bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of an instrument to measure collaboration and satisfaction about care decisions
Authors: Gedney Judith
Published: March 2003

The psychometric assessment of a new instrument for measurement of the construct of nurse‐physician collaboration in making specific patient care decisions, Collaboration and Satisfaction About Care Decisions (CSACD), is reported Content validity for the tool was supported by literature review, nurse and physician experts, and potential subjects In a pilot study 58 neonatal intensive care nurses’and resident physicians’responses showed variance, alpha reliability of the collaboration questions was 0 95 Construct validity of the collaboration questions was supported by finding expected correlational patterns and by factor analysis revealing a single factor that explained 75% of the variance in collaboration Further psychometric testing of the instrument is proposed, particularly in the context of substantive studies that would allow investigation of its association with patient outcomes
Registered nurses’and physicians’reflections on their narratives about ethically difficult care episodes
Authors: Lindseth Anders , Marhaug Venke , Norberg Astrid , Udén Giggi
Published: March 2003

Thirteen registered nurses and eight physicians in medical and oncological care reflected on their previous narratives about ethically difficult care situations Although the interviewees had narrated different kinds of stories there were more similarities than differences in their reflections Common themes were meeting death, balancing between being open to one's own and others’reactions and being sheltered, handling advanced medical technology and grasping care as a whole The two groups, however, disclosed different cognitive styles and types of rationality The nurses referred to their personal expenence of giving care and also receiving care very much within a praxis perspective, while physicians referred to science and proven experience within a poiesis perspective
Helpfulness of mental health day care: client and staff views
Authors: Ricketts Tom , Kirshbaum Marilyn N
Published: March 2003

Seventeen clients of a mental health day service were interviewed regarding their treatment experiences Content analysis of this information was undertaken, and the clients then rank‐ordered the reported aspects of treatment from most to least helpful Staff undertook a similar procedure to enable clients' views to be placed in context Both clients and staff reported counselling as the most helpful aspect of treatment Clients and staff disagreed as to the relative helpfulness of medical and group aspects of treatment Clients reported medical treatment as the second most helpful aspect, and staff reported groups and the planned approach to care second Social contact with other clients was reported to be just as helpful as organized group therapy by clients Clients identified that just having somewhere to go to meet people was very helpful Communication difficulties between staff and clients were evident with regard to the planned approach to care, discharge planning, and group activities The ability of clients to evaluate their treatment experiences differentially is highlighted
The implementation of problem–based learning: changing pedagogy in nurse education
Authors: Creedy Debra , Hand Brian
Published: March 2003

Problem‐based learning (PBL) employs approaches to teaching and learning in nurse education that develop meaningful links between theory and practice The adoption of such approaches, however, may require changes in pedagogical beliefs and practices which reflect a student‐centred approach to teaching and learning This paper focuses on a group of volunteer nurse educators (n= 14) who attended a 7‐month professional development programme centred on introducing pedagogical changes when adopting PBL From this group, three nurse educators participated in an in‐depth study which aimed to examine the processes of conceptual change associated with adopting PBL as part of alternative teaching strategies These three participants held common concerns about the changes required to their current teaching practices when moving to a new pedagogical approach On completion of the programme, varying degrees of change in existing instructional practices were evident This change was found to result from engaging educators in reflection about practice, providing opportunities to implement the new approaches on a trial basis, and providing feedback and support throughout the change process
A comparative analysis of Orem's self‐care model and Peplau's interpersonal theory
Authors: Comley Anita L
Published: March 2003

The process of choosing a nursing model or theory to guide one's clinical practice, curriculum development or theoretical framework for research can be facilitated by analysis of and comparison of existing theories, with each other and then with one's personal philosophies This paper summarizes the major concepts and assumptions of Dorothea Orem's self‐care model and Hildegard Peplau's interpersonal theory, and then compares the two for similarities and differences in their origins of theory development, meanings related to nursing metaparadigm concepts, logical adequacy, usefulness and generalizability, parsimony and testability
An exploratory study of research utilization by nurses in general medical and surgical wards
Authors: Rodgers Sheila
Published: March 2003

