bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic differences in breast self‐examination practice and health beliefs
Authors: Foxall Martha J. , Barron Cecilia R. , Houfek Julia
Published: March 2003

Thirty‐two African American nurses (AAN) and 78 Caucasian nurses (CN) were compared on breast self‐examination (BSE) practice and health beliefs. Relationships between these variables were also examined. The Health Belief Model provided the framework for the study. The sample is a subset of 269 women from a larger study. AANs were recruited from a professional nurses’ group. CNs were recruited from a list of female employees of a university medical centre. The results oft‐tests revealed no significant group differences on BSE frequency (P=0·06) or BSE proficiency (P=0·10). Noted was that 42% of AANs compared to 20% of CNs examined their breasts 12 or more times during the year. AANs were more likely to consider BSE beneficial (P=0·002) and to feel confident (P=0·006) about doing BSE; CNs perceived more barriers (P=0·001) to BSE. For AANs, BSE frequency and proficiency were positively related to confidence and inversely related to barriers; BSE frequency was also related to health motivation. For CNs, BSE frequency and proficiency were inversely related to seriousness. Implications include additional research to validate findings and to increase the knowledge base of all nurses regarding BSE.
Policy as an influence on public health nursing education in the Republic of Ireland
Authors: Chavasse Judith
Published: March 2003

Nurses are recognizing the need to influence health care policies; this requires an understanding of the ways in which policies are made. The key players and processes which influence public policy in the Republic of Ireland and the lack of policies referring explicitly to nurses and nursing are discussed in relation to a public health nursing curriculum. The lack of specific policies on nursing has had deleterious effects on some aspects of the curriculum but has also given the planners freedom to include primary health care and nursing values. It is argued that it may be better to have few policies than inappropriate ones. The preferred solution would be for nurses to be more involved in wider policy‐making, ensuring that policies reflect nursing values and concerns. An opportunity for a nursing voice to be heard and relevant policies recommended is provided by the Irish government's Commission on Nursing.
Productive international faculty exchange: one Columbia University to Gothenburg University example
Authors: Byrne Mary Woods
Published: March 2003

This article describes the preparation, implementation and outcomes of a visiting professor exchange experience from the United States to Sweden, and provides recommendations for other faculty who may be asked to enact a similar international role. The major goals of the visit were to coalesce the themes of the earlier administrative contacts into specific projects, and to model a scholarly faculty role consistent with the Columbia University School of Nursing mission as a World Health Organization Collaborating Centre for International Nursing Development. Professional nursing activities during the exchange visit were comprised of three main categories: teaching, consultation, and socialization. Strategies are described that enhanced the bilingual lectures for the Swedish students. The relationships that developed from consulting at the college and on site at various clinical locations culminated in the mutual identification of collaborative research projects and plans for the cross‐cultural adaptation of the author’s parent education model. Recommendations are made concerning the range of philosophical, institutional, professional and personal resources needed for international exchanges.
Fuzzy thinking
Authors: Cave Peter
Published: March 2003

Philosophical analysis is increasingly applied to nursing issues. Whereas pre‐analytical discussions might be sloppy, analysis should bring rigour. This paper explores some mistakes and misconceptions concerning nurse‐related reasonings. It uses, as a running theme, a recent paper in the Journal of Advanced Nursing by Rolfe. The mistakes and misleadings to be found in the paper are not uncommon; so the paper’s correction quest aims more widely than single author critique. The mistakes and misconceptions could initially appear abstract and without practical outcome; in order to avoid the threatened appearance, a nursing case study is presented, displaying some undesirable consequences for a nurse who is misled by her reading. It is hoped that this paper shows how some accuracy may be well leading.
Women’s perceptions of group support and adaptation to breast cancer
Authors: Samarel Nelda , Fawcett Jacqueline , Krippendorf Klaus , Piacentino Jayne C. , Eliasof Barbara , Hughes Phyllis , Kowitski Carol , Ziegler Elaine
Published: March 2003

