bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to and facilitators of research utilization, as perceived by a group of registered nurses in Sweden
Authors: Kajermo Kerstin Nilsson , Nordström Gun , Krusebrant Åsa , Björvell Hjördis
Published: March 2003

A survey was conducted to describe registered nurses’ (n=237), perceptions of the barriers to and the facilitators of research utilization at two hospitals in Sweden. A questionnaire, Barriers and Facilitators to Using Research in Practice developed by Funk et al., was used to collect the data. The major barriers to research utilization were that the research is not readily available along with inadequate facilities for implementation of research findings, lack of competent colleagues with whom to discuss research, lack of time for reading and implementing research findings and the nurses lack of authority in the organization. The nurses who had studied research methods in their basic nursing education, seemed to perceive fewer barriers than those who had not. The facilitating factors most frequently suggested by the nurses were diverse models of education to increase their knowledge of research methods and to develop skills in evaluating research findings. The allocation of resources for education and implementation of research findings in clinical practice, in addition to special positions in clinical practice for nurses with scientific qualifications, were also suggested.
Elderly recipients of home nursing services: pain, disability and functional competence
Authors: Ross Margaret M. , Crook Joan
Published: March 2003

Despite increasing evidence that pain is a problem with which many in their later years must contend, little is known about the experience of community‐dwelling seniors who require the assistance of home nursing services to remain independent and functional in their homes. This study investigated the prevalence and experience of pain among seniors who were recipients of home nursing services. The study was guided by the World Health Organization Classification of Impairment, Disability and Handicap. Face to face interviews were conducted with 66 individuals who reported whether they were often troubled by pain and/or had experienced pain of a noteworthy nature within the 2 weeks prior to the interview. In addition, they responded to standardized questions about their pain experience and their levels of disability and functional competence. Findings revealed that although three‐quarters of respondents reported pain, there was no association between pain and measures of disability. Findings, however, revealed an association between pain and measures of funtional competence, more specifically, global function, level of depressive symptomatology, sleep impairment and satisfaction with life. Implications for nursing include the need for a heightened awareness of the prevalence of pain in community‐dwelling older adults and the development of assessment and intervention strategies that support their quality of life.
The phenomenon of compulsive overeating in a selected group of professional women
Authors: Lyons Margaret A.
Published: March 2003

Many data have been generated concerning individuals with eating disorders such as anorexia and bulimia. However, few data exist that have explored the phenomenon of compulsive overeating or binge eating. The purpose of this study was to determine the meaning of compulsive overeating, or binge eating, in the lives of adult professional women. Six adult women from the south‐east United States were interviewed using an open‐ended interview format. Interviews were audio‐taped and analysed using the Giorgi (1979) method of phenomenology. Recurrent themes that emerged from data collection included those pertaining to childhood experiences with food, descriptions of the types of food most often eaten during the adult years, eating behaviours in the adult years, perceptions of loss of control, reasons for overeating, emotional consequences of overeating, compensatory behaviours, and prevention strategies. The synthesis of meaning statement elicited was that of a personal struggle to achieve or maintain an acceptable weight and gain mastery over binge eating behaviours. This struggle can be likened to an addictive process in which the individual thinks about food constantly, consciously or unconsciously, and eats compulsively in spite of the consequences.
Complementary therapies as a means of developing the scope of professional nursing practice
Authors: Cole Alison , Shanley Eamon
Published: March 2003

The development of the extended role in nursing has been seen by some as primarily a means for nurses taking on tasks that have traditionally been the work of junior doctors. Others object to this view and ascribe to the ‘new nursing’ perspective of Salvage. She sees the extended role as moving towards increasing autonomy and operating in a professional rather than a bureaucratic occupational model. This view militates against the development of nurses as mini‐doctors. This paper discusses the controversy surrounding the development of the extended role, focusing particularly on the use of complementary therapies as a legitimate component of the ‘new nurses’ role.
A qualitative study utilizing a focus group to explore the role and concept of the nurse practitioner
Authors: Torn Alison , McNichol Elaine
Published: March 2003

This paper describes the first part of a two‐stage study exploring the concept of the nurse practitioner role. By utilization of a focus group methodology, data were collated from a cohort of eight RCN trained nurse practitioners. The transcript from their discussion was subjected to a qualitative‐based content analysis. Eight categories emerged from the data and this paper explores four of them. These are: role recognition, feature of the nurse practitioner role, nurse/patient relationship and doctor/patient relationship. As a whole the focus group discussion highlighted the diversity in application of the nurse practitioner title. This in part, reflects the rapidly evolving role and the ongoing debate regarding the terms advanced and specialist practitioner.
The discursive construction of dementia care: implications for mental health nursing
Authors: Adams Trevor
Published: March 2003