An exploratory study into research utilization is described Firstly an agreed definition of research utilization was arrived at through consultation with a range of nurses in both academia and clinical practice Potential factors that may influence research utilization were identified through a review of current research on research utilization and through a period of fieldwork carried out on two hospital wards in Scotland The findings indicate that research utilization appears to be a complicated issue and cannot be decontextualized or fractionated in order to lead to an understanding but must address multiple factors simultaneously This paper refers to research that may be utilized in clinical nursing practice rather than in education or nursing management The impact of research in clinical practice on education and nursing management is not discounted but the focus of this study is on the influence that research may have on the actual delivery of patient care and in this sense, education and management developments are encompassed
Sensing an improvement: an experimental study to evaluate the use of aromatherapy, massage and periods of rest in an intensive care unit
Authors: Dunn Christine , Sleep Jennifer , Collett David
Published: March 2003

There is widespread belief that the use of aromatherapy and massage in an intensive care environment offers a means of increasing the quality of sensory input that patients receive, as well as reducing levels of stress and anxiety Despite a wealth of anecdotal evidence in support of these claims, there have been few objective studies to evaluate the effects of these therapies In this experimental study 122 patients admitted to a general intensive care unit were randomly allocated to receive either massage, aromatherapy using essential oil of lavender, or a period of rest Both pre‐ and post‐therapy assessments included physiological stress indicators and patients' evaluation of their anxiety levels, mood and ability to cope with their intensive care experience Ninety‐three patients (77%) were able to complete subjective assessments There were no statistically significant differences in the physiological stress indicators or observed or reported behaviour of patients' ability to cope following any of the three interventions However, those patients who received aromatherapy reported significantly greater improvement in their mood and perceived levels of anxiety They also felt less anxious and more positive immediately following the therapy, although this effect was not sustained or cumulative
Marginality: concept or reality in nursing education?
Authors: Andersson Ewa Pilhammar
Published: March 2003

The concept of marginality has provided a powerful framework for examining individuals or groups who leave one group or culture without making a satisfactory adjustment to another Although little research appears to have been undertaken into marginality in the health care profession, this paper discusses the concept of marginality and its relevance in the education of student nurses One point examined in the paper is the student nurses' position in the intersection of two relatively distinct cultures or traditions (academic vs professional and student culture vs working culture) Another is the students' experience and feelings of being in that position The critical incident technique was used to collect data and the responses were inductively categorized In all, 79 critical incidents (50 negative and 29 positive evidents) were analysed The results indicate that student nurses develop different strategies for coping with their marginal position They can behave in an anticipated fashion by withdrawing into the role of pupil, they can form alliances with different groups of health care personnel, and they can try to escape from their working responsibilities The results shows that the concept of marginality is useful for describing the students' situations and that students' experiences can form a base upon which critical analysis of the nursing profession can be developed
Search for meaning in long‐term cancer survivors
Authors: Dirksen Shannon Ruff
Published: March 2003

The purpose of this study was to explore search for meaning in long‐term survivors of malignant melanoma and the relationship of this meaning to self‐blame and well‐being The sample consisted of 31 long‐term melanoma survivors who had been free of disease for 5 years or longer Measures included the Search for Meaning scale, a single item on self‐blame and the Index of Well‐Being Data were analysed by descriptive statistics and t‐tests Findings revealed that 52% (n = 16) of the sample did search for meaning which resulted in an identifiable cause for their cancer and a quiet reassessment of life Subjects indicating self‐responsibility for their cancer expressed a greater meaning search than the group who did not blame self (P < 0.01) Well‐being scores were not significantly related to this search for meaning Results suggest that for some survivors the cancer experience elicits a search for meaning which is significantly associated with self‐blame This study extends developing nursing theory on survivorship by providing insight into the meaning of the cancer experience in long‐term survivors
Interpretive approaches in nursing research: the influence of Husserl and Heidegger
Authors: Koch Tina
Published: March 2003

This paper aims to throw some light on Husserlian phenomenology and Heideggerian hermeneutics, and to discuss their influences and applicability to the nursing research agenda There are definite distinctions between Husserhan transcendental phenomenology and Heideggerian hermeneutic phenomenology and these distinctions have implications for the methodology employed These traditions are discussed with respect to some fundamental research issues the philosophical perspectives of the traditions and the notion that data that result from the inquiry are created by the interaction between researcher and researched The central recommendation in this paper is that nurse researchers appraise the philosophical underpinnings of the methodologies they pursue
The effects of medication education on adherence to medication regimens in an elderly population
Authors: Esposito Linda
Published: March 2003