Women’s perceptions of group support and adaptation to breast cancer¶ Formal cancer support groups are thought to assist women to adapt to the physiological and psychosocial sequelae of breast cancer. To shed some light on this untested clinical assumption, this Roy Adaptation Model of Nursing‐based study was designed to explore women’s own reports about their adaptation to breast cancer and their participation in support groups. This article reports the results of the quantitative content analysis of structured telephone interviews with 70 women who participated in group social support and education for breast cancer. Almost three‐quarters of the women expressed a positive change in attitude towards breast cancer, and all regarded participation in the groups as positive. A majority reported adaptive physiological, self‐concept, role function, and interdependence mode effects of breast cancer and group participation. Additional research is needed to show how different types of cancer support groups, including social support and education groups and psychotherapy groups, contribute to women’s responses. Research is also needed to separate the effects of group social support and education from other sources of social support that may have contributed to the women’s responses, and to further explore feelings of normalization expressed by some women.
Transcending the physical: spiritual aspects of pain in patients with HIV and/or cancer
Authors: Newshan Gayle
Published: March 2003

Transcending the physical: spiritual aspects of pain in patients with HIV and/or cancer¶ Spirituality is an important though often neglected aspect of pain in patients with human immunodeficiency virus (HIV) and/or cancer, for both patients and nurses. The spiritual domain involves: (1) meaning, (2) hope and (3) love and relatedness. The author examines spiritual aspects of pain in persons with HIV and/or cancer, as supported by the literature. Understanding spiritual aspects of pain carries implications for nursing. One of these implications is that it is important for the nurse to be closer to his/her own spirit in order to be there for the patient in pain. Other nursing implications include spiritual assessment and interventions, such as presence, attentive listening, acceptance and judicious self‐disclosure, for promoting comfort and diminishing pain.
Listening to them and reading me: a hermeneutic approach to understanding the experience of illness
Authors: Robertson‐Malt Suzie
Published: March 2003

Listening to them and reading me: a hermenuetic approach to understanding the experience of illness¶Developing a method that is pragmatic yet theoretically consistent with the philosophies of hermeneutics and phenomenology is a constant hurdle for any researcher endeavouring to engage their inquiry in this manner, particularly when its proponents refute the credence of hermeneutics as a research method. This paper discusses how Van Manen's six research activities can act as a framework, that when modified to suit the particular needs of the research project, can promote a process of inquiry that works with these philosophies towards an unfoldment of new understandings of the human experience in illness.
The effects of primary nursing on work‐related factors
Authors: Melchior Matthijs E.W. , Halfens Ruud J.G. , Abu‐Saad Huda Huyer , Philipsen Hans , Van Den Berg Andre A. , Gassman Patrick
Published: March 2003

The effects of primary nursing on work‐related factors¶This study investigates the effects of a primary nursing care delivery system on some work‐related factors of nurses in long‐stay psychiatric care settings. In a quasi‐experimental research design a cohort of 176 nurses was followed for 2·5 years. Results showed that as a result of primary nursing the primary nurses found more autonomy in their work and experienced it to be less complex. Furthermore, primary nurses performed personal care tasks less frequently and worked more according to a patient‐oriented care model. Several additional analyses were performed owing to the two main problems encountered in this study, namely a high dropout due to job turnover among nurses and the imitation of the intervention by the control group.
Relationships between family dynamics of Finnish child‐rearing families, factors causing strain and received support
Authors: Hakulinen Tuovi , Laippala Pekka , Paunonen Marita , Pelkonen Marjaana
Published: March 2003

Relationships between family dynamics of Finnish child‐rearing families, factors causing strain and received support¶ The aim of this study was to determine the relationships between family dynamics, the factors causing strain on child‐rearing parents and the support available to families from public health nurses. Family dynamics was defined as the family's unique way of functioning and was conceptualized by means of six different dimensions. Questionnaires were sent to 118 families, and of these 85 mothers and 79 fathers participated in the study. According to the findings the majority of parents involved in bringing up children aged 3–4 years assessed their families to be well‐functioning. There was a correlation between a low level of factors causing strain on the family and a positive evaluation of family dynamics based on the various dimensions. According to the mothers the support, i.e. emotional, appraisal and instrumental support, received from public health nurses, along with a small number of strain‐causing factors on the partner relationship, correlated well with their positive assessments of the mutuality and flexibility of their families.
Managing caregiver tasks among family caregivers of cancer patients in Hong Kong
Authors: Chan Carmen W.H. , Chang Anne M.
Published: March 2003