This paper sets out a new approach to dementia that may be used to underpin mental health nursing practice. The paper begins by examining the development of community care. Various models of service provision to people with dementia are then critically examined. As an alternative to these approaches a new model of dementia is developed which highlights the position of various family members in the provision of dementia care including the person with dementia and also the importance of linguistic devices such as narrative and discourse. Finally the implications of this approach upon the mental health nursing practice are examined together with various suggestions for the development of research.
Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non‐caregivers of non‐demented elderly people
Authors: Almberg Britt , Jansson Wallis , Grafström Margareta , Winblad Bengt
Published: March 2003

Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non‐caregivers of non‐demented elderly people Fifty‐two caregivers for demented and 66 non‐caregivers for non‐demented elderly were investigated both within a gender and between genders. All participants were relatives and a burden questionnaire was used. The results showed that there was not always a difference between the caregivers for demented and the non‐caregivers for non‐demented elderly which may indicate that being a relative, even to a non‐demented elderly, has obviously its own problems and importance. However, results showed more significant differences between female caregivers and female non‐caregivers than between male caregivers and male non‐caregivers, with females caring for a demented elderly suffering most strain. Their strain was exhibited by health problems, conflicts in the family, strained relations with family and others, a less positive outlook and limits in social support because of the caregiving situation. When investigating the group of male caregivers and male non‐caregivers, it was found that males caring for a demented elderly person experienced a lack of positive outlook and a need for social support. The elderly person's residence in the group of caregivers for demented elderly people and in the group of non‐caregivers for non‐demented elderly people did not, however, appear to indicate any significant differences.
Limitations on life: women’s lived experiences of angina
Authors: Miklaucich Maria
Published: March 2003

Limitations on life: women’s lived experiences of angina¶ The purpose of this study was to build on the notion of nursing as a human science by using the approach of phenomenology and grounded theory to explore and describe the lived experience of women suffering with angina. Eight women aged between 50 and 70 years old were asked to participate for a 2‐month period. The women were selected soon after admission to a hospital in southern England. They were interviewed on two occasions and were asked to keep a diary of events. From the analysis of the transcribed data and the diary records it is possible to detect a clear adjustment process that emerged as the women recovered and dealt with the limitations on their lives.
Clarifying the social support theory‐research linkage
Authors: Hupcey Judith E.
Published: March 2003

Social support is a multi‐faceted concept that has been difficult to conceptualize, define and measure. Although this concept has been extensively studied, there is little agreement among theoreticians and researchers as to its theoretical and operational definition. As a result, the concept remains fuzzy and almost anything that infers a social interaction may be considered social support. Social support researchers have consistently ignored the complexity of the concept and have measured the variable in a simplistic manner. The purpose of this article is to analyse the linkage between theory and research related to social support by categorizing definitions of social support, exploring the theoretical aspects and conceptualizations of the concept, proposing models of social support, and examining how social support is measured in current social support research (1993–1996). The inadequacy of current research and directions for future study are discussed.
Myocardial infarction patients' use of metaphors to share meaning and communicate underlying frames of experience
Authors: Jairath Nalini
Published: March 2003

Myocardial infarction patients' use of metaphors to share meaning and communicate underlying frames of experience¶The onset of a myocardial infarction (MI) is frequently associated with distinct sensations that may shape the personal meaning of the MI illness experience. Although highly important, patients may have difficulty communicating the personal meaning of the MI illness experience because of lack of congruence between the clinician's and patient's frames of experience. The frame of experience defines the context and agenda for encounters from each participant's perspective. This secondary analysis of data explored MI patients' use of metaphorical language to convey aspects of their underlying frame of experience. Specifically, this paper addressed (a) the structural and linguistic features of metaphorical language used by patients to describe MI pain, (b) the content and structure of associated patient metaphors, and (c) the similarities and differences between the content of patient metaphors and descriptions of MI pain. Our findings confirm that even in encounters characterized by clinician imposition of an organizing framework upon the patient encounter, patients use metaphors to reveal their underlying frame of experience and aspects of the personal meaning of the MI illness experience. Furthermore, although non‐metaphorical descriptions provide insights into the patients' cognitive understanding of events associated with the MI, metaphorical descriptions are particularly helpful in eliciting aspects of the affective response to the MI.
Mentoring today — the students’ views. An investigative case study of pre‐registration nursing students’ experiences and perceptions of mentoring in one theory/ practice module of the Common Foundation Programme on a Project 2000 course
Authors: Watson Naomi A.
Published: March 2003

