bluuebunny/crossref_metadata_2025 huggingface dataset:
‘All the services were excellent. It is when the human element comes in that things go wrong’: dissatisfaction with hospital care in the last year of life
Authors: Rogers Angie , Karlsen Saffron , Addington‐Hall Julia
Published: March 2003

‘All the services were excellent. It is when the human element comes in that things go wrong’: dissatisfaction with hospital care in the last year of life

Patient satisfaction surveys are seen as an important way of obtaining ‘user views’ of health service provision. However, there is a growing body of research and theoretical literature that questions the validity of the concept of ‘patient satisfaction’ and hence the use of this type of survey. A postbereavement survey of people who registered a random sample of cancer deaths in an inner London health authority was undertaken in 1996/7. The survey questionnaire (VOICES) included 14 open‐ended questions which asked respondents to add any comments they felt were relevant about the care of the deceased. This paper uses these data to examine the causes of dissatisfaction with hospital‐based care. Of the 229 informants responding to the questionnaire, 138 included some written comment about care in hospital. At least one negative comment was made by 59% (82) of those making any comment. Of these, 55% (44) rated the care given by doctors as ‘excellent’ or ‘good’ and 63% (50) rated that given by nurses as ‘excellent’ or ‘good’. Qualitative analysis of responses to open questions suggest that expressions of dissatisfaction arise from a sense of being ‘devalued’, ‘dehumanized’ or ‘disempowered’ and from situations in which the ‘rules’ governing the expected health professional–patient relationships were broken. As such, the causes of dissatisfaction for this particular group of patients are similar to the causes of dissatisfaction with health care in general reported elsewhere. The palliative care approach emphasizes patient‐ and family‐centred care and aims to promote physical and psychosocial well‐being. The study findings suggest that adoption of the palliative care approach could reduce the experience of dissatisfaction for many service users, not only those whose deaths are anticipated.
Researching ethnic diversity in the British NHS: methodological and practical concerns
Authors: Gerrish Kate
Published: March 2003

Researching ethnic diversity in the British NHS: methodological and practical concerns

The collection of data on ethnic groupings has become an increasingly pervasive feature of contemporary health policy and research in the United Kingdom, with attention concentrating primarily on monitoring access to and utilization of services by different ethnic groups, together with epidemiological data on morbidity and mortality. At the same time, the collection of data on ethnic populations by census and health agencies has been the subject of a wide‐ranging and contentious debate and there is a growing critique that challenges the collection and use of such data on political, methodological and practical grounds. This paper explores the nature of these debates as they apply to health research. Issues of validity and reliability arising from the application of pre‐defined ethnic categories, such as those used within the National Health Service derived from the 1991 census, are considered and alternative approaches which utilize a range of variables such as language, religion and length of residency in a country suggested. Experiences derived from an ethnographic study of the provision of district nursing care to patients from different ethnic backgrounds are used to illustrate some of the practical issues of researching ethnic diversity. Strategies for addressing some of the methodological and practical concerns are proposed.
Effort–reward imbalance and burnout among nurses
Authors: Bakker Arnold B. , Killmer Christel H. , Siegrist Johannes , Schaufeli Wilmar B.
Published: March 2003

Effort–reward imbalance and burnout among nurses

This study among a sample of 204 German nurses tested the hypothesis that an imbalance of high extrinsic efforts spent (i.e. job demands) and low extrinsic rewards obtained (e.g. poor promotion prospects) are associated with the burnout syndrome: the depletion of nurses’ emotional resources. The results of a series of analyses of variances confirmed this hypothesis, by showing that those nurses who experienced an effort–reward imbalance (ERI) reported higher levels on two of the three core dimensions of burnout (i.e. emotional exhaustion and depersonalization) than those who did not experience such an imbalance. Moreover — as additionally hypothesized — significant interaction effects indicated that burnout (i.e. emotional exhaustion and reduced personal accomplishment) was particularly prevalent among those nurses who experienced ERIandput relatively high intrinsic effort into their jobs, as reflected by their strong tendency to be personally in control over job conditions.
Manual handling activities and injuries among nurses: an Australian hospital study
Authors: Retsas Andrew , Pinikahana Jaya
Published: March 2003

Manual handling activities and injuries among nurses: an Australian hospital study