The purpose of this intervention study was to evaluate educational protocols to see which would be more effective in increasing medication compliance rates within an elderly population Forty‐two patients were randomized into four groups Group 1 received a standard education protocol, group 2 received the standard education and 30 minutes of verbal instruction, group 3 received the standard education and a medication schedule, and group 4 received the standard education, a medication schedule, and 30 minutes of verbal instruction The intervention was given on the day of hospital discharge Home visits were made 2 weeks, 1 and 2 months post‐hospital discharge Results of the visits revealed that groups 1 and 2 had higher rates of errors with medications than groups 3 and 4 In conclusion, the groups with a medication schedule had higher compliance rates Considering the sample size of 42, this study can act as a pilot study to justify further research in the effects of a medication schedule on compliance
The recent health reforms in the United Kingdom: some tentative observations on their impact on nurses and nursing in hospitals
Authors: Bradshaw Peter L
Published: March 2003

The British National Health Service has recently undergone the most profound reforms since it was conceived some 50 years ago In an attempt to contain the rising cost of spending the principles of market competition have been introduced Similar developments are occurring internationally This paper describes briefly the history of the reforms in the United Kingdom It outlines the rationale for a market in health services which is largely publicly funded The paper then provides an analysis of the serious impact of the new business culture on the control of nurses and nursing work in hospitals In doing so, it identifies the threats which confront the future well‐being of the nursing profession It concludes with a brief resumé of opportunities which the profession must seize if it is to retain its identity
Advanced nursing practice: new ideas and new perspectives
Authors: Sutton Frances , Smith Colleen
Published: March 2003

The authors of this paper contend that advanced nursing practice differs substantially from other forms of nursing practice, such as expert and specialist practice Additionally, they contend that the difference resides in the way that advanced nurse practitioners think about, see and experience clinical practice Historically, nursing in Australia has been strongly influenced by events and ideas generated in North America The authors argue this has led to the development of an emphasis on the nature, role and function of specialist and expert nursing practice to the detriment of ascertaining and fostering the notion and nature of advanced nursing practice This influence of North American nursing has also significantly directed and influenced the way in which we use and understand the term ‘advanced nursing practice’, and further, that the way in which we use the term does not give full regard to the context of Australian nursing The authors outline some of the key issues and ideas emerging in South Australia with respect to advanced nursing practice and in particular offer beginning theonzations into the different ways in which advanced nurse practitioners think, see and experience nursing practice
A classical view of the theory‐practice gap in nursing
Authors: Allmark Peter
Published: March 2003

The perceived problem of the theory‐practice gap is built upon the assumption that theory can and must be directly applied to nursing practice, otherwise it is irrelevant Whilst the spirit in which this claim is made is healthy, the assumption is false An examination of the Greek origins of theory and practice show that the ancient Greeks had different terms for the different types of knowledge contained with theory and within practice The type of knowledge associated with practice could not be taught through theory, nor well represented in theoretical terms The knowledge of the bicycle rider and the piano player illustrate this well If this is correct then simplistic notions of ‘applied theory’ are nonsensical The knowledge of the practitioner is not theory, but something else However, there is a proper relationship between theory and practice, and there are clear examples of this in the way science informs nursing practice The problem is that much of this is obscured by the false claim of theorists that nursing theory (such as normative models) is also science In fact, what it represents is inadequate attempts by theory to represent knowledge which cannot be represented in that form Nursing is practice, not theory. If so, then the term ‘nursing theory’ seems to be oxymoronic
Identifying the characteristics of optimum practice: findings from a survey of practice experts in nursing, midwifery and health visiting
Authors: Butterworth Tony , Bishop Veronica
Published: March 2003

In a questionnaire survey in England of 1221 practising nurses, midwives and health visitors, 18 key characteristics of optimum practice, made up from 77 sub‐item categories, were identified by respondents Five open‐ended questions asked respondents to consider various aspects of optimum practice and to comment on factors which encouraged those in practice to deliver care of the highest quality Consensus of view was obtained through a Delphi approach The researchers offer commentary on the implications of this research for commissioners, providers and the professions and suggest action for those concerned with the provision of health care
Supporting one another: the nature of family work when a young adult has cancer
Authors: Lynam M Judith
Published: March 2003

Families, and the support they provide, are one of the most important resources of the informal health care delivery system As nurses we are called upon to enable clients to maximize their use of family resources and to enable families to cope with illness‐related events While research has clearly documented the important role of support in enabling persons to cope effectively with illnesses and illness related events, further research to understand the processes of providing support within families has been called for With such information we may be more effective in our efforts to guide and support families as they cope with illness in a family member This paper was developed from a qualitative study with young adults with cancer that examined social relationships in order to understand the nature of interactions perceived as supportive and the context within which they occurred In‐depth interviews conducted with young adults provided detailed data regarding the nature of support young adults received from and offered to their families in order to maintain family functioning The processes of offering and receiving support have been conceptualized into five categories of ‘family work’ The nature of the work is described and the roles of family members in accomplishing the work are addressed The findings are discussed in relation to current issues in practice
Nursing as the promotion of well‐being: the client's experience
Authors: Wallace Cathie L. , Appleton Cathy
Published: March 2003