Mentoring today — the students’ views. An investigative case study of pre‐registration nursing students’ experiences and perceptions of mentoring in one theory/practice module of the Common Foundation Programme on a Project 2000 course¶ The study reported in this paper investigated the mentoring experiences and perceptions of pre‐registration nursing students in one organization, on a theory/practice nursing module. It considered the extent to which students’ understanding and expectations matched their actual experiences. Interviews were conducted with 35 students on a Common Foundation Programme, and 15 allocated mentors, using a semi‐structured interview guide. These were done within the clinical setting of the wards on which the students were placed as part of their requirements for completion of the module. A distortion of the actual meaning of mentoring appears to be present because of the lack of clarity provided, both internally by organizations and by the English National Board (ENB) who have provided loose guidelines. The implications of this distortion are discussed. The application of a mentoring role in practice needs to be re‐examined, with the provision of a clear structured guide internally and externally, with regard to the needs of students and staff who are expected to act as mentors. The study was small scale and cannot be generalized. Mentoring, however, is now widely used within pre‐registration nursing education, even though it is generally considered that its use may not be appropriate. Follow‐up studies need to be undertaken on an ongoing basis, to examine what actually happens in practice, and to consider ways of ensuring that the benefits for staff and students are enhanced.
Continuing education in nursing: a review of the literature
Authors: Furze Gill , Pearcey Pat
Published: March 2003

Continuing education in nursing: a review of the literature¶The literature concerning continuing professional education (CPE) in nursing will be reviewed, with an emphasis on the experience of CPE in the United Kingdom (UK). The reviewed literature will cover aspects of the implementation of CPE, including motivational factors, needs analysis and outcome evaluations, and in addition CPE in the UK will be set in its socio‐political context. The literature shows a fragmented, inequitable and poorly funded provision of CPE to date in the UK. The literature has not shown the cyclical nature of CPE, suggesting that a more holistic approach to educational research is needed. There continues to be a lack of research showing the impact of CPE on patient care. If this is not remedied it may be difficult to justify future expenditure of public funds on CPE for nurses.
The concepts of expectation and satisfaction: do they capture the way patients evaluate their care?
Authors: Staniszewska Sophie , Ahmed Laila
Published: March 2003

The concepts of expectation and satisfaction: do they capture the way patients evaluate their care?¶ The measurement of patient satisfaction has become a common way to elicit patients' views of their health care. However, difficulties arising from the limited theoretical underpinning of satisfaction, the difficulty in defining expectations and satisfaction and the methodological problems associated with their measurement have cast doubt on the validity of studies. This paper reviews the methodological and theoretical difficulties in measuring these concepts and argues that a better understanding of expectations and satisfaction, which is based in patient experience, must first be achieved before theoretical modelling and valid measurement can progress. It presents the findings of a study which attempted to clarify the concepts of expectations and satisfaction by exploring the experience of cardiac patients. The findings are discussed in the context of the key issues in this area.
Daily pain assessment: value for nurses and patients
Authors: De Rond Marlies , De Wit Rianne , Van Dam Frits , Van Campen Brigitte , Den Hartog Yvonne , Klievink Rietje , Nieweg Roos , Noort Janny , Wagenaar Margret , Van Campen Barbara
Published: March 2003

Daily pain assessment: value for nurses and patients¶ Current guidelines for pain management recommend systematic assessment of pain. A few standardized tools exist for the daily assessment of pain intensity, for example the numeric rating scale or visual analogue scale, yet these instruments are rarely used by nurses. In the study reported in this paper, a numeric rating scale accompanied by an educational programme for nurses, was implemented in three hospitals. The paper describes the feasibility of daily pain assessment from the nurses' and patients' perspective in multiple settings. The outcomes studied were the professional compliance of nurses with daily pain assessment, and the value of daily pain assessment for both nurses and patients. The results show that nurses' compliance with daily pain assessment is high (73·9%) and that daily pain assessment is feasible and valued by nurses; however, differences between the three hospitals and two specialties (medical vs. surgical wards) were found. Although patients have difficulty with expressing their pain by use of a number, almost all patients are able to give a pain score and a majority is positive about daily pain assessment. From this study it can be concluded that daily pain assessment is practical and appreciated by nurses as well as patients, but attuning the implementation protocol to the needs of the specific setting is necessary.
AIDS in southern Thailand: stories of krengjai and social connections
Authors: Bechtel Gregory A. , Apakupakul Nualta
Published: March 2003

