bluuebunny/crossref_metadata_2025 huggingface dataset:
Chinese values, health and nursing
Authors: Chen Yu‐chih
Published: March 2003

Chinese values, health and nursing

Purpose. To describe the roots of Chinese values, beliefs and the concept of health, and to illustrate how these ways have influenced the development of health care and nursing among Chinese in the Republic of China (ROC) and the People’s Republic of China (PRC).

Scope. Based on the literature and direct observation in the PRC and ROC, this is an introduction to Chinese philosophies, religion, basic beliefs, and values with a special meaning for health and nursing. Chinese philosophies and religion include Confucian principles, Taoism, theory of ‘Yin’ and ‘Yang’, and Buddhism. Beliefs and values include the way of education, practice of acupuncture, herbal treatments and diet therapy. How people value traditional Chinese medicine in combination with western science, and the future direction of nursing and nursing inquiry are also briefly addressed.

Conclusion. Chinese philosophies and religions strongly influence the Chinese way of living and thinking about health and health care. Nurses must combine information about culture with clinical assessment of the patient to provide cultural sensitive care. A better way may be to combine both western and Chinese values into the Chinese health care system by negotiating between the traditional values while at the same time, respecting an individual’s choice. The foundation of China’s philosophical and aesthetic tradition, in combination with western science is important to the future advancement of nursing research that will be beneficial to the Republics, Asia, and the world.
Nurses’ communication skills: an evaluation of the impact of solution‐focused communication training
Authors: Bowles Nick , Mackintosh Carolyn , Torn Alison
Published: March 2003

Nurses’ communication skills: an evaluation of the impact of solution‐focused communication training

Aims. This paper describes the evaluation of a short training course in solution‐focused brief therapy (SFBT) skills. This evaluation examined the relevance of SFBT skills to nursing and the extent to which a short training course affected nurses’ communication skills.

Background. Nurses’ communication skills have been criticized for many years, as has the training in communication skills that nurses receive. The absence of a coherent theoretical or practical framework for communication skills training led us to consider the utility of SFBT as a framework for a short training course for qualified nurses, the majority of them are registered nurses working with adults.

Design and methods. Quantitative and qualitative data were collected: the former using pre‐ and post‐training scales, the latter using a focus group conducted 6 months after the training. Data were analysed using the Wilcoxon signed‐rank test and content analysis.

Results and findings. Quantitative data indicated positive changes in nurses’ practice following the training on four dimensions, and changes in nurses’ willingness to communicate with people who are troubled reached levels of significance. Qualitative data uncovered changes to practice, centred on the rejection of problem‐orientated discourses and reduced feelings of inadequacy and emotional stress in the nurses.

Conclusions. There are indications that SFBT techniques may be relevant to nursing and a useful, cost‐effective approach to the training of communication skills. Solution focused brief therapy provides a framework and easily understood tool‐kit that are harmonious with nursing values.
Masterworks of art and chronic illness experiences in the elderly
Authors: Hodges Helen F. , Keeley Ann C. , Grier Elaine C.
Published: March 2003

Masterworks of art and chronic illness experiences in the elderly

Aim. This article presents findings of a qualitative study, conducted between 1997 and 2000, to investigate the plausibility of integrating masterworks of art with care of the chronically ill elderly, and to analyse perceptions about chronic illness among three groups: registered nurses, nursing students, and the elderly.

Background and significance. Statistically the incidence of chronic illness increases in the elderly. Although pathophysiology of chronic illness is increasingly understood, few studies explore the experience of living with chronicity from the perspective of the elderly. Understanding and intervening appropriately for the elderly with chronic illness may contribute significantly to improving quality of life for this growing population.

Ethical issues and approval. The study was approved through an Institutional Review Board. Facility permission and participant informed consent were obtained. Anonymity and confidentiality were protected.

Design. Using hermeneutic phenomenology and masterworks of art as a centre point for dialogue, the investigators explored the perceptions of nurses, students, and the elderly about living with a chronic illness. A purposive sample of 65 participants made up seven focus groups with which group interviews were conducted. Themes were explicated and analysed from audiotaped interviews until data saturation was reached.

Findings. Content analysis of focus group interviews revealed themes of social isolation, inevitable role change, and inertia–movement. Only the elderly acknowledged hope and a steadfast refusal to give up, while nurses and students viewed chronicity more negatively. Themes of social isolation and role change are consistent with other studies of the elderly. A paradox of inertia–movement in the chronically ill elderly has not been reported in the nursing literature.

