they worked, in‐between their own values and those of others, and in‐between competing values and interests.

Conclusions. Analysis of the experiences and concerns of the nurses offered new understanding of ethics in nursing and direction for the development of ethical theory pertinent to nursing practice.