AIDS in southern Thailand: stories of

krengjaiand social connections¶ HIV‐disease in southern Thailand has reached epidemic proportions. The␣declining Thai economy, coupled with social discrimination among people with the disease, has adversely affected individual, family and community krengjai. Among Thai's, krengjai is used to describe social order, avoid personal conflict, and maintain harmony in relationships. Using the framework of story, this narrative study explores the experiences of five individuals with HIV‐disease and their tenuous relationship with krengjai.
Quality of life in newly diagnosed cancer patients
Authors: Rustoen  , Moum  , Wiklund  , Hanestad
Published: March 2003

Quality of life in newly diagnosed cancer patients¶ The aim of this study was to examine which domains of quality of life are most strongly affected in patients with newly diagnosed cancer, and to examine if quality of life was related to gender, age, educational level, cohabitation, time since diagnosis, treatment or type of cancer in these patients. Ferrans and Powers Quality of Life Index and the Cancer Rehabilitation Evaluation System, short form, were completed by 131 newly diagnosed Norwegian adult cancer patients. The patients had different cancer diagnoses, with breast cancer being the most common type. None of them were terminally ill, and 80% had been diagnosed within the last 6 months. The patients turned out to be satisfied with their lives, especially with the family and marital domains. They were least satisfied with health, functioning and sex life. Analyses of variance and multiple regression analysis were conducted to examine the impact on quality of life of cohabiting, age, gender, educational level, cancer diagnosis, treatment and time since diagnosis. Those cohabiting had significantly higher quality of life compared with those living alone. In contrast the younger group (19–39 years) living alone had significantly lower quality of life than the older groups living alone. Although age was only significantly associated with quality of life in one sub‐scale, the elderly people reported their quality of life to be better in almost all sub‐scales. Time since diagnosis was not associated with quality of life, while treatment was associated with quality of life as measured by Ferrans and Powers Quality of Life Index. Gender and educational level were only associated with one or two domains in quality of life, respectively.
Catching the wave: understanding the concept of critical thinking
Authors: Duchscher Judy E. Boychuk
Published: March 2003

Catching the wave: understanding the concept of critical thinking¶As a practice‐orientated profession, nursing is clearly guided by theoretical concepts. Concept clarification attempts to show speakers and readers how they can liberate themselves from the judgement limitations imposed by rigid, unexamined beliefs, by exposing differences in the interpretation of language and how that interpretation creates meaning. Critical thinking is one way nurses apply the process of inquiry. As a method of assessing, planning, implementing, evaluating and reconstructing nursing care, a critical thinking approach encourages nurses to challenge established theory and practice. Existing literature on critical thinking is confusing in its description of the process, and ambiguous in drawing relationships between critical thinking and the language currently used to illustrate the process of nursing. This paper examines elements and components of critical thinking as they relate to the language of nursing: problem solving, decision making, clinical judgement, reflection, and the nursing process. The purpose of this analysis is to illuminate the meaning and clarify the intent of critical thinking application to nursing practice. The paper begins by briefly outlining the historical aspects of critical social theory, suggesting that the foundational tenets of critical theory have influenced the development of critical thinking. The paper also critically compares the language used to describe critical thinking and that language that has traditionally defined nursing.
The nature and structure of supervision in health visiting with victims of child sexual abuse
Authors: Scott Linda
Published: March 2003

The nature and structure of supervision in health visiting with victims of child sexual abuse¶Rationale Part of a higher research degree to explore professional practice. Aim To explore how health visitors work with victims of child sexual abuse and the supervision systems to support them. Objective To seek the views and experiences of practising health visitors relating to complex care in order to consider the nature and structure of supervision. Methodology The research reported in this paper used a qualitative method of research and semi‐structured interviews with practising health visitors of varying levels of experience in venues around England. Qualitative research enabled the exploration of experiences. Outcomes Identification of the need for regular, structured, accountable opportunities in a `private setting' to discuss whole caseload work and current practice issues. Results Supervision requires a structured, formalized process, in both regularity and content, as a means to explore and acknowledge work with increasingly complex care, to enable full discussion of whole caseloads. Supervision is demonstrated as a vehicle to enable the sharing of good practices and for weak practices to be identified and managed appropriately. Supervision seeks to fulfil the above whilst promoting a stimulating, learning experience, accommodating the notion that individuals learn at their own pace and bring a wealth of human experience to the service. Study limitations The size of the study was dictated by the amount of time available within which to complete a research master's degree course primarily in the author's own time, over a 2‐year period. The majority of participants volunteered their accounts in their own time. For others I obtained permission from their employers for them to participate once they approached me with an interest in being interviewed. Conclusions This research provides a model of supervision based on practitioner views and experiences. The article highlights the value of research and evidence‐based information to enhance practice accountability and the quality of care. Proactive risk management can safeguard the health and safety of the public, the practitioner and the organization.
Motivation to perform activities of daily living in the institutionalized older adult: can a leopard change its spots?
Authors: Resnick Barbara
Published: March 2003