Conclusions. Paradoxical tension of inertia–movement in the chronically ill elderly appears to be linked to the broader concept of energy in nursing science, and to Parse’s theory of human becoming. Masterworks of art can generate energy exchange between the elderly and caregivers, providing a plausible catalyst for meaningful interventions that transcend age and practice settings.
Eating as both coping and stressor in overweight control
Authors: Solomon Margot R.
Published: March 2003

Eating as both coping and stressor in overweight control

Aim. The aim of this study was to test a conceptual model proposing that stress evokes eating as coping, that eating then becomes a stressor in itself, and that a coping repertoire specific for overeating is required to moderate its yield of negative mood states.

Background. It is known that stressors may evoke eating as a coping response, and that some persons respond to lapses in their dietary regimen with depression and self‐criticism. These two findings are linked within the context of a stress and coping paradigm that has in the past been applied to the study of substance abuse.

Method. A survey of 79 women who reported overeating was implemented, including the administration of five instruments and a telephone interview.

Findings. Over 43% of the variance in the dependent variable, negative mood states, was explained by hierarchical regression of the independent variables, entered sequentially as exemplars of: social stressors, coping, degree of required calorie consumption, use of overweight control strategies and the interaction between the degree of required weekly calorie consumption and use of overweight control strategies. Significant contributions were made by variables denoting stressors, coping, and the interaction between degree of required calorie consumption and use of overweight control strategies. Of particular interest was the suggestion that for individuals who frequently use strategies to control overeating and overweight, eating may produce negative mood states. Individuals intensively involved in efforts to control their weight may be vulnerable for dysphoria, may require unique nursing interventions, and thus deserve continued study in this context.
The practical, methodological and ethical dilemmas of conducting focus groups with vulnerable clients
Authors: Owen Sara
Published: March 2003

The practical, methodological and ethical dilemmas of conducting focus groups with vulnerable clients

Aim. This paper presents some of the practical, methodological and ethical dilemmas that were encountered in a study that used focus groups to elicit the views of women with serious and enduring mental health problems about the services they were receiving.

Findings. The dilemmas identified included the time and effort taken to gain access to the women, the role of the researcher as facilitator, communication and interaction in the focus group, accepting the women’s reality, and the thin divide between research and therapy.

Conclusion. The paper concludes with some recommendations for researchers who are planning to use focus groups to elicit the views of vulnerable clients.
From hospital to home care: a randomized controlled trial of a Pain Education Programme for cancer patients with chronic pain
Authors: De Wit Rianne , Van Dam Frits
Published: March 2003

From hospital to home care: a randomized controlled trial of a Pain Education Programme for cancer patients with chronic pain

Aim of the study. To investigate the role of district nurses in the care of cancer patients with chronic pain at home, as well as the effects of a Pain Education Programme for patients and their district nurses. The Pain Education Programme consisted of a tailored multi‐method approach in which they were educated about pain, instructed how to report pain, and how to contact health care providers.

Background. No educational programs for patients in pain have been studied in outpatients nor integrated with the home care provided.

Design and methods. One hundred and four patients and their 115 district nurses were enrolled in a prospective, longitudinal, randomized controlled study. The primary outcome of interest was type of care provided by district nurses, satisfaction with the pain treatment, and agreement in estimating patients’ pain intensity.

Results. Results showed that continuity of care was poor as only 36% of the district nurses were informed about patients’ pain by hospital nurses. Pain was rarely the reason for referring the patient to district nursing after discharge. Although pain control was not a main reason for district nurses to visit a patient, pain was a subject for discussion in 76% of visits. Besides discussing the pain problem with patients, district nurses provided only a few pain‐relieving interventions. District nurses randomized to the intervention group significantly better estimated patients’ pain intensity, and were more satisfied about patients’ pain treatment, but no differences were found in their assessment of patients’ pain relief.

Conclusions. These findings suggest a significant but moderate effect of the Pain Education Programme, with district nurses only playing a minor role in the treatment of cancer pain.
The concept of self‐management of type 1 diabetes in children and adolescents: an evolutionary concept analysis
Authors: Schilling Lynne S. , Grey Margaret , Knafl Kathleen A.
Published: March 2003

The concept of self‐management of type 1 diabetes in children and adolescents: an evolutionary concept analysis

Aim. An evolutionary concept analysis was undertaken to clarify the concept of self‐management of type 1 diabetes in children and adolescents.