The aims of this study were to identify patterns of manual handling activities and their associated injuries and consequences among nurses working at a large teaching and referral medical centre in Melbourne, Australia. A self‐report 140‐item questionnaire was distributed to 523 registered nurses working full time at the medical centre. Of the 269 (51·4%) nurses who completed the questionnaire, 108 (40·1%) retrospectively reported an injury associated with manual handling activity, of which 75·9% (82) comprised back injuries. When all full‐time nurses working at the medical centre are considered, the prevalence of all manual handling injuries was 20·6% (n=108) and 15·7% (n=87) for back injuries. About two‐thirds (67·6%) of all manual handling injuries were associated with direct patient care activities and another third (32·4%) with non‐direct patient care activities. Approximately one‐third (34·3%) of all injuries were associated with lifting patients and this activity comprised one half of all causes associated with injuries arising from direct patient care activities. The consequences of injuries were significant. Recommendations for reducing manual handling activities and injuries are made and future research directions are discussed.
Videotaped recording as a method of participant observation in psychiatric nursing research
Authors: Latvala Eila , Vuokila‐Oikkonen Päivi , Janhonen Sirpa
Published: March 2003

Videotaped recording as a method of participant observation in psychiatric nursing research

This paper describes videotaped recording as a data collection method when conducting participant observation in a psychiatric nursing study. The videotaped episodes were part of the daily life of psychiatric nursing in a hospital environment. The advantages and limitations of using videotaped recording in nursing research will be discussed. This paper is based on two studies. The data consisted of 21 videotaped episodes of nursing report sessions or interdisciplinary team meetings in the psychiatric clinic of a university hospital. The participants consisted of patients, their significant others, nurses, doctors, social workers and physiotherapists. All videotaped material was transcribed verbatim. An essential advantage of videotaping is that most potentially useful interaction and behaviour can be captured. The advantage in terms of the credibility of videotaping was that the investigator was able to review the same videotaped situations again and again. Videotaped material is rich and provides several possibilities for analysing the data. In these studies data and source triangulation enabled the researchers to reduce personal influence on the results. The investigator must also be aware of the limitations concerning this method. The most essential limitations are mechanical problems and the influence of videotaping on behaviour. Careful ethical considerations are important concerning personal privacy, informed consent and respect for the self‐determination of psychiatric patients.
Evidence‐based practice and health visiting: the need for theoretical underpinnings for evaluation
Authors: Elkan Ruth , Blair Mitch , Robinson Jane J.A.
Published: March 2003

Evidence‐based practice and health visiting: the need for theoretical underpinnings for evaluation

In this paper we argue that evidence‐based practice, which is being introduced throughout the British National Health Service to make decisions about the allocation of limited resources, provides a welcome opportunity for health visitors to demonstrate their efficacy, skills and professionalism. However, the paper argues that to view health visiting as evidence‐based is not to reduce health visiting merely to a technology through which scientific solutions are applied to social problems. Rather, health visiting needs to be viewed as a political movement, based on a particular model of society, which shapes the goals which health visitors pursue and influences the strategies they adopt to achieve their goals. The paper describes various models of health visiting as a way of showing how the goals of health visiting are always framed within a particular set of assumptions and causal explanations. The paper then turns to look at the issue of evaluating health visiting services. It is argued that evaluation should properly take account of the models which shape health visitors’ goals and intervention strategies, and in turn, health visitors need to be explicit about the theoretical frameworks underpinning their interventions. Finally, it is argued that health visitors’ knowledge and understanding of a range of models of society enables them to move between the various models to choose the most appropriate and effective means of intervention. Hence it is concluded that the emphasis on evidence‐based practice provides health visitors with a valuable opportunity to show that their unique, professional skills and understanding are the preconditions for effective intervention.
Living with stroke: a phenomenological study
Authors: Burton Christopher R.
Published: March 2003