An essential question of the discipline of nursing is What do nurses do to promote the client's well‐being’Using a phenomenological‐hermeneutic approach to inquiry, this study explored the client's experience of nursing as the promotion of well‐being, explicating in three distinct metathemes the meaning of well‐being as transforming and nursing as caring Based on this critical view of nursing, prospective directions for education, research and practice are suggested
Uncertainties in the teaching of ethics to students of nursing
Authors: Allmark Peter
Published: March 2003

Whilst ethics is now commonplace on nursing curricula in the United Kingdom there remains doubt as to how and what to teach This doubt has its origins in interlinked uncertainties within nursing, ethics and education In nursing there are uncertainties about whether we are teaching ethics to professionalize or because we are a profession, and about whether there is something which is uniquely‘nursing ethics’In ethics there are competing paradigms of ethical theory and competing theories of moral development In education there are competing epistemologies, theories of learning and models of curriculum planning These uncertainties are interlinked and an understanding of them will help clarify the debate as to what to teach and how to teach it
The clinical nurse specialist: a way forward?
Authors: Miller Sue
Published: March 2003

The words clinical nurse specialist have been part of the nursing vocabulary for some time, but are these nurses specialized practitioners like many of us, or is there a larger role for them to play? This paper is a piece of reflective writing and is intended to further the debate concerning clinical nurse specialists The paper examines clinical nurse specialists from an intensive care unit perspective It looks at the intensive care unit and the wealth of under‐utilized experience these environments contain The paper examines the existing and envisaged roles of clinical nurse specialists, their education and utilization, and also the difficulties that they are likely to face in their evolution, both from within the nursing profession and from outside it
Busy doing nothing: activity and interaction levels amongst differing populations of elderly patients
Authors: Nolan Mike , Grant Gordon , Nolan Janet
Published: March 2003

This paper considers the activity and interaction levels amongst three differing populations of elderly patients (long‐stay, short‐stay and respite) It begins with a consideration of the literature on staff‐patient interactions in care environments for elderly patients, highlighting the virtual absence of planned, purposeful activity Data are then presented which suggest that, despite the emphasis nurses place on communicating with their patients, many patients continue to spend most of their time inactive It is suggested that if the quality of care elderly patients receive is to improve, nursing staff must see the provision of activity as an integral part of their role and function
Quality indicators in clinical nursing: a review of the literature
Authors: Idvall Ewa , Rooke Liselotte , Hamrin Elisabeth
Published: March 2003

The purpose of the present study was, by means of a literature review, to describe and analyse the characteristics of clinical indicators used to assess and promote quality improvement in nursing care.

It was found that a generally accepted definition of a clinical indicator is a ‘quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities’. By the seriousness of the event and the degree to which it can be avoided, clinical indicators are described as sentinel event or rate‐based indicators. They can measure structure, process or outcome of care. Authors have had different approaches in focus when selecting and developing indicators viz. specific aspects of care/nursing diagnosis, medical diagnosis, generic aspects of care and clinical areas. These different points of departure were influenced by research knowledge, theories/frameworks, or by the opinions of patients or staff.

The threshold of an indicator is essential when measuring the quality of care as it describes a critical level between what is considered good or not.

Thresholds should be dynamic, realistic, and improve over time. However, the literature on how to establish specific thresholds is limited.

The review has also revealed that there is an uncertainty regarding the use of terms such as indicators, standards, norm, criteria and aspects of care.
Observations on the neglected concept of intervention in nursing research
Authors: Johnson Martin
Published: March 2003

In this paper I will examine the concept of researcher intervention in nursing research. In will suggest that the concept is essentially problematic for both positivist and qualitative researchers, which may have some bearing upon its relative neglect as an area for discussion.