Background. Several problems exist in the literature on self‐management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self‐management of diabetes in children and adults.

Methods. Ninety‐nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts.

Results. The three essential attributes of the concept were identified as process, activities, and goals. Self‐management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision‐making between child and parent. It is a process that involves collaboration with health care providers. Self‐management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested.

Conclusions. It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.
Barriers and bridges to care: voices of homeless female adolescent youth in Seattle, Washington, USA
Authors: Ensign Josephine , Panke Aileen
Published: March 2003

Barriers and bridges to care: voices of homeless female adolescent youth in Seattle, Washington, USA

Aim. The purpose of this study was to conduct an assessment of reproductive health‐seeking behaviours, sources of advice, and access to care issues among a sample of clinic‐based homeless adolescent women.

Background. Adolescent women are among the most vulnerable and medically underserved subgroups within the homeless population in the United States. Homeless youth are rarely invited to participate in research aimed at improving their access to appropriate health care. Also, the culture in which they live and the personal experience of being homeless are often not addressed.

Study method. The research was descriptive, using focus groups and individual interviews with a purposeful sample of 20 female youth, aged 14–23 years.

Findings. The women said that they seek health advice from other women, including their mothers even while they are homeless. They reported first trying self‐care interventions, and going to clinics when self‐care actions no longer worked. They stated that the main barriers to health care were lack of insurance, confusion over consent, transportation problems, lack of respect (from providers) for their own self‐knowledge, and judgementalism from providers.

Conclusion. Using the concept of cultural competency, the results provide insights into how to improve communication and health care services for these women.

Recommendations. Health care providers need to recognize and appreciate the lifestyle, beliefs, and adaptive attitudes of homeless youth, rather than labelling them as ‘deviant’. All personnel who interact with and on behalf of homeless youth must be adequately trained in general knowledge regarding the health of homeless youth as well as in an understanding of the role that culture plays in their health‐seeking behaviours.
Psychosocial consequences of falling: the perspective of older Hong Kong Chinese who had experienced recent falls
Authors: Kong Karol Siu‐wai , Lee Fung‐kam , Mackenzie Ann E. , Lee Diana T.F.
Published: March 2003

Psychosocial consequences of falling: the perspective of older Hong Kong Chinese who had experienced recent falls

Aim of the study. The study's aim was to explore the psychosocial consequences of falling with a group of older Chinese who had recently fallen.

Background. Older people fall more frequently. Thus, the consequences of these falls and their influence on health outcomes need to be determined. One important outcome, namely the psychosocial consequence of falling, has not been extensively studied. As a result, this study explored the psychosocial consequences of falling with a group of older Chinese who had recently experienced a fall.

Research approach. An explorative qualitative approach with semi‐structured interviews was used in this study.

Sample. Twenty informants, with recent fall experiences either in the community or hospital setting, were interviewed in two elder care wards in an acute care hospital.

Findings. Three major categories of psychosocial consequences of falling emerged from the interview data: powerlessness, fear and seeking care. Powerlessness was also exemplified in three subcategories: lack of control, self‐comforting and lack of emotion. Informants perceived falls as unpredictable and not preventable, expressing fears that falling could result in dependence on others and becoming a care burden. The interview data also showed that there is a need by older Chinese to seek care and advice from relatives and health care professionals.

Conclusions. Findings from this study have provided insights into the psychosocial consequences of falling for older Chinese. These insights suggest nursing interventions should promote a sense of mastery in prevention of falls, facilitate supportive social interactions with relatives and give empathetic responses to those who have fallen.
Getting evidence into practice: the role and function of facilitation
Authors: Harvey Gill , Loftus‐Hills Alison , Rycroft‐Malone Jo , Titchen Angie , Kitson Alison , McCormack Brendan , Seers Kate
Published: March 2003

Getting evidence into practice: the role and function of facilitation

Aim of paper. This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice.

Background. In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on‐going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity.

Methods. The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence‐based practice.

Findings. The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders.