Living with stroke: a phenomenological study

Understanding how stroke sufferers experience their stroke and recovery is essential if the development of rehabilitation services is to be effective and appropriate. Previous research in this area has tended to be either cross‐sectional or with a limited amount of informant follow‐up, and consequently has limited utility. This paper describes a study underpinned by a phenomenological approach, which tracked the experiences of six patients admitted to a rehabilitation unit in the north‐west of England. Informants were followed for at least 12 months after stroke, and a total of 73 interviews were undertaken during the study. The data demonstrate that recovery from stroke involved restructuring and adaptation in physical, social and emotional aspects of an individual’s life. Two important features of recovery were highlighted. First, whilst aspects of pre‐stroke life may be used to describe individual progress, no end‐point to recovery was identified as informants described and anticipated life with stroke. Second, informants focused on the social context of recovery where engagement in the social world was emphasized over discrete physical function. Although no common path of recovery was found, it is recommended that stroke services are structured to take account of the long‐term needs of stroke patients and their families in their home environment.
Experiencing liver transplantation: a phenomenological approach
Authors: Forsberg Anna , Bäckman Lars , Möller Anders
Published: March 2003

Experiencing liver transplantation: a phenomenological approach

In order to promote health, nurses and other health care professionals need to discover and articulate the meaning that is implicit in experiencing life after liver transplantation. From such an understanding, appropriate nursing interventions can be based. The aim of this study was to investigate the subjective experiences of the meaning of having a liver transplant, 1 year after the transplantation. After approval from the ethics committee at Göteborg University, 12 patients, nine women and three men, were interviewed. The study sample was chosen strategically to represent common diagnoses preceding liver transplantation. A phenomenological approach was chosen for the study. Analyses of the interviews were based on a modified version of a phenomenological method by Karlsson. Seven categories emerged: facing the inevitable; recapturing the body; emotional chaos; leaving the experts; family and friends; the threat of graft rejection; and honouring the donor. Having undergone a liver transplant meant living in a paradoxical situation. Knowing that you survived, it was a struggle to regain physical strength under great emotional stress. The recipients had to self‐administer life‐long medication, recognize symptoms indicating a potential problem and monitor for the possibility of graft rejection. Social support was essential for recovery. Meeting others with the same experience helped liver‐transplanted patients to deal with their identity crises as well as undergo a transformation from being utterly unique to a survivor among others. The clinical implications from this study are that interventions, such as patient education, and social and mental support, are important tools to optimize both self‐care capacity and the ability to maintain a healthy perception of identity after having a liver transplant at least up to 12 months post‐transplant.
The current scope and future direction of perioperative nursing practice in Victoria, Australia
Authors: Riley Robin , Peters Gwenda
Published: March 2003

The current scope and future direction of perioperative nursing practice in Victoria, Australia

Unlike some overseas countries, perioperative nursing roles in Australia are largely undeveloped, and very little research has explored the opinions of perioperative nurses regarding the development of their specialty. This study was undertaken to identify the current scope, possible future directions, and the barriers to developing perioperative nursing practice in the state of Victoria (Australia). The study design was descriptive and utilized survey methodology. An instrument was constructed by the researcher for the specific purposes of the study, and comprised three stages of development: questionnaire development; validation by a panel of experts; and a pilot study. The questionnaire was sent randomly to selected perioperative nurses (n=224) and a response rate of 79% (n=176) was obtained. Data were analysed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were used to summarize data, and independent samplet‐tests, one‐wayANOVAand Wilcoxon signed rank tests were used to test differences between groups. For the purpose of data reduction factor analysis was undertaken. The findings of the study indicated that the perioperative nursing model in its espoused form is not being practised, but a large majority of participants believe that perioperative nursing practice should not be restricted to the intraoperative phase of the perioperative model. Expanded rather than extended activities and functions were perceived as more important for development of the specialty, and perceived barriers to advanced perioperative nursing practice centred predominantly on the current application of the perioperative model. Recommendations include refinement of the perioperative nursing model to reflect changes in the delivery of healthcare, addressing issues of cost associated with further education, and undertaking interpretive research to provide more detailed information on the possible future direction for perioperative nursing.
Towards an aesthetics of nursing
Authors: Wainwright Paul
Published: March 2003

Towards an aesthetics of nursing

This paper re‐appraises the work of Barbara Carper on aesthetics and the art of nursing. It identifies serious flaws in Carper's original arguments and the way in which she and subsequent authors have conflated the concepts of art and aesthetics in nursing. The paper explores a broader approach to aesthetics and proposes a way in which a theoretical approach to nursing aesthetics could be developed. The paper concludes that nursing is a fit object of aesthetic appreciation and that aesthetic quality is a necessary attribute of good nursing practice.
Using mass media within health‐promoting practice: a nursing perspective
Authors: Whitehead Dean
Published: March 2003