Managing caregiver tasks among family caregivers of cancer patients in Hong Kong¶ Twenty‐nine family caregivers of terminally ill cancer patients in Hong Kong were asked about their perceived difficulty in managing caregiver tasks. Results showed that the level of difficulty in handling the three main aspects of tasks, that is the direct care, intrapersonal tasks, and interpersonal ties, were similar (χ2 = 0·71,P > 0·05). The individual tasks identified as extremely difficult included compensation for personal time (31%), updating knowledge of reimbursement mechanism (20·7%), and emotionally accepting the likelihood of a progressive downward course of illness (17·2%). Mann–Whitney tests indicated that caregivers who had a shorter duration of caregiving experience perceived significantly greater difficulty in direct care (P < 0·05), intrapersonal tasks (P < 0·05), and overall tasks (P < 0·05). These findings indicate the need for the provision of counselling and educational support for these caregivers.
Finnish nurses' attitudes to pain in children
Authors: Salanterä Sanna
Published: March 2003

Finnish nurses' attitudes to pain in children¶This study measured the attitudes of Finnish paediatric nurses to children in pain and the connection between nurses' attitudes, nurses' attributes and nurses' own view of their knowledge and ability to take care of children in pain. The measurements were based on a purpose‐designed instrument consisting of a 41‐item Likert‐type questionnaire and demographic data. The convenience sample consisted of paediatric nurses at all five university hospitals in Finland (n = 303). The response rate was 87%.
ANOVA and non‐parametric Kruskal–Wallis
ANOVA were used as statistical methods. The results show that, taken as a whole, the attitudes of these nurses do not hinder effective pain management but there are some misconceptions that need further attention. It also emerged that such attributes as nurses' age, education, experience, place of work and field of expertise do not have a significant effect on nurses' attitudes. Nurses working in operating theatres felt they had a limited scope to work together with parents and in some hospitals nurses felt they had limited scope to work together with other staff groups. The units differed significantly in nurses' views about the unit's possibilities to provide treatment for pain. The findings of this study indicate that although nurses' attitudes to pain management are mainly positive, there is much variation in how they feel they can actually provide quality care to control pain. More attention should be paid to training nurses and to providing knowledge about the treatment of pain in children. Future research should look at nurses' existing knowledge base as well as their activities in the assessment and management of pain.
Further evaluation of a scale to screen for risk of emotional difficulties in bone marrow transplant recipients
Authors: Molassiotis Alexander
Published: March 2003

Further evaluation of a scale to screen for risk of emotional difficulties in bone marrow transplant recipients¶ A study was designed to evaluate a scale screening for risk of emotional difficulties in bone marrow transplant (BMT) patients. Forty subjects were assessed before the transplant by an experienced BMT nurse familiar with the patients and immediately after hospitalization for BMT by two raters: a psycho‐social BMT nurse and an independent researcher generating record‐review ratings. The pre‐transplant ratings were compared with emotional difficulties of patients during their isolation for BMT. A predictive value of emotional problems during BMT based on the pre‐BMT assessment was found (rs = 0·57, P < 0·001). Main pre‐BMT psycho‐social characteristics showing a significant correlation with emotional difficulties during BMT included quality of affect, mental status and proneness to anticipatory anxiety. Such a scale can be valuable in anticipating patients' emotional difficulties at an early stage, where more time is allowed for careful planning of care and the patients can be involved in the management of their care.
A socio‐ecological approach to understanding barriers to prenatal care for women of low income
Authors: Sword Wendy
Published: March 2003

A socio‐ecological approach to understanding barriers to prenatal care for women of low income