Conclusions. We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task‐focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.
The psychological well‐being of renal peer support volunteers
Authors: Brunier Gillian , Graydon Jane , Rothman Barbara , Sherman Charline , Liadsky Roselyn
Published: March 2003

The psychological well‐being of renal peer support volunteers

Aim of the study. The purpose of this study was to describe the characteristics of renal peer support volunteers (PSVs) and explore the effects on their psychological well‐being from helping others.

Background. Dialysis patients, transplant patients and family members who become renal PSVs receive special training in empathy, listening, self‐awareness and problem solving. The trained renal PSVs offer a unique service to others struggling to learn to live with renal failure because they have faced the same struggles.

Methods. This exploratory study utilized a longitudinal design. The first time for data collection was immediately after the volunteers had completed a Kidney Foundation of Canada training programme. Subsequent interviews were at time intervals of 4, 8 and 12 months after the first interview. Information on the psychological well‐being of the volunteers was collected at each interview in two different ways: the 38‐item Mental Health Inventory (MHI) and open‐ended questions.

Findings. Thirty‐one PSVs completed all four interviews. The average age of the volunteers was 45 years and almost half had a university level of education. They identified themselves as belonging to 12 different ethno‐cultural groups. Analysis of the quantitative data from the MHI indicated that the mental health of the PSVs stayed remarkably stable over time. Analysis of the qualitative data from the open‐ended questions revealed four major themes which, taken together, showed notable increases in personal growth and well‐being for the PSVs over time.

Conclusion. After participating in a training programme, renal PSVs maintained, and possibly improved, their own well‐being by helping others with chronic renal failure.
The safety and effectiveness of a nurse‐led anticoagulant service
Authors: Connor Carole A. , Wright Chris C. , Fegan Christopher D.
Published: March 2003

The safety and effectiveness of a nurse‐led anticoagulant service

Aim. The aim of this study was to compare the safety and effectiveness of anticoagulant nurses and a consultant haematologist in managing anticoagulant patients in a hospital outpatient setting.

Background. Nurses are increasingly developing roles traditionally undertaken by medical staff. As a result nurse‐led practice has expanded in many areas including anticoagulant services. Previous studies have attempted to demonstrate the effectiveness of using other professionals to manage anticoagulant clinics over short periods of time. This research evaluates the safety and effectiveness of a consultant‐led and a nurse‐led service over two sequential 18‐month periods.

Research methods. A nonexperimental design was adopted. Data were collected retrospectively, from a random sample of 197 patients, who had been managed by both the consultant‐led and nurse‐led service. Two main outcome measures were selected: anticoagulant control between professional groups and interval between outpatient clinic appointments.

Results. No statistically significant difference in anticoagulant control was found between professional groups (P=0·137). There was evidence that patients attended anticoagulant clinics on significantly fewer occasions with nurse‐led management (P < 0·0005).

Conclusion. At the department within which this research was conducted, anticoagulant nurses were found to be at least as safe and effective as the consultant haematologist in managing outpatient anticoagulant patients over the study period. These findings are of importance in both shaping the future provision of anticoagulant care and also contributing to the wider area in evaluating the impact of nurse‐led practice within health care.
Two theories/a sharper lens: the staff nurse voice in the workplace
Authors: DeMarco Rosanna
Published: March 2003

Aim of the paper.  This paper (1) introduces the two theoretical frameworks, Silencing the Self and the Framework of Systemic Organization (2) describes the design and findings briefly of a study exploring spillover in nurses utilizing the frameworks, and (3) discusses the process and value of theory triangulation when conducting research in the context of complex nursing systems phenomena where gender, professional work, and gender identity merge.

Background/rationale.  A research study was designed to analyse the actual workplace behaviours of nurses in the context of their lives at work and outside work. An exploration of theoretical frameworks that could direct the measurement of the phenomena in question led to the use of two frameworks, the Framework of Systemic Organization (Friedemann 1995) and the Silencing the Self Theory (Jack 1991), and the creation of a valid and reliable summative rating instrument (the Staff Nurse Workplace Behaviours Scale, SNWBS).

Design/Methods.  A descriptive correlational design was used to measure behaviours between work and home.

Results/findings.  There were statistically significant relationships found between workplace behaviours, family behaviours, and silencing behaviours as measured by the two separate scales measuring framework concepts.