Using mass media within health‐promoting practice: a nursing perspective

For some time health professionals have recognized the growing importance of utilizing mass media strategies as part of their health‐promoting practice. The ever‐evolving climate of technology and increasing reliance on mass communications has further reinforced the position of mass media initiatives. The enormous potential for mass media resources to reach certain audiences and influence their health‐related behaviours has become particularly well established. Despite these facts, however, it is argued that the nursing profession has been less than pro‐active in acknowledging, accommodating and adopting such practices. Consequently, the incorporation of health‐related mass media initiatives into nursing's health‐promotional role remains an elusive exercise. The maintenance of such a position, it is claimed, is potentially damaging for the profession as a whole. In light of this state of affairs, this paper seeks to review the literature surrounding the nature and processes of mass media strategies, their relevance to health promotion and nursing, how they are currently utilized and how they can be incorporated further into nursing practice. In conclusion, it is argued that nursing should seek to become a more active user of mass communication/media technology — especially in relation to its health‐promotional practices.
An integrated approach to ethical decision‐making in the health team
Authors: Botes Annatjie
Published: March 2003

An integrated approach to ethical decision‐making in the health team

When making ethical decisions there are different perspectives that health care professionals may use. This may lead to conflict and insufficient co‐operation between the members of the health team. Two of these perspectives are the ethics of justice and the ethics of care. In a bid to gain a better understanding of the nature of ethical decision‐making in the health team, a comparison was drawn between the ethics of justice and the ethics of care. The investigation into and comparison between the ethics of justice and the ethics of care revealed that the deficiencies in each of the two perspectives in isolation, in fact, necessitate the application of a combination of both perspectives. The aim of the article is to describe how the members of the health team can, in an integrated manner, apply both the ethics of justice and the ethics of care in their ethical decision‐making. The central argument of the article is based on the following premises: (1) the inadequacy of the ethics of justice and the ethics of care in isolation necessitates that both these perspectives be applied; (2) the application of both these perspectives again requires an extended rationality and discourse and (3) discourse, in its turn, requires that the emphasis falls on a specific telos and that the participants in the discourse be endowed with certain virtues in order to abide by the rules of discourse.
Concept analysis: chronic fatigue
Authors: Trendall Judith
Published: March 2003

Concept analysis: chronic fatigue

This concept analysis attempts to clarify and analyse the concept ‘chronic fatigue’ and does so by utilizing the framework outlined by Walker and Avant (1995). The aim is to use this work to underpin future research into the care of patients suffering from chronic obstructive pulmonary disease (COPD). The literature revealed no universal definition of fatigue and a confusion exists between fatigue and chronic fatigue. Three concept analyses are considered to assist clarification. Everyday meanings are sought as well as meanings revealed in poetry. A continuum from tired to exhausted is identified and definitions offered. Defining attributes are decided upon which will be used as an operational definition in later research. Constructed cases are created; antecedents and consequences are devised from the literature; scales, tests and descriptions of general appearance which appear within the literature are considered as empirical referents. However, whilst assisting with the understanding of the concept and future research, the complexity of this subject is still evident.
Nursing home placement: an exploration of the experiences of family carers
Authors: Ryan Assumpta Ann , Scullion Hugh F.
Published: March 2003

Nursing home placement: an exploration of the experiences of family carers

This study examines some of the factors leading family carers to place their older relatives in a nursing home. It also explores their thoughts and feelings about their relatives’ admission to a nursing home. Analysis of in‐depth interviews with relatives (n=10) found that the decision to place an older relative in a nursing home was a difficult one for families. The interviewed carers stated that admission to a nursing home was held off as long as possible but the deteriorating health of the older relative and in some cases their own health meant that there was no other option. Admission to institutional care usually followed a period of prolonged home care and occurred at a time of crisis. Family carers complained that they were given inadequate support from health care professionals and often had no choice in the decision‐making process. This was particularly evident in the case of carers whose relative was transferred directly from hospital to a nursing home setting. The majority of carers in this study experienced ambiguous feelings about placing their elderly relative in a nursing home. Feelings of relief that the burden of care had been lifted, contrasted sharply with feelings of guilt that they could not continue with their ‘duty of care’. Families also felt a need to justify their decision by emphasizing how friends and other family members agreed that they could not continue with home care in the interests of both their own and the older relative’s health. The findings suggest that while many carers are relieved of the physical exhaustion surrounding home care, the emotional turmoil continues long after admission to a nursing home.
Heart health‐associated health beliefs and behaviours of adolescents of African and African Caribbean descent in two cities in the United Kingdom
Authors: Higginbottom Gina Marie Awoko
Published: March 2003