Motivation to perform activities of daily living in the institutionalized older adult: can a leopard change its spots?¶The concept of motivation has great relevance for the older adult because of the multiple problems that can result in functional limitations. The ability to overcome and transcend these problems is related to the individuals' motivation to maintain and/or improve function. The purpose of this study, which used a naturalistic or constructivist inquiry, was to explore what motivates the institutionalized older adult to perform functional activities. Primary selection was used to obtain the sample which included 44 older adults, 37 (84%) females, and 7(16%) males. The average of participants was 88 ± 6·4, and they were institutionalized for 2·8 ± 2·8 years. Semi‐structured interviews were done in the participants room. Data analysis involved content analysis. A total of 27 codes were initially identified, and these were categorized and developed into five major themes: Personality, Goals, Beliefs, Fear and Physical factors. The participants indicated that basic personality had a major on motivation, i.e. `a leopard can't change his spots'. Further findings suggested that although personality may be central to the individuals' motivation to perform, goals, fear, beliefs and physiological sensations also influenced motivation and behavior. Appropriate interventions can be used to foster motivation to perform functional activities for institutionalized older adults.
The performance of a self‐managing day surgery nurse team
Authors: Macdonald Margaret , Bodzak Wilma
Published: March 2003

The performance of a self‐managing day surgery nurse team¶ The objective of this study was to assess the validity of the hypothesis that a self‐managing nurse team can successfully combine traditional caring, expanded nursing and modern management roles and that morale among team members will be high. The study comprised a 15‐month longitudinal case study of eleven members of a day surgery nursing team at a newly established day surgery unit in a district general hospital. The main outcome measures were as follows. Morale: sickness absence statistics, results of staff surveys. Caring role: patient satisfaction survey results. Expanded nurse role: day case activity performance indicators. Management role: financial performance measures. Morale in the day surgery team was higher than average for hospital staff. The results of patient satisfaction surveys were overwhelmingly positive. Day case activity performance improved to that of the top percentile for Scotland. Financial performance targets were exceeded. The day surgery team successfully combined caring, expanded nursing and management roles and staff morale was higher than hospital average.
Predialysis education helps patients choose dialysis modality and increases disease‐specific knowledge
Authors: Klang Birgitta , Björvell Hjördis , Clyne Naomi
Published: March 2003

Predialysis education helps patients choose dialysis modality and increases disease‐specific knowledge¶The aims of this study were first, to evaluate the effects of a patient‐education programme for a group of 28 uraemic patients (the Experimental (EG) group) with regard to their knowledge and perceived amount of information and to relate these effects to their sense of coherence and secondly, to study the patients' perception of their dialysis treatment. The results were compared with a comparison group (the Companion (CG) group, n = 28) which had received routine information only. The education programme seemed to have covered what the EG wanted to know. Significantly more patients in the EG group stated that they had acquired sufficient knowledge to enable them to participate in choosing dialysis modality compared with the CG group. The EG patients were significantly more informed in the post‐educational evaluation compared with the pre‐educational evaluation. In the EG, there was a significant relationship between the scores for knowledge and perceived amount of information. Men and younger patients perceived that they had received a greater amount of information than women and older patients. After having started dialysis treatment, there were no differences in the scores for knowledge and information between the EG and the CG. This indicates that other sources of knowledge and information were available to the CG patients. There was no significant correlation between the score of the Sense of Coherence (SOC) scale and the knowledge and information scores. Kidney transplantation, progression of renal failure, other patients' experiences of dialysis, dependence — independence, present and future wellbeing, how to cope with physical and psycho‐social demands and continuity in their contacts with doctors and other health professionals were predominant concerns for the two groups of patients. Conclusion: the predialysis group education programme enabled patients to choose dialysis modality to achieve an understanding of their illness and its treatment. It also provided the possibility of informal support by fellow patients and health professionals. The study emphasizes the special needs of elderly patients and we recommend that education programmes are tailored to their requirements.
Caring control: methodological issues in a discourse analysis of waterbirth texts
Authors: Redwood Rachel
Published: March 2003