I will examine the redundancy of the more popular moral frameworks in dealing with the problems raised by intervention and suggest that nursing research, being ‘messy’, requires the articulation of a more reflexive and contextual approach. This applies both to moral justification and to more pragmatic methodological issues. In the paper I suggest that humanistic action research, informed by recent feminist thinking, has potential to produce a more creative and clinically relevant future for nursing research than is currently so.
The theory‐practice relationship in nursing: an exploration of contemporary discourse
Authors: Fealy Gerard M.
Published: March 2003

The nature of nursing practice, the nature and origins of nursing theory and the issue of the relationship between theory and practice are matters which have and continue to generate extensive philosophical discourse within nursing. Despite the abundance of literature on these matters, to date there have been few attempts to bring together, to summarise and to characterise the various ways in which the theory‐practice relationship is understood within nursing. This paper offers a description of the principal ways in which the theory‐prctice relationship is commonly understood within contemporary philosophical discourse. An exploration of contemporary, scholarly discourse within the nursing literature, using Carr's typology of theories of theory and practice, as a framework for analysis, points to evidence that the theorypractice relationship is understood in a number of different ways. Foremost among these is the tendency to think of nursing as an applied‐science and there is a tendency to think of theory and practice as separate endevours. The content of the discourse also points to a ten dency to view the relationship as one in which the basis for practice lies in the collective ‘common‐sense’ understandings of practitioners engaged in practice. The relationship is also understood in terms of nursing being an ‘ethical’ activity in which practical wisdom, deliberation, judgements and choices are required for the conduct of practice. There is, in more recent discourse, evidence of views wihch attempt to contextualise nursing within tis social reality and thus to conceive of the theory‐practice relationship in ways congruent with the recognition that nursing practice is a human and a social enterprise that is inherently ‘problematic’. These contemporary conceptualizations of the theory‐practice relationship would appear to have evolved through a process n which each new conception has been accommodated with and assimilated into the already existing understandings. Ways of viewing the theory‐practice relationship are expressed either explicitly or, in many instances, are implicit in and recoverable from expressions of views, beliefs and assumptions. It would appear that the current state of thinking with respect to the theory‐practice relationship is one of eclecticism and pluralism and there is a general openness to the contribution of different paradigms of knowing to epistemological development.
Antenatal education – where next?
Authors: Nolan Mary L.
Published: March 2003

The history of antenatal education throws light on why contemporary class attenders represent only a particular section of the childbearing population. Since Victorian times, the non‐availability of the women's network to middle class women has forced them to seek knowledge of their own bodies, confidence in their childbearing capacities and the support of other women through formal educational opportunities. Research suggests that antenatal classes often fail to provide women with a realistic account of birth and parenting to replace the lived experience of earlier decades and may not be facilitated in such a way as to create the support groups which class attenders critically need. Teaching approaches often promote dependency amongst clients rather than nurturing the decision‐making skills required by a consumer‐driven maternity service.
Hong Kong nurses' health‐related behaviours: implications for nurses' role in health promotion
Authors: Callaghan Patrick , Fun Ma Kuk , Yee Fung Ching
Published: March 2003

The health‐related behaviours of a random sample (n=92) of Hong Kong nurses were assessed by a questionnaire written either in English or in English and Chinese. Hong Kong nurse reported negligible smoking or a alcohol use, low levels of breast self‐examination, cervical screening behaviour and regular exercising, seat belt use and driving within the speed limit. The sample reported high levels of making efforts to avoid foods high in cholesterol, eating foods high in fibre and eating fruit daily. Dental hygiene was reported to be high. Just over half the sample reported sleeping 7–8 hours each night and eating breakfast daily. Most nurse reported maintaining their body weight at a healthy level and eating snacks between meals. The English language version of the questionnaire produced a slightly better response rate than the bilingual questionnaires. The results are discussed with reference to previous studies of females' health‐related behaviours in Hong Kong and elsewhere. The implications for Hong Kong nurses' role in health promotion is discussed.
Undergraduate nursing students' perceptions of their clinical learning environment
Authors: Dunn Sandra V. , Hansford Brian
Published: March 2003

The clinical learning environment (CLE) is an interactive network of forces influencing student learning outcomes in the clinical setting. This study used mixed methods to identify factors characterizing students' perceptions of the CLE. The sample consisted of 229 undergraduate students in the second or third year of their biophysical nursing strand. The five subscales of the Clinical Learning Environment Scale, ‘Staff‐student relationships’, ‘nurse manager commitment’, ‘patient relationships’, ‘student satisfaction’ and ‘hierarchy and ritual’, were supported by qualitative data obtained from student interviews. Interpersonal relationships between the participants in the CLE were crucial to the development of a positive learning environment. Student satisfaction with the CLE was both a result of, and influential in creation, a positive learning environment. Nurse educators, clinical venues, and all others participating in the undergraduate nursing students' clinical education, must colloborate in order to crate a CLE which promotes the development of well‐educated registered nurses capable of providing safe, cost‐effective patient care.
Computer literacy in nursing; developing the information technology syllabus in nursing education
Authors: Saranto Kaija , Leino‐Kilpi Helena
Published: March 2003