Heart health‐associated health beliefs and behaviours of adolescents of African and African Caribbean descent in two cities in the United Kingdom

The following paper presents the findings of an exploratory ethnography, the purpose of which was to identify and describe heart health associated beliefs and behaviours of year seven (Y7) and year 10 (Y10) secondary school young people of African and African Caribbean descent in two UK cities. Data were collected by the data collection technique of focus groups. However, eight focus groups were conducted involving 47 Y7 young people and 29 Y10 pupils, 76 pupils in total. The data were analysed utilizing ATLAS/ti qualitative data analysis software. This software is informed by grounded theory. Data from the study formed six themes. The findings informed the development of an interactive health promotion website which can be found at http://www.shef.ac.uk/web/uni/projects/mshhp. The paper argues that in order to provide meaningful programmes of health promotion to be developed by health care providers including school nurses and health visitors, it is essential that interventions are informed by an understanding of the health beliefs and behaviours of African and African Caribbean young people.
Nurse‐sensitive outcomes of advanced practice
Authors: Ingersoll Gail L. , McIntosh Elaine , Williams Mamie
Published: March 2003

Nurse‐sensitive outcomes of advanced practice

Advanced practice nurses (APNs) in the USA are registered nurses who hold masters or doctoral degrees in a specialized area of nursing. They provide advanced clinical care to clients, manage health care systems and influence health care decision‐making through expert clinical reasoning and research and theory‐based action. APN impact on health care outcomes is supported by studies using physician‐focused indicators, although a few studies have identified several that are sensitive to or reflective of advanced practice nursing. A modified Delphi survey was conducted during May 1997–December 1998 to determine the outcome indicators APNs recommend for use in measuring their effect on care delivery outcomes. A convenience sample of 66 APNs attending a statewide outcomes conference identified 27 potential outcome indicators. These indicators were included in a mailed survey sent to APNs working in Tennessee. Respondents were asked to rate each indicator for validity, sensitivity, feasibility, utility and cost. In the second round of the survey, they were asked whether or not they agreed with the rank ordering of indicators, which was determined by the means calculated from responses in the first round. The 10 highest ranked indicators were satisfaction with care delivery, symptom resolution/reduction, perception of being well cared for, compliance/adherence with treatment plan, knowledge of patients and families, trust of care provider, collaboration among care providers, frequency and type of procedures ordered and quality of life. APNs identified both direct and indirect measures of effect on care delivery outcomes. Some of these are currently used as indicators of advanced practice, but many are not. Additional research is needed to determine whether the indicators proposed are valid and sensitive to advanced practice care by nurses.
Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems
Authors: Gosney Margot
Published: March 2003

Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems

Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co‐existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8‐week period in January and February. The study additionally identified factors that may have influenced patients’ participation in this immunization programme. Six hundred and forty‐nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side‐effects, or fear of anticipated side‐effects. In those unvaccinated three‐quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co‐existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side‐effects. The role of community doctors and nurses in facilitating the vaccination of such an at‐risk group is evident and should be incorporated into resource planning.
The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal qualitative study
Authors: Gray Morag A. , Smith Lorraine N.
Published: March 2003