Caring control: methodological issues in a discourse analysis of waterbirth texts¶ This paper describes a study where the discourses surrounding waterbirth were identified by an analysis of texts in professional journals and broadsheet newspapers. While one particular discourse, caring control, will be discussed, the focus of the paper is on the method of discourse analysis. What discourse analysis can offer nurses and midwives is a position from which to analyse systematically and to arrive at some understanding of how oppression and inequality of power relations, which are inherent in many forms of health care provision, are created and sustained.
The evaluation of the `stages of change' model for use in counselling client's undergoing predictive testing for Huntington's disease
Authors: Houlihan Gary D.
Published: March 2003

The evaluation of the `stages of change' model for use in counselling client's undergoing predictive testing for Huntington's disease

Nurses are increasingly working in new and novel situations which may be outside the realms of traditional nursing practice. Therefore when evaluating theories and models that may be utilized in these situations it may be necessary to look beyond established nursing theories and concepts. This paper therefore attempts to evaluate Prochaska & DiClemente's (1983) stages of change model for its goodness of fit when counselling people as part of the predictive testing programme for Huntington's disease. The model demonstrates that in order to provide effective communication it is important to recognize the particular stage a client is at in his/her decision‐making process concerning predictive testing. The relevance of the model to generic genetic counselling in nursing practice is discussed and the importance of stage‐matched nursing interventions is emphasized. The model's non‐reliance on the medical model or the concept of illness means that it may also be a useful model when applied to other nursing situations.
An exploration of psychiatric nurses' and patients' opinions regarding in‐patient care for suicidal patients
Authors: McLaughlin Columba
Published: March 2003

An exploration of psychiatric nurses' and patients' opinions regarding in‐patient care for suicidal patients

This study explores psychiatric nurses' and patients' opinions regarding the care provided for in‐patients who were admitted following: (i) depression as a result of psychosocial difficulty, (ii) suicidal ideation, or (iii) an overt suicidal behaviour. It also explores how care for such patients could be improved. A total of 20 psychiatric nurses and 17 in‐patients were interviewed. The results show that nurses and patients believe that communicating with patients about their difficulties is the most important skill in psychiatric nursing. Most nurses were disappointed with the limited time they had available to communicate with patients and they were constructively critical of their pre‐registration training in communication skills. Patients suggested that nurses should spend more time in helping to problem‐solve their difficulties. Both nurses and patients suggest that situational factors impinge on the time available for psychotherapeutic care. Findings have implications for pre‐ and post‐registration education and practice. Responses from both cohorts suggest how care could be improved.
Correlates of expected success at adherence to health regimen of people with IDDM
Authors: Lo Ruth
Published: March 2003

Correlates of expected success at adherence to health regimen of people with IDDM

Patient non‐adherence is a well‐recognized although poorly understood phenomenon that affects patients in all areas of health care. Failure to comply with health regimens is extremely costly both in economic terms and the health status of individuals. This study assesses factors which correlate with the expected success of health regimen adherence in 146 insulin‐dependent diabetes mellitus (IDDM) subjects. The results indicate that success in complying with a health regimen is associated with good family support and rapport with health professionals, an absence of chronic stress and the capacity to take up the challenges posed by the disease. Health professionals have a role in engendering optimism, in maintaining enthusiasm, and facilitating and encouraging maintenance in health behaviours.
Fatigue in chronic illness: the experience of individuals with chronic obstructive pulmonary disease and with asthma
Authors: Small Sandra , Lamb Marianne
Published: March 2003

Fatigue in chronic illness: the experience of individuals with chronic obstructive pulmonary disease and with asthma