This paper critically examines the notion of barriers as conceptualized in the literature and suggests an expanded orientation to more fully appreciate its complexity. This alternative approach not only takes into account factors and processes relevant to the individual that create constraints to utilization, but also acknowledges influences on the design and delivery of health care. These latter considerations determine the availability and characteristics of programmes and services that may or may not encourage or enable participation by persons of low income. A socio‐ecological model is proposed that compels health care practitioners and researchers to acknowledge the many influences on utilization behaviour. The literature on barriers to prenatal care is subsequently reviewed and evaluated, with consideration given to the range of behavioural determinants suggested by the model. Finally, a case is made for qualitative methods for inquiry to further enhance knowledge about factors and processes influencing use of the health care system, including prenatal care. It is argued that these approaches lead to enhanced appreciation of behaviour as a social product and are consistent with the ideology of health promotion.
Deconstructing the language of psychiatric hospitalization
Authors: Mohr Wanda K.
Published: March 2003

Deconstructing the language of psychiatric hospitalization

The purpose of this study was to deconstruct the language of psychiatric nurses' documentation and charting. Employing concepts developed by post‐modern theorists, everyday professional activities can be examined in unique ways that uncover how they conceal or skew rather than reveal and illumine patient conditions. The study design and sample was exploratory; content analysis with first and second level analyses. Nine major categories of charting entry were found. Deconstruction of the language and discourse of nursing through a Foucaultian lens goes beyond what is manifest to what is not said. Professional assumptions about patients and the social construction of patients and patient problems are exposed.
Skills competency in nurse education: nurse managers' perceptions of diploma level preparation
Authors: Carlisle Caroline , Luker Karen A. , Davies Carol , Stilwell John , Wilson Robert
Published: March 2003

Skills competency in nurse education: nurse managers' perceptions of diploma level preparation

This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the `fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long‐standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the `core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.
The self in self‐awareness
Authors: Cook Stephen H.
Published: March 2003

The self in self‐awareness

The concepts of ‘self’ and ‘person’ are central to educational and therapeutic endeavours. This paper examines the emergence of ‘self‐awareness’ as an explicit concern in the education of preregistration nurses. In particular, it questions the claims that specific experiential learning strategies are the most appropriate for promoting self‐awareness in students, and that these strategies produce greater understanding of theory in students and give greater depth of meaning to theory for students. It argues that the long and complex history associated with the concepts of self, self‐awareness and ‘person’ makes the unproblematic stance adopted towards them in the nursing literature untenable, and calls for a more rigorous and critical appraisal of experiential learning strategies commonly used to promote self‐awareness.
Considering the nature of intersubjectivity within professional nursing
Authors: Pierson Wanda
Published: March 2003

Considering the nature of intersubjectivity within professional nursing

The notion of intersubjectivity raises fundamental epistemological and ontological questions concerning how individuals come to know one another and how that knowing affects action. Within the sphere of professional nursing, relationship, as an intersubjective process between individuals, constitutes an integral element of professional nursing practice. Understanding the notion of relationship in terms of an intersubjective process is frequently laden with difficulty due to the polarization of intersubjectivity within either a traditional scientific position or a human science perspective. Reconciliation of both ways of knowing, however, may allow nurses to bring forward a broader base and scope of information to appreciate the experience of others. This article examines some of the notions of intersubjectivity and proposes an alternative understanding.
The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice
Authors: Buchan James
Published: March 2003

The ‘greying’ of the United Kingdom nursing workforce: implications for employment policy and practice

One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age‐shift is two‐fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be ‘younger’ than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the ‘pool’ of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility.
Women’s perceptions of phenomena they label premenstrual tension: normal experiences reflecting ordinary behaviour
Authors: Sveinsdóttir Herdís , Lundman Berit , Norberg Astrid
Published: March 2003

Women’s perceptions of phenomena they label premenstrual tension: normal experiences reflecting ordinary behaviour