The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal qualitative study

Parker and Carlisle (Journal of Advanced Nursing24, 771–778) argue that there is a scarcity of empirical research focusing on issues such as supernumerary status and mentorship in Project 2000 courses from the students’ perspective. This paper presents the findings of a longitudinal cohort study using Grounded Theory to discover the effect(s) of mentorship on student nurses following the introduction of the 1992 programme of education leading to a Diploma of Higher Education in Nursing and registration with the United Kingdom Central Council (UKCC). The cohort consisted of 10 students from a large Scottish College of Nursing & Midwifery who were interviewed on five occasions during the three years of their course. Students also kept a diary to record their thoughts and experiences regarding mentorship during their practice placements. In addition, a further seven students volunteered to participate by diary only. Data were analysed with the aid of NUD.IST and subjected to the constant comparative method of analysis. Findings indicate that Diploma students quickly lose their idealistic view of their mentor and over time develop an insight into the qualities they perceive are required of an effective mentor. Students quickly become aware of the importance of choosing good role models and learning their own mentor’s likes and dislikes as they realize this impinges on the outcome of their assessment. As students move into their Branch programme, a gradual distancing from their mentor is evident. This coincides with a development in their confidence, skills and a holistic perspective of care.
Using focus groups to develop a culturally sensitive videotape intervention for HIV‐positive women
Authors: Murdaugh Carolyn , Russell Rebecca Baker , Sowell Richard
Published: March 2003

Using focus groups to develop a culturally sensitive videotape intervention for HIV‐positive women

Research‐based interventions for women with the human immunodeficiency virus (HIV) are usually developed without input from the women who receive the intervention. An exploratory study was performed using focus group methodology to develop a culturally sensitive videotape intervention for educating HIV‐positive women about pregnancy and antiretroviral use. Women who met the study criteria were HIV‐positive and of childbearing age. These women volunteered to participate in the focus groups to provide information on decisions concerning pregnancy and antiretroviral use during pregnancy to decrease perinatal transmission. A total of five focus groups were conducted in 1998. Responses to three questions that were relevant to the video are presented in this article. Information gained from the focus groups was used successfully to develop a videotape currently being used in a multisite intervention study. Focus group methodology is a useful strategy to develop culturally and content relevant educational interventions for research and practice.
Oral health care needs of dependent older people: responsibilities of nurses and care staff
Authors: Fitzpatrick Joanne
Published: March 2003

Oral health care needs of dependent older people: responsibilities of nurses and care staff

The population of older people as well as the number of dependent older people is steadily increasing. Those unable to live independently at home are being cared for in a range of settings and varying degrees of dependency means that many are unable to attend fully to their needs, one aspect of which is oral care. The fact that the oral and dental health of the UK population is generally improving, makes more emphatic the responsibilities of nurses and care staff in this area. This review of the literature reveals that oral health of older people in continuing care settings is generally inadequate and that nurses’ and care staff’s knowledge and practice of oral care for older people is variable. Inadequate oral care is identified as multifactorial, with implications for educators, policy makers, practitioners and researchers. The need to address oral care for nurses pre‐ and post‐registration as well as adequate preparation for support workers is highlighted. Development of a robust oral assessment tool, as well as empirical investigation of the effectiveness of oral cleaning agents, equipment and techniques to inform standard setting is indicated, with monitoring of standards being imperative.
Forecasting models for human resources in health care
Authors: O’Brien‐Pallas Linda , Baumann Andrea , Donner Gail , Murphy Gail Tomblin , Lochhaas‐Gerlach Jacquelyn , Luba Marcia
Published: March 2003

Forecasting models for human resources in health care

This article is a review of the approaches published between 1996 and 1999 that have been used to forecast human resource requirements for nursing. Much of the work to date generally does not consider the complex factors that influence health human resources (HHR). They also do not consider the effect of HHR decisions on population health, provider outcomes such as stress, and the cost of a decision made. Supply and demand approaches have dominated. Forecasting is limited, too, by the availability of reliable and valid data bases for examining supply and use of nursing personnel across sectors. Three models – needs based, utilization based, and effective demand based – provide substantially different estimates of future HHR need. The methods of analysis employed for forecasting range from descriptive to predictive and are borrowed from demography, epidemiology, economics, and industrial engineering. Simulation models offer the most promise for the future. The forecasting methods described have demonstrated their accuracy and usefulness for specific situations, but none has proven accurate for long‐term forecasting or for estimating needs for large geographical areas or populations.
‘More than just money’– widening the understanding of the costs involved in cancer care
Authors: Pearce Susie , Kelly Daniel , Stevens Warren
Published: March 2003

‘More than just money’– widening the understanding of the costs involved in cancer care

Aim.  This paper examines the literature relating to the wider concept of cost in cancer care and the implications this has for the development of services particularly within the changing context of cancer care.