Although fatigue has been identified as a major problem for individuals with chronic obstructive pulmonary disease and with asthma, no research was found in which the symptom was directly studied in persons with these conditions. From studies carried out on various patient populations, it appears that fatigue has some specificity to disease state. Thus, it is important to describe the experience of fatigue within patient populations. To expand theoretical understanding of fatigue, qualitative research methods need to be applied. The purpose of this study therefore was to describe and compare the fatigue experiences of persons with chronic obstructive pulmonary disease (n=17) and with asthma (n=19). Data were obtained by use of a semi‐structured questionnaire and were content analysed for categories and themes. There were many similarities between the fatigue experiences of the two groups. Fatigue is inextricably linked to laboured breathing. Although it interferes with their ability to carry out meaningful activities, the majority of individuals with chronic obstructive pulmonary disease or asthma cope well with it. The informants identified two types of coping strategies they use to manage their situation, which may be categorized as: problem‐focused, including energy conservation, utilization and restoration; and emotion‐focused, including being positive, accepting the physical limitations, distracting and normalizing.
Understanding dissatisfied users: developing a framework for comprehending criticisms of health care work
Authors: Coyle Joanne
Published: March 2003

Understanding dissatisfied users: developing a framework for comprehending criticisms of health care work

Recent government proposals have underlined the importance of ascertaining users’ views of health care. Traditionally these have been obtained through satisfaction surveys. However, researchers argue that the focus of attention should now shift to exploring dissatisfaction because it highlights more clearly any problems in lay‐practitioner relationships. Research has shown that dissatisfaction is a complex social construct which is underpinned by a range of values, beliefs, attitudes and experiences. The aim of this paper is to provide insights into the meaning of dissatisfaction by exploring how dissatisfied users attribute cause, responsibility and blame for their untoward experiences. Forty‐one people were identified from a household survey of user views as experiencing problems with their health care. They were interviewed in depth, and a grounded theory approach was used to construct a framework inductively from their accounts. This identified a number of normative expectations through which health work was routinely criticized; these included respondents casting aspersions on the professional integrity of health care practitioners and preserving their own moral identity through demonstrating competence, knowledge, rationality, reasonableness and concern for others. Moreover, it is argued that these patterns help practitioners to understand how dissatisfied users’ perceive subsequent health care encounters.
Training for transformation: reorientating primary health care nurses for the provision of mental health care in South Africa
Authors: Petersen Inge
Published: March 2003

Training for transformation: reorientating primary health care nurses for the provision of mental health care in South Africa

Using programme research, this paper reports on the evaluation of a programme designed to orientate primary health care nurses towards the provision of a comprehensive approach to care. In addition to training in psychiatric care, this was deemed necessary in order to facilitate comprehensive integrated primary mental health care in South Africa. Nurse–patient consultations were evaluated on indicators of comprehensive care before and after the programme. Interviews were also conducted with the participants individually and in a group. The results indicate that there are several factors which mediate the provision of comprehensive care by primary health care nurses. These include individual factors as well as contextual factors,inter alia, the structure and organization of the health care system, which historically has been organized to promote biomedical care. Furthermore, biomedicine has dominated training models in South Africa, instilling in nurses a biomedical approach to patient care.
A conceptual treadmill: the need for ‘middle ground’ in clinical decision making theory in nursing
Authors: Thompson Carl
Published: March 2003

A conceptual treadmill: the need for ‘middle ground’ in clinical decision making theory in nursing

This paper explores the two predominant theoretical approaches to the process of nurse decision making prevalent within the nursing research literature: systematic‐positivistic approaches as exemplified by information processing theory, and the intuitive‐humanistic approach of Patricia Benner. The two approaches’ strengths and weaknesses are explored and as a result a third theoretical stance is proffered: the idea of a cognitive continuum. According to this approach the systematic and intuitive theoretical camps occupy polar positions at either end of a continuum as opposed to separate theoretical planes. The methodological and professional benefits of adopting such a stance are also briefly outlined.
Validation of the Sign and Symptom Check‐List for Persons with HIV Disease (SSC‐HIV)
Authors: Holzemer William L. , Henry Suzanne B. , Nokes Kathleen M. , Corless Inge B. , Brown Marie‐Annette , Powell‐Cope Gail M. , Turner Joan G. , Inouye Jillian
Published: March 2003

Validation of the Sign and Symptom Check‐List for Persons with HIV Disease (SSC‐HIV)