Conclusions.  Although both theories had different origins and philosophical tenets, the findings of a research study created an opportunity to integrate the concepts of each and unexpectedly increase and broaden the understanding of spillover for women who are often nurses.
Nurse practitioner knowledge of complementary alternative health care: foundation for practice
Authors: Sohn Patricia M. , Loveland Cook Cynthia A.
Published: March 2003

Aim.  With the increasing use of complementary alternative treatments by the general public in the United States of America (USA), it is critical that nurse practitioners have the most up‐to‐date information about the use and safety of these modalities. A strong knowledge base is crucial in delivering competent and culturally sensitive care, yet the level and source of nurse practitioner knowledge in this area is largely unknown. The purpose of this study was to investigate the level and source of nurse practitioner knowledge of complementary alternative health care practices, as well as their referral practices involving these treatments.

Methods.  Using a cross‐sectional descriptive research design, a sample of 151 nurse practitioners from Missouri and Oregon completed an adapted version of Sapp's self‐administered survey that explored these issues. Evaluation of the psychometric properties of the adapted instrument demonstrated good face validity, test–retest reliability (kappa = 0·81) and internal consistency reliability were 0·90 and 0·92 for two subscales with continuous response categories.

Findings.  Eighty‐three percent of the nurse practitioners recommended complementary alternative treatments to their patients with the most frequent being massage therapy, chiropractic care, acupuncture or acupressure, nutritional therapy and herbal treatment. However, only 24% reported that formal nurse practitioner education was a source of knowledge about these treatments. Instead, over 60% relied on their personal experiences for this knowledge, as well as lay and professional journals.

Conclusion.  Nearly 9 out of 10 nurse practitioners recommend the use of complementary alternative therapies to patients, but their source of knowledge is not derived from professional education. Attention needs to be given to increasing content about complementary alternative therapies in formal academic programs, professional conferences and in‐service education opportunities.
Fears and worries associated with hypoglycaemia and diabetes complications: perceptions and experience of Hong Kong Chinese clients
Authors: Tak‐Ying Shiu Ann , Yee‐Man Wong Rebecca
Published: March 2003

Aim.  This paper reports the second phase of a study that explored the perceptions and experience of Hong Kong Chinese insulin‐treated clients who demonstrated fear of hypoglycaemia and worry about diabetes complications.

Background.

 The first phase of the study, a descriptive survey (
n  = 120), identified 15% of respondents as simultaneously sustaining fears and worries associated with hypoglycaemia and diabetes complications. Although a small percentage, given the increasing number of clients using insulin treatment, this finding suggests a pocket of clients suffering from undesirable emotional health. However, a search of the literature identified few studies exploring Chinese clients' perceptions and experience in this area.

Design.  The second phase of the study employed a purposive sampling method and semi‐structured interviews to collect data from 13 participants experiencing these fears and worries.

Findings.  Two researchers independently used content analysis to code and categorize data. Six categories identified were: the influence of perceptions of glycaemic control on emotion, hypo‐ and hyperglycaemia as a constant threat, keeping optimal glycaemic control or maintaining a working life, financial and psychological burden of blood glucose self‐monitoring, being alone with the threat and finally distancing as the coping method. An overriding issue, a sense of losing control, emerged from the findings that described participants' perceptions and experience. This issue and two major health needs, developing self‐efficacy and emotional support from nurses, were drawn from the findings for discussion. It is suggested that self‐efficacy theory can be adopted as a conceptual framework to guide nursing practice for enhancing clients' capacity to exercise control over diabetes self‐management.

Conclusions.  Findings obtained from the second phase of the study illuminated those from the first phase. Implications for nursing practice were identified, including facilitating both technical and psychosocial self‐efficacy, assessing clients' total life situation, strengthening competence in counselling skills and forming alliances with clients.
Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease
Authors: Tak Young Ran , McCubbin Marilyn
Published: March 2003

Family stress, perceived social support and coping following the diagnosis of a child's congenital heart disease

Background.  Congenital heart disease (CHD) is now estimated to be the second most prevalent chronic illness. A child's chronic illness may have effects that have pervasive consequences for family life. Recently, attention has focused on resiliency variables, especially social support and coping strategy, regulating the impact of stress. In the resiliency model of family stress, adjustment and adaptation, social support is viewed as one of the primary moderators or mediators between stress and well‐being.

Aims.  The purpose of this study was to explore the relationships of family stress, perceived social support, and coping and determine the resiliency factor associated with coping by families who have a child with chronic illness.