This study has two main purposes: first, to identify and describe the computer skills required in nursing; and second, to find out what should be taught about information technology in nursing education. A three‐round Delphi survey was education, nurse students and consumers. The panel showed a consensus of opinion on 71% of the items included in the questionnaire designed for the study. The experts agreed that nurses must known how to use the computer for word‐processing purposes, for accessing and using the hospital information system, and for emailing. Nurses must also be aware of system security and show a positive attitude towards computers. It is concluded that hospital information systems and nursing informatics should be integrated into laboratory and hospital training.
An analysis of nursing in context: the effects of current health policy
Authors: Antrobus Sue
Published: March 2003

This paper intends to analyse the effects of recent health policy changes in the United Kingdom upon nursing, examining some of the anomalies raised by the rhetoric of the politics and the actualities of the change process and exploring and analysing nursings’presence within that change process. Specific reference will be paid to the philosophy and ideology of the reforms and comparisons made with some of the original factors underpinning the purpose and functioning of the British National Health Service and professional groups within it.

In particular, this paper considers the functioning of nursing as an holistic, intuitive, humanistic, and caring act within the context of the scientific, rational, performance and outcomes‐orientated new public management ideology presently sweeping the health service. The resultant tensions this apparent dichotomy is causing nursing will be tentatively explored. Lastly, an agenda for change will be proposed which will identify ways in which nursing can respond and, more importantly, be proactive within the contextual changes highlighted.
Nurses’ learning experience and expressed opinions regarding seclusion practice within one NHS trust
Authors: Alty Ann
Published: March 2003

Brief face‐to‐face interviews took place with 64 mental health nurses working within one National Health Service Trust about their education and training regarding seclusion practice. Free comments were also recorded as to their opinions about seclusion practice. Seventy‐three per cent claimed to have either implemented seclusion or supervised patients in seclusion. Only 28% recalled any training or education regarding seclusion practice with 34% recalling reading articles. Training experiences were perceived to be more appropriate to practice than reading articles. Sixty‐six per cent claimed that they would like more information. Seventy‐eight per cent disagreed with the statement that seclusion should no longer be used with 52% agreeing that seclusion was a valuable intervention. Brief comments made during interviews were sorted into six thematic categories. Nurses’ comments involved issues concerning: (1) keeping safe; (2) seclusion abuse; (3) nurses’ role conflict in implementing seclusion; (4) the value of seclusion in ‘real world’ practice; (5) the learning process; and (6) ‘against the wall’ decision‐making. Nurses were more able to identify difficulties than define proper use of seclusion. Nurses most closely involved with seclusion were more likely to refuse to be interviewed about their experiences reflecting the fact that issues surrounding seclusion continue to be a sensitive area for research.
A three‐step method of self‐reflection using reflective journal writing
Authors: Riley‐Douchet Cheryl , Wilson Sharon
Published: March 2003

Fiscal and financial constraints present a challenge for nurse educators to broaden the diversity and scope of teaching/learning methodologies. One method designed to promote autonomy and self‐direction of nursing students is self‐reflection combined with reflective journal writing. This paper describes a three‐step process of self‐reflection encompassing critical appraisal, peer group discussion and self‐awareness. This process of self‐reflection was initiated with one group of clinical nursing students. Using student and teacher feedback, implications for employing this teaching/learning strategy in clinical practice are suggested.
The nurses' aide: past and future necessity
Authors: Edwards Margaret
Published: March 2003

Popular images of nursing, largely based on Victorian ideals, have tended to ignore the role played by the unqualified nurse. Yet nurses' aides have been described as providing the backbone of health services and in many clinical areas have traditionally performed the greater part of basic nursing care. Demographic pressures, including increased numbers of elderly people with health care needs and the reduction in the number of school leavers entering nursing, together with reforms in nurse education, will mean that the demand for nurses is likely to continue to outstrip supply. The nurses' aide is likely to remain indispensible to nursing provision in the United Kingdom. Despite the contribution of unqualified nurses, little attention has been paid historically to their training needs. Studies have attempted to compare the effectiveness of qualified staff with that of nurses' aides, even though the latter have received little or no training. The validity of such approaches is questionnable since ‘unqualified’ and ‘untrained’ have been accepted as synonymous by the nursing profession. Other studies which have looked at the caring abilities of unqualified staff suggest that despite their lack of training they have the potential to deliver therapeutic care as long as trained nurses provide appropriate role models within a therapeutic unit philosophy. The value of the qualified nurse may in fact involve the organization of care rather than hands on care alone.
Towards a rhetoric of spirituality in mental health care
Authors: Nolan Peter , Crawford Paul
Published: March 2003