Symptom management for persons living with HIV disease is recognized as an extremely important component of care management. This article reports the validation of a new sign and symptom assessment tool designed to assess the intensity of HIV‐related symptoms using two samples (study 1: n=247; study 2: n=686) of people living with HIV disease. Study 1 data were collected between 1994 and 1996 before the initiation of highly active antiretroviral therapy (HAART). Study 2 data were collected between 1997 and 1998 after the wide adoption of HAART therapy. The initial version of the Sign and Symptom Check‐List for Persons with HIV Disease (SSC‐HIV) included 41 signs and symptoms. This scale was submitted to a principal components factor analysis with a varimax rotation. The final solution reports six factors explaining 68·9% of the variance. The six symptom clusters (factors), the number of items in the factor, and the Cronbach alpha reliability estimates were: malaise/weakness/fatigue (six items, alpha=0·90); confusion/distress (four items, alpha=0·90); fever/chills (four items, alpha=0·85); gastrointestinal discomfort (four items, alpha=0·81); shortness of breath (three items, alpha=0·79); and nausea/vomiting (three items, alpha=0·77). These six factors have strong reliability estimates and a stable factor structure that supports the construct validity of the 26‐item instrument. Additional evidence supports the concurrent validity of the scale as well as its sensitivity to change over time. The final version of the SSC‐HIV is a 26‐item scale available for use by clinicians and researchers to measure the patient’s self‐report of HIV‐related signs and symptoms.
Experience of social support in rehabilitation: a phenomenological study
Authors: Nätterlund Birgitta , Ahlström Gerd
Published: March 2003

Experience of social support in rehabilitation: a phenomenological study

The progressive muscular weakness brought on by muscular dystrophy causes the sufferer many problems in everyday life. Earlier studies in Sweden have shown that adults with hereditary muscular dystrophy often have difficulty in gaining access to rehabilitation. For this reason a special rehabilitation programme was drawn up and carried out, extending over a period of 18 months. The purpose of the study is to describe the participants’ experience of social support in connection with the programme. Thirty‐seven participants (21 women and 16 men) were interviewed. The analytical method was phenomenological, incorporating validation by independent judges. Nine overall themes emerged from the interviews: psychosocial support, meeting other people with muscular dystrophy, knowledge and learning, adjustment in daily life, coping with illness‐related problems, adjustment at work, management of physical disability, medical examination and treatment, and involvement of relatives. The results indicate that the participants encountered staff with a sense of commitment and felt themselves to be ‘seen and confirmed’. From the discussions and the contact with others in the same situation there arises a sense of affinity and a better understanding of one’s own situation. There was appreciation of the education about the disease, its hereditary aspect, technical aids, grants and physical training. Hardly any of the participants spoke of knowing such things before. In conclusion there was approval of the received support, and recognition that persons with muscular dystrophy should be given access to recurrent rehabilitation.
Clinical supervision: a concept analysis
Authors: Lyth Gordon M.
Published: March 2003

Clinical supervision: a concept analysis

Clinical supervision is a commonly discussed concept within nursing. There appears to be a common belief that it is a good thing for nursing. Many practitioners, however, are still unsure what clinical supervision is and what is expected of them. A number of definitions and models of supervision have been developed but it remains ill defined. This paper develops a conceptual analysis of clinical supervision using the method developed by Rodgers (1989). A review of the literature precedes description of the attributes, antecedents, consequences and references. A model case is outlined prior to a proposed definition of supervision being given. It is hoped that this paper will stimulate further exploration and study of this concept.
Weaving the seamless web of care: an analysis of parents’ perceptions of their needs following discharge of their child from hospital
Authors: Smith Lynda , Daughtrey Hilary
Published: March 2003

Weaving the seamless web of care: an analysis of parents’ perceptions of their needs following discharge of their child from hospital

Changes in children’s nursing services in the United Kingdom in recent years have focused on the need for adequate and efficient services to be provided in the interests of the child. Early discharge is now the norm and children are often sent home in an earlier recovery stage than adults with comparable conditions. Whilst the contributions of paediatric community nursing services have gone some way to providing specialist nursing care for children and their families in their own homes, the majority of children are discharged home without such support being available. This may place an overwhelming responsibility of caring for a recovering child onto parents. The purpose of the qualitative research reported in this paper was to identify any gaps in nursing services for acutely sick children and their families following discharge, and to suggest ways to improve integration and communication between hospital and primary care to facilitate a ‘seamless web of care’ for families. Families were surveyed following discharge (n=164) and interviews carried out with those experiencing problems (n=20). General practitioners were also surveyed for their opinion as key contributors of primary care. Findings revealed the isolation felt by parents following discharge, with their need for information about a child’s illness and expected recovery, and for reassurance and specific advice through some means of support, which was clearly not being met. The perceived benefit of continuity of care was a common theme, with both parents and professionals acknowledging the importance of closer liaison between hospital and primary health care services. This study is valuable in providing preliminary qualitative information regarding the gaps in children’s nursing services and how these can be overcome by using our present resources more imaginatively, in order to ensure the delivery of cost‐effective and quality health care services in the best interests of local need.