Design.  In a secondary analysis of a large longitudinal study, the sample consisted of 92 families who had a child under age 12 who was newly diagnosed with CHD within the last 3–4 months.

Findings.  Results from regression analysis revealed that perceived social support operated as a resiliency factor between family stress and both parental and family coping. Child and family characteristics appeared to be the important predictors of perceived social support and parental coping. Although perceived social support appeared to be an important predictor of parental and family coping, neither the moderating nor mediating model was supported in full but partial causal relations were confirmed.

Conclusions.  Findings provided evidence for the theoretical and empirical significance of perceived social support as a predictor of family coping. Further, these findings suggest that perceived social support is a factor influencing the resiliency of relatively high‐risk groups of families who have a child with chronic illness.
Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain
Authors: Simons Joan , Roberson Elaine
Published: March 2003

Aim of the study. To explore the perceptions of nurses and parents of the management of postoperative pain in children. This paper focuses on issues of knowledge and communication.

Background. Nurses are the key health care professionals with responsibility for managing children's pain, however, nurses are not well supported educationally to manage the level of responsibility.

Results. Using matched interviews between 20 parents and 20 nurses many issues arose relating to the nurse/parent communication process. It was also clear that despite nurses' knowledge of pain management being deficient, they had expectations that required parents to have a level of knowledge they did not possess.

Conclusions. The findings suggest that nurses' poor communication with parents and nurses' knowledge deficits in relation to children's pain management create obstacles to effective pain management. These obstacles need to be addressed in order to improve the management of children's pain through better education of nurses and two way communication with parents.
Empowering practitioners: an unrealistic expectation of nurse education?
Authors: Leyshon Stephen
Published: March 2003

Background.  Empowerment has become an increasingly popular theme in nurse education. This is evident from the growing number of courses that claim to enable nurses to become empowered. However, this is taking place in an environment with little critical debate about the assumptions and implications for educators and students. Consequently there is a risk of creating hegemony and regimes of truth.

Aim.  This paper sets out to review critically existing discourses on empowerment and to suggest a more reflexive and realistic view.

Themes.  The origins of empowerment are established, together with its relationship to professional education. There is a review of the nature of power and autonomy, followed by an examination of the effects of expectations of empowering practice on educators and students. The lack of reflexivity in notions of empowerment is discussed. Consideration is given to the possibility of rehabilitating empowerment by offering an alternative conception that is realistic and reflexive.

Conclusions.  Conclusions are drawn to suggest that although much of the writing on empowerment in education is insufficiently self‐critical and consequently is open to censure, ideas of empowerment should not be rejected completely: they may serve to stimulate educators (and their students as future practitioners) to connect with and challenge society.
Coping with menstruation: understanding the needs of women with Parkinson's disease
Authors: Tolson Debbie , Fleming Valerie , Schartau Elgin
Published: March 2003

Aims. To understand how women with Parkinson's disease (PD) experience and cope with menstruation and associated gynaecological problems, and adjustments to womanhood. This paper focuses on menstruation.

Rationale. Unique hormonal fluctuations are known to affect women with idiopathic PD, however, our understanding of the impact of these changes on daily lives and opportunities for nursing support are limited.

Methods. Descriptive multiple case study design was adopted, and data collection involved a variety of approaches. Including semi‐structured interviews, conversational interviews, group interview, reflective diaries and creative writing. A flexible approach was encouraged whereby consenting women chose how and when they wanted to participate.

Findings. A total of 19 women participated, 17 were experiencing naturally occurring periods. The majority had been diagnosed around the age of 39 years, and at the time of study participants ages ranged from 34 to 56 years. Three of the women reported no change in the experience of their periods following diagnosis, 15 reported worsening problems which in two extreme situations led to hysterectomy. During the monthly cycle PD symptoms were often exaggerated, medication effectiveness reduced and ‘off times’ increased. The period itself involved high levels of pain, fatigue and sometimes humiliating experiences when self‐care was impossible.

Conclusions. This study offers a unique contribution to our understanding of the needs of young women with PD, and suggests that health professionals need to look beyond the mask of a disease associated with old age. The nursing profession has a responsibility to develop models of best practice to enable women of any age to be themselves and to adapt to the rhythm of their hormones as they live and grow older with PD.
Journeying from the philosophical contemplation of constructivism to the methodological pragmatics of health services research
Authors: Appleton Jane V. , King Lindy
Published: March 2003

Aim.  This paper presents our journey through a contemplation of the philosophical origins of constructivism to consider its role as an active methodology in qualitative research.