Remarkably little empirical knowledge exists about premenstrual tension (PMT), a construct that has been studied intensively during the last 30 years. Practically nothing is known about the perceptions women have about PMT. The purpose of this study is to describe the perceptions healthy women have about PMT. Seventeen women, who had 4 years earlier participated in a concurrent diary study assessing the prevalence of PMT, were interviewed. The interviews were analysed by means of a qualitative content analysis. Four main categories describing the women’s perceptions were formed: (1) individual experiences of phenomena referred to as PMT; (2) phenomena referred to as PMT reflect ordinary experiences in healthy women; (3) biopsychosocial explaining of phenomena referred to as PMT; (4) internal and external resources used to manage the variability of phenomena referred to as PMT. The content of these categories reflects the participants’ perceptions of PMT as the common, normal and very variable experiences which women handle by the use of management strategies commonly used in contemporary society to deal with life in general. Experiences of women differ with respect to what they experience and the timing and persistence of those experiences. This the participants explain from a biopsychosocial perspective. It is suggested that women have adapted a medical term, PMT, to describe what they consider normal female phenomena.
Power and empowerment in nursing: three theoretical approaches
Authors: Kuokkanen Liisa , Leino‐Kilpi Helena
Published: March 2003

Power and empowerment in nursing: three theoretical approaches

Definitions and uses of the concept of empowerment are wide‐ranging: the term has been used to describe the essence of human existence and development, but also aspects of organizational effectiveness and quality. The empowerment ideology is rooted in social action where empowerment was associated with community interests and with attempts to increase the power and influence of oppressed groups (such as workers, women and ethnic minorities). Later, there was also growing recognition of the importance of the individual’s characteristics and actions. Based on a review of the literature, this paper explores the uses of the empowerment concept as a framework for nurses’ professional growth and development. Given the complexity of the concept, it is vital to understand the underlying philosophy before moving on to define its substance. The articles reviewed were classified into three groups on the basis of their theoretical orientation: critical social theory, organization theory and social psychological theory. Empowerment seems likely to provide for an umbrella concept of professional development in nursing.
Implementing contract learning in a clinical context: report on a study
Authors: Chan Sally Wai‐chi , Wai‐tong Chien
Published: March 2003

Implementing contract learning in a clinical context: report on a study

This paper reports on a study of the implementation and evaluation of learning contracts in a clinical context for a group of students who were in their third year of study in a pre‐registration bachelor of nursing degree programme in Hong Kong. A learning contract was implemented as a learning tool in the students’ clinical placement in mental health nursing. An action research approach was used in this study. Data were collected from questionnaires and interviews with students and clinical instructors. Results showed that students and clinical instructors generally agreed that there was an increase in students’ autonomy and motivation in learning with the use of a learning contract. It also increased the sharing between students and clinical instructors. The findings of the questionnaire and interviews supported each other. However, the lack of experience in using contract learning and the limited time in the clinical areas created difficulties for both students and clinical instructors. Despite the limitations, contract learning is considered beneficial to students’ learning and has the potential to be used in clinical learning.
Acute childhood illness at home: the parents’ perspective
Authors: Neill Sarah J.
Published: March 2003

Acute childhood illness at home: the parents’ perspective

This critical review of British literature explores the phenomenon of acute childhood illness at home from the parents’ perspective. The Literature was searched using four CD‐ROM databases: CINAHL, MEDLINE, ASSIA and PSYCHLIT, augmented by hand searching of current journal issues. Sandelowski’s (1995) stages of qualitative data analysis were used to develop a rigorous approach to conducting qualitative overviews. The majority of childhood illness is of short duration and takes place in the child’s own home. Yet the research which addresses this area is limited. Mothers constantly monitor their child’s health, identifying illness as a change in behaviour of the child from their perception of normal. Their usual response to illness is nonprofessional care, including general nursing care and ‘over the counter’ medicines. When mothers do seek help this is usually from the family doctor. Mothers are often dissatisfied with the help and advice they receive. This is partially explained by the mismatches which occur concerning the perceptions of mothers and of health care professionals regarding appropriate use of services and the needs of these mothers and their children. The literature reviewed indicates a need to address the service users perceptions of the services provided. Areas where further research is required are identified.
Mother, daughter, patient, nurse: women’s emotion work in aged care
Authors: Gattuso Suzy , Bevan Celia
Published: March 2003