Background.  Cancer remains a major cause of morbidity and mortality in the United Kingdom (UK), treatment is often complex and expensive; both in financial and human terms. Service patterns for cancer care are shifting away from traditional inpatient, hospital settings towards short stay/day‐care and home care models. This is in response to developments in health care policy, but it is also because of the availability of better tolerated treatments and demand for more patient‐focused health care.

Review of the literature.  The databases of Cinhahl and Medline were accessed using the keywords of costs, treatment, outpatients, home care and cancer. Additional sources of literature were also accessed through hand searching key journals. The paper explores the literature in three themes. First, the cost‐effectiveness of cancer treatment; second, the often invisible indirect or ‘out of pocket’ costs incurred by patients and their families during cancer treatment and finally, the ‘human costs’ of a cancer diagnosis and cancer therapy.

Conclusions.  In view of recent calls to improve the effectiveness of cancer care in the UK, we suggest that research is needed to address all the dimensions of cost. It is only by exploring total costs from this broad perspective that appropriate, effective and holistic services can be planned for the future.
Stories seldom told: paediatric nurses’ experiences of caring for hospitalized children with special needs and their families
Authors: Ford Karen , Turner DeSales
Published: March 2003

Stories seldom told: paediatric nurses’ experiences of caring for hospitalized children with special needs and their families

Aims of the study.  This study explored paediatric nurses’ experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses’ experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses’ stories.

Study design/methods.  Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes.

Findings.  The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt.

Conclusions.  The study emphasized the context‐specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.
Patients’ and relatives’ experiences and perspectives of ‘Good’ and ‘Not so Good’ quality care
Authors: Attree Moira
Published: March 2003

Patients’ and relatives’ experiences and perspectives of ‘Good’ and ‘Not so Good’ quality care

Aims. To explore patients’ and relatives’ perceptions of care and identify key criteria used to evaluate quality care, via descriptions of actual care experiences.

Method. A qualitative approach using Grounded Theory was adopted; data collected by semistructured interviews, from a purposive sample of 34 acute medical patients and 7 relatives, was subjected to question and thematic analysis.

Findings. The nature of the care provided and interpersonal aspects of caring emerged as key quality issues for patients. Good Quality Care was characterized as individualized, patient focused and related to need; it was provided humanistically, through the presence of a caring relationship by staff who demonstrated involvement, commitment and concern. Care described as ‘Not so Good’ was routine, unrelated to need and delivered in an impersonal manner, by distant staff who did not know or involve patients.

Conclusions. Empirical evidence was found which support these findings, which are in opposition of the received view that patients place greater emphasis on the technical aspects of care tasks. The quality issues identified as important by patients and relatives in this study are not always evaluated in care audits. Those responsible for evaluating health care quality might consider combining traditional (professional/technical) audit criteria with those used by health care users to achieve a more comprehensive evaluation.
A critical incident study of nurses’ responses to the spiritual needs of their patients
Authors: Narayanasamy Aru , Owens Jan
Published: March 2003

A critical incident study of nurses’ responses to the spiritual needs of their patients

Aims of study. The aims of the study were to carry out a critical incident study to: (1) Describe what nurses consider to be spiritual needs; (2) Explore how nurses respond to the spiritual needs of their patients; (3) Typify nurses’ involvement in spiritual dimensions of care; (4) Describe the effect of nurses’ intervention related to spiritual care.

Background. In the caring professions a focus on individuals as bio‐psychological‐spiritual beings is gaining recognition and this notion is based on the premise that there should be a balance of mind, body and spirit for the maintenance of health in a person (Stoll 1979). Emerging research highlights the importance of spiritual care in nursing and suggests that there is scope for improving this dimension of care in order to improve the quality of life for many patients. However, there is very little evidence about how nurses respond to the spiritual needs of their patients. Therefore the purpose of this study was to map by critical incident techniques how nurses construct and respond to patients’ spiritual needs in a variety of clinical settings.

Methods. Critical incidents were obtained from 115 nurses. The data from these incidents were subjected to content analysis and categories were developed and described. The emerging categories were subjected to peer reviews to ensure reliability and validity of findings.