Method.  The first part of the paper summarizes the philosophical background of constructivism and the five principles underpinning this paradigm as described through the works of Guba and Lincoln. The philosophical roots of constructivism are then compared with postpositivism, critical realism and participatory inquiry. The paper moves on to consider their common methodological steps, before examining how the constructivist research strategy is being adopted and adapted within the pragmatics of health service research. Recent studies will be drawn upon to illustrate the use of constructivist methodology.

Conclusion.  Questions are raised about the role of philosophy and the extent to which it should or does underpin or influence qualitative research strategies. We believe that if researchers gain an understanding of both philosophy and methodology a richer and more robust study is likely to result.
Evaluating Emergency Nurse Practitioner services: a randomized controlled trial
Authors: Cooper Mark A. , Lindsay Grace M. , Kinn Sue , Swann Ian J.
Published: March 2003

Background. Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP‐led care. These tools were then tested in a randomized controlled trial.

Methods. A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP‐led care (n = 99) or Senior House Officer (SHO)‐led care (n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a ‘Documentation Audit Tool’. A follow‐up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored.

Results. Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to (P = 0·009); gave them information on accident and illness prevention (P = 0·001); and gave them enough information on their injury (P = 0·007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs (P < 0·001). ENPs' clinical documentation was of higher quality than SHOs (P < 0·001). No differences were found in recovery times, level of symptoms, time off work or unplanned follow‐up between groups. Missed injuries were the same for both groups (n = 1 in each group).

Conclusion. The study was sufficiently large to demonstrate higher levels of patient satisfaction and clinical documentation quality with ENP‐led than SHO‐led care. A larger study involving 769 patients in each arm would be required to detect a 2% difference in missed injury rates. The methods and tools used in this trial could be used in Accident and Emergency departments to measure the quality of ENP‐led care.
A study to evaluate the pain knowledge of two sub‐populations of final year nursing students: Australia and Philippines
Authors: Chiu Lee Huang , Trinca Jane , Lim Lee Meng , Tuazon Josefina A.
Published: March 2003

Background.  Pain management is an essential and important aspect of nursing care. Deficits in pain knowledge and attitudes continue to be reported despite a growth of educational programmes. A lack of basic knowledge of pain at an undergraduate level may limit nurses from effectively developing their knowledge after graduation.

Aim of the study.  To assess the type and level of knowledge of basic aspects of pain mechanisms and treatment principles in complete classes of final year nurses, at three nursing schools.

Method.  Data were collected in 1999, from 150 students (81 Australian and 69 Philippine) via a 23‐item pain knowledge test questionnaire, previously used to assess undergraduate health professionals including nurses.

Results.  The mean score of concordant answers for all students was 38·6%, scores ranged from 0% to 70%, 95% Confidence Interval of the mean was 36–41%. There were few significant differences between the groups for individual questions and no significant difference in overall mean scores. Common questions answered poorly included those related to complex regional pain syndrome, pharmacology and central sensitization.

Most students perceived their undergraduate pain education to be minimal. Thirty‐six per cent of Australian students compared with 50% Filipino students perceived their pain knowledge was adequate for their clinical needs. Additionally, most students believed that graduating doctors should be able to answer the test questions correctly.

Conclusion.  The results demonstrate consistently low levels of knowledge and also knowledge gaps about basic pain mechanisms, terms and treatment amongst these three final year nursing classes. Such information is useful to define levels of basic knowledge about this topic, and can be explored further as to whether some or all of these facts are deemed necessary for inclusion in nursing curriculum by reference to documents such as the International Association for the Study of Pain curriculum.
Cancer patients' decision‐making regarding treatment and nursing care
Authors: Sainio Carita , Lauri Sirkka
Published: March 2003

Background.  Patient participation in decision‐making has produced many debates among health care professionals. The research evidence concerning patient participation in decision‐making is not clear, and shows conflicting results.

Aims.  To identify to what extent cancer patients participate in decision‐making and to what extent background characteristics, information obtained and relationships with staff explain cancer patients' participation in decision‐making.