Mother, daughter, patient, nurse: women’s emotion work in aged care

This paper examines emotion work within the predominantly female environment of aged‐care nursing, identifying phenomena which must be accounted for in a theory of emotional labour. These phenomena include the blurring of public and private in women’s experiences and maternal models of care. Initial findings demonstrate the high levels of stress experienced by staff, related to emotional labour and to conflicts around the erosion of care standards. Sixteen women, from rural Australia, participated in the first stage of the research. The oldest was in her sixties, the youngest in her thirties. Length of aged‐care experience ranged from 2 to 33 years. Although most of the women expected to still be in aged care in 5 years’ time, they were negative in their attitudes to personal ageing, suggesting an ambivalence in their feelings about working in aged care. Three women nurses are the particular focus of this paper. Their narratives illustrate the intersection of private and public caring in nurses’ lives and the implications of this for emotional labour. Phenomena such as dual caring, conflicts in insider‐outsider roles, and transference are revealed in their narratives. We argue that the welfare of the recipient of gerontic nursing is linked to the well‐being of the nurse‐carer but that a cultural change is needed so as to recognize and value emotion work. However, endorsing Staden, we agree that such a change is dependent on the politicization of ‘caring’. There is also need for further and broader research concerning the nature of emotional labour and the ethics of care.
Managing post‐discharge care at home: an analysis of patients’ and their carers’ perceptions of information received during their stay in hospital
Authors: Driscoll Andrea
Published: March 2003

Managing post‐discharge care at home: an analysis of patients’ and their carers’ perceptions of information received during their stay in hospital

This small‐scale study carried out in a Melbourne metropolitan hospital explored patients’ and their carers’ perceptions of information, adequacy of information, and their utilization of information concerning post‐discharge care received from health professionals during their stay in hospital. The research design consisted of two stages. Stage one involved a qualitative approach using focused interviews of five pairs of patients and their carers, 2 weeks after discharge from hospital. Five main themes emerged from the content analysis of the interview transcripts: information given by health professionals to patients and carers, patients’ and carers’ psychological well‐being, activities of daily living, caring tasks of the patients, and community linkages. A quantitative approach was used for stage two involving two sets of questionnaires, one for the patient and one for the carer, developed from the themes identified in stage one. A pilot study was conducted on three pairs of patients and their carers, 2 weeks after discharge from hospital. The main study consisted of a convenience sample of 40 pairs of patients and their carers who completed the questionnaires 2 weeks post‐discharge. Data analysis of stage two of the study consisted of descriptive statistics and cross‐tabulations. The main findings suggested that carers received very little information from health professionals concerning their patients’ health problems and care at home. The carers’ health and employment states were often not considered in their patients’ discharge plan. Carers who were present with their patients when they received information concerning post‐discharge care experienced a decrease in anxiety during their patients’ convalescence at home, greater satisfaction with the information they received, and their patients experienced fewer medical problems post‐discharge. The implications for nursing practice and research include recommendations for a more effective system of discharge planning, and further research to include a larger population with a more varied group of participants.
Nurses’ experiences of making decisions to call emergency assistance to their patients
Authors: Cioffi Jane
Published: March 2003

Nurses’ experiences of making decisions to call emergency assistance to their patients

Patient survival often depends on decisions by nurses to call emergency assistance. The experiences of nurses calling emergency assistance have not been described. This descriptive study explored the experiences of registered nurses (n=32) using unstructured interviews. The main findings were that nurses questioned whether they were doing the ‘right thing’ calling the emergency team, sometimes collaborated with others prior to calling and most felt nervous and anxious. They recognized patient deterioration from feelings they had that something was wrong. However, they were not able ‘to put their finger on it’. Knowing the patient and past experiences were involved in the recognition of deterioration. This association indicates the importance of experience in the development of clinical decision‐making skills. Further, nurses calling emergency assistance need to be provided with the opportunity to debrief after calling. Their heavy reliance on subjective data before searching for objective data as outlined in the emergency calling criteria suggests that it is essential that nurses do not devalue or ignore concerns they may have about patients.
Reducing distress in first level and student nurses: a review of