Findings. The findings suggest that there is confusion over the notion of spirituality and the nurse’s role related to spiritual care. A variety of approaches to spiritual care emerged in this study from the critical incidents derived from nurse respondents. These were categorized as ‘personal’, ‘procedural’, ‘culturalisit’ or ‘evangelical’. There was an overwhelming consensus that patients’ faith and trust in nurses produces a positive effect on patients and families, and nurses themselves derived satisfaction from the experience of giving spiritual care. In this respect, spiritual care interventions promote a sense of well‐being in nurses as well as being a valuable part of total patient care.

Conclusion. The study concluded that there is scope for developing an ideal model of spiritual care using the critical incident data from this study.
Why is pain management suboptimal on surgical wards?
Authors: Schafheutle Ellen Ingrid , Cantrill Judith A. , Noyce Peter R.
Published: March 2003

Why is pain management suboptimal on surgical wards?

Background. During a patient’s stay on a surgical ward, nurses hold a great deal of responsibility for pain management, especially when analgesics are prescribed on a PRN (‘as needed’) basis. Despite the availability of effective analgesics and new technologies for drug administration, studies continue to demonstrate suboptimal pain management.

Aim of the study. To identify perceived barriers to effective pain management in nursing practice.

Methods. The data are drawn from six nurse interviews and a survey of 180 nurses in 14 United Kingdom (UK) hospitals, which built upon detailed observations of nurses on surgical wards.

Results. In a question about possible reasons for suboptimal pain management, nurses identified a number of barriers that concerned organizational aspects such as workload and lack of staff, and also legal or institutional constraints. Nurses further stated that analgesic prescribing was sometimes inadequate, or that doctors or the pain team were unavailable to review medication. Further barriers that nurses may be less aware of were identified in a question concerning nurses’ reasons for not asking patients a pain‐related question during drug rounds. Previous observations had shown this to be the predominant time for pain questioning. The most commonly mentioned reasons were that patients were asleep, on epidural or patient controlled analgesia (PCA), or had recently had an analgesic. Nurses’ replies also revealed that they relied considerably on patients’ nonverbal behaviour and used this to assess analgesia requirements. Nurses’ views and judgements regarding pain management were further supported in replies to a number of attitude statements and a question about the aim of administering analgesia.

Conclusion. The strength of this work is that it identified two types of potential barriers to effective pain management, recognized and more subconscious ones, and both need to be addressed before introducing systems aimed at improving pain management.
Focus groups as a research method: a critique of some aspects of their use in nursing research
Authors: Webb Christine , Kevern Jennifer
Published: March 2003

Focus groups as a research method: a critique of some aspects of their use in nursing research

Objective. To evaluate and critique reports in the nursing literature in the period 1990–1999 of the use of focus groups as a research method.

Methods. The articles were identified by a computerized search of the CINAHL database and subjected to critical review.

Findings. The result of the search was that very few articles were found that reported on a specific piece of research using the method. Methodological discussions were more common and these were sometimes at a somewhat superficial level without analysis or critique. The largest category of articles was concerned with service development projects. The research‐based articles were found to be relatively unsophisticated in their use of the method, in particular in relation to data analysis and social interaction within focus groups. Terms such as ‘content analysis’ and ‘grounded theory’ were used in nonrigorous ways and incompatibility between the underlying research approach and implementation of the method was identified in the cases of phenomenology and grounded theory. Whilst selection of the focus group method was often justified in terms of the benefits that participant interaction could yield, this interaction was rarely reported or discussed in the articles. One author proposed a scheme for analysing this type of interaction, and this is recommended to future researchers as a possible framework for interaction analysis.

Conclusions. The article concludes by calling for more in‐depth consideration at the research planning stages of the underlying assumptions of methodological approaches that may be used to underpin focus group research and methods to be used to analyse and report the data generated.
Negotiating motherhood: the struggles of teenage mothers
Authors: Hanna Barbara
Published: March 2003

Negotiating motherhood: the struggles of teenage mothers

Aims. This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting.

Background. Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support.

Design. This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12‐month period from five homeless Australian sole‐supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants.

Findings. The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives.

Conclusions. It was concluded that becoming a sole‐supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.