Design/Method.
 A structured questionnaire based on earlier research and qualitative interviews was designed. The questionnaire was completed by 273 cancer patients who were inpatients or outpatients in haematology, oncology clinics and other clinics at two university hospitals in Finland. The questionnaire consisted of five areas: (1) demographic data; (2) mood; (3) information obtained; (4) relationships with staff; and (5) decision‐making. The scale used was ordinal. The data were analysed using descriptive statistics and nonparametric tests such as Mann–Whitney U‐test, Kruskall–Wallis, and Wilcoxon matched‐pairs signed‐rank tests.

Results.  The majority of the respondents perceived that they had participated in making treatment decisions at least to some extent, together with the physician. In decision‐making about nursing care, respondents felt that they had participated most in decisions about personal hygiene, rest and sleep. Respondents' physical condition, marital status, age and time since diagnosis, as well as information obtained and relationships with staff, were associated with participation in decision‐making.

Conclusion.  This study provided evidence that some cancer patients participated in decision‐making and felt participation to be important. Staff played a crucial role in patient participation in decision‐making. In future, staff should work to improve cancer patients' opportunities to participate in decision‐making in order that those who wish to be involved can do so.
Putting the pieces together: teaching undergraduate research from a theoretical perspective
Authors: Dobratz Marjorie C.
Published: March 2003

Problem/purpose. Baccalaureate graduates are expected to utilize research across a wide variety of practice settings. While the literature reports a variety of teaching approaches, few studies examine baccalaureate students' comprehension of research content. Teaching techniques that focus on a conceptual or theoretical approach may foster research comprehension. Therefore, the purpose of this paper is to evaluate teaching/learning outcomes of an undergraduate nursing research course designed from a conceptual or theoretical approach.

Procedure/findings. Two classes of senior baccalaureate nursing students (n = 47) at a private institution, whose curriculum was based on the Roy adaptation model, were surveyed in 1990 and 1991 at the end of their undergraduate research course. The survey tool consisted of seven three‐point Likert scale questions, four open‐ended questions, and one unstructured comment. Findings showed that 72% strongly agreed that they would continue to read nursing articles in their practice field, 57% disagreed that they were intimidated by research language, and 55% agreed that they trusted their ability to use and utilize nursing research in practice. The most helpful learning activity was the research critique (34%) followed by group work (28%). The support of the teacher and Instructor's use of own research examples was also seen as most helpful (36%), while abstract cards (8%) were least helpful. Nonetheless, 23% requested more group activities, 13% wanted more class examples, and 11% asked for more time to comprehend definitions.

Implications. Students who approached research from the perspective of a nursing conceptual framework indicated that they put the pieces of the research puzzle together by working in groups, being supported by the Instructor, and learning from a variety of teaching methods.
Impending extinctions of North American freshwater mussels (Unionoida) following the zebra mussel (Dreissena polymorpha) invasion
Authors: RICCIARDI ANTHONY , NEVES RICHARD J. , RASMUSSEN JOSEPH B.
Published: March 2003

1.  Freshwater mussels (Order Unionoida) are the most imperiled faunal group in North America; 60% of described species are considered endangered or threatened, and 12% are presumed extinct. Widespread habitat degradation (including pollution, siltation, river channelization and impoundment) has been the primary cause of extinction during this century, but a new stress was added in the last decade by the introduction of the Eurasian zebra mussel, Dreissena polymorpha, a biofouling organism that smothers the shells of other molluscs and competes with other suspension feeders for food. Since the early 1990s, it has been spreading throughout the Mississippi River basin, which contains the largest number of endemic freshwater mussels in the world. In this report, we use an exponential decay model based on data from other invaded habitats to predict the long‐term impact of D. polymorpha on mussel species richness in the basin.

2.  In North American lakes and rivers that support high densities (>3000 m−2) of D. polymorpha, native mussel populations are extirpated within 4–8 years following invasion. Significant local declines in native mussel populations in the Illinois and Ohio rivers, concomitant with the establishment of dense populations of D. polymorpha, suggest that induced mortality is occurring in the Mississippi River basin.

3.  A comparison of species loss at various sites before and after invasion indicates that D. polymorpha has accelerated regional extinction rates of North American freshwater mussels by 10‐fold. If this trend persists, the regional extinction rate for Mississippi basin species will be 12% per decade. Over 60 endemic mussels in the Mississippi River basin are threatened with global extinction by the combined impacts of the D. polymorpha invasion and environmental degradation.