The spiritual dimension of care is frequently alluded to in the nursing literature, but rarely examined in terms of what it means in practice or how it might be taught to students entering the profession. Some of those most in need of spiritual care are people suffering from mental illness or psychological distress. The aim of this paper is to explore the different meanings of spirituality and to suggest ways in which the spiritual care of clients can be implemented. It further recommends which aspects of spirituality could usefully be included in nursing curricula. The paper concludes by alerting nurses to the causes and manifestations of spiritual apathy in contemporary health care and calls for a rhetoric that will counter the jargon of cost analysis which currently prevails in the health services.
Learning from practice? Mental health nurses' perceptions and experiences of clinical supervision
Authors: Scanlon C. , Weir W.S.
Published: March 2003

In recent years nursing as a whole has moved from a position of apparently little manifest concern in the issue of ‘clinical supervision’ to a veritable explosion of interest which is beginning to find expression in the literature. Beginning with a discussion of clinical supervision from within a psychodynamically informed interpersonal nursing framework this paper reports on a small scale qualitative inquiry which aimed to explore mental health nurses' perceptions and experiences of clinical supervision. Analysis of data derived from a series of semi‐structured interviews provides very encouraging early indications that mental health nurses are becoming better able to reflect upon the nature of their own formative learning needs and so to take seriously their need for professional support as they strive towards a more therapeutic relationship with their patients. However, whilst all of the participants in the study had a positive perception of the potential value of clinical supervision, there is clear evidence to suggest that their actual experience was that ‘good enough supervision’ was more the exception than the rule. The participants' perceptions and experiences are described and the implications for research, practice, education and the management of service delivery systems are outlined.
Problem solving in clinical nursing practice
Authors: Taylor Catherine
Published: March 2003

Problem solving in clinical nursing practice is the essence of good care delivery. This paper gives an overview of a research study which identified the cognitive problem solving process nurses use while delivering care. The study was conducted in the clinical setting and used a qualitative research methodology of observation, followed by in‐depth semi‐structured interview. The analysis of the study revealed diagnostic reasoning is the process used by clinicians. Information regarding the differences between novices and experts is offered as topics for discussion throughout the paper, and recommendations for changes to educational processes are made.
Sleep satisfaction, perceived pain and acute confusion in elderly clients undergoing orthopaedic procedures
Authors: Bowman Ann Marie
Published: March 2003

This paper reports the results of a descriptive study of elderly subjects undergoing orthopaedic hip surgery under two qualitatively different events; planned surgery for hip replacement and unplanned emergency surgery following hip fracture. Its purpose was to describe sleep satisfaction, pain perceptions and psychological concerns of subjects undergoing similar procedures but having different contexts for their experience and different outcomes. Delirium is a common phenomenon following orthopaedic hip surgery. The extent to which an individual's integrity is disrupted by psychological distress, pain and changes in sleep satisfaction as manifested by delirium was investigated. The results revealed that the context or nature of the experience strongly influences the perceptions of subjects despite their having undergone treatments of similar magnitude and their having received similar postoperative care. Pain was greater for unplanned surgery subjects and in particular for unplanned surgery subjects who succumbed to delirium. Sleep satisfaction was markedly poorer among subjects who experienced delirium. The findings are discussed with respect to nursing practice priorities and attitudes toward pain management.
The quality of assessment of patients with chest pain: the development of a questionnaire to audit the nursing assessment record of patients with chest pain
Authors: Meurier C.E.
Published: March 2003

The quality of nursing and medical records has been a source of concern for many years ( Audit Commission 1995). This study has two main purposes: firstly, to design an audit questionnaire to evaluate the quality of nursing assessment records of patients with chest pain; and secondly, to make some tentative conclusions about the quality of nursing assessment of patients with a chest pain in order to pinpoint areas that need further study. A sample of 30 patients was selected for this study on the basis of some well‐defined inclusion criteria. The nursing assessment notes of these patients were evaluated using the audit questionnaire. It was found that the questionnaire was effective in gleaning appropriate information from the nursing notes to be able to derive some tentative conclusions about the quality of nursing assessment of patients with chest pain, i.e., on the whole nursing assessment was found to be superficially carried out, potentially making errors of omission and commission likely to occur. The inter‐rater reliability of the questionnaire was found to be good. The questionnaire also seems to measure what it purports to measure (i.e. has content validity). However, this needs to be further checked by using a larger sample.
Alertness to the needs of others: a study of the emotional labour of caring
Authors: Staden Helene
Published: March 2003

This study attempts to recognize and value emotional labour and the skills involved and embodied within it. Also, there is an attempt to deliberately re‐value the caring component of nursing. Caring is identified as the central task of the nurse, emotional labour is part of caring and therefore a defence of emotional labour is central to affirming nursing’s worth. The study draws on the work of Hochschild who first used the term emotional labour to define the undefined, unexplained component of the work mainly carried out by women. Such caring work also is not officially recorded and may only be passed on in an oral tradition. Case studies of three experienced enrolled nurses (level 2) who were on a course to convert their nursing qualification to registered nurse (level 1) were compiled. Phenomenology as an inductive, descriptive research method was used to investigate and describe their experiences as emotion managers at home and emotion workers in clinical hospital settings. From the case studies, it was concluded that all three women recognize emotion work as work but also that this type of work is not recorded. They also were not able to name skills used for such work and generally believe that it is through life experience that they have learnt emotion management. I used the information from my conversations with the women to name skills, indeed the title of the study is one such skill. All three women demonstrated a positive self‐evaluation of their work although they felt that society did not value care work. I use some of their comments, the literature and my own thoughts to discuss ways of improving and valuing the emotional labour of nursing.
Consensus guidelines for the promotion and management of continence by primary health care teams: development, implementation and evaluation
Authors: Button Denise , Roe Brenda , Webb Christine , Frith Tony , Colin‐Thome David , Gardner Lance
Published: March 2003

A project was undertaken as part of the NHS Executive Strategy for Major Clinical Guidelines, involving the development of national clinical guidelines for the promotion and management of continence by primary health care teams, through the process of managed consensus based on scientific review. The guidelines were then implemented at one urban general practice. This article outlines the development and implementation of the guidelines and describes the study undertaken to evaluate the impact of implementation on clinical outcomes. The study involved a pre‐and post‐implementation postal survey of a random sample of 17% of patients aged 18 years and over from the practice (n=1503). The pre‐implementation survey determined the period prevalence of incontinence, related biological data and data on the pre‐implementation management of incontinence. Incontinence sufferers were invited to have their condition assessed or reviewed. All sufferers who agreed to be followed‐up were sent the post‐implementation survey, which identified those patients who had sought help, and ascertained reasons for not seeking help. Data on the management of incontinence post‐implementation were also obtained. Clinical outcomes measured pre‐ and post‐implementation were a validated severity index for urinary incontinence, (also adapted for faecal incontinence) and perception of the incontinence as a problem. A 3‐month period was allowed between pre‐ and post‐implementation surveys. The study confirmed previous research which showed that few incontinence sufferers respond to invitations to seek help, and that help‐seeking behaviour was significantly related to severity of incontinence. The guidelines did not have any positive impact on the clinical outcomes measured, although slight improvements in approaches taken by the primary health care team to the promotion and management of continence were recorded. However, the study was limited by the small sample size and short time scale. Further evaluation of the impact of the guidelines on these outcomes is therefore recommended.
‘We have to put up with it — don’t we?’ The experience of being the registered nurse on duty, managing a violent incident involving an elderly patient: a phenomenological study
Authors: Chambers Nadia
Published: March 2003

The incidence of violence directed towards nurses is well known. However, despite guidelines and training aimed at preventing or minimizing these incidents, recent reports indicate an increase in their occurrence. This phenomenological study investigated the experiences of five registered nurses who had to manage a violent incident involving an elderly patient. The purpose of this was to discover what these nurses ‘know’ about the structure of such an experience and, through the use of Colaizzi’s method of data analysis, present this knowledge in the form of an exhaustive description of the experience. Taped interviews were used to collect the data. The analytical process revealed that the experience is structured around five themes: professional competence, nursing identity, powerlessness and oppression, loss (neglected and deserted) and strategies for survival. The discussion analyses these themes and the relationships between them, highlighting the issues of nurse autonomy and exercising accountability. The implications for nursing practice, education and research include recognition of nurses as a professional group to enable autonomous practice, the ways in which nurses’ perceptions of nursing knowledge may affect their educative role and the need to extend this study further to provide answers to the questions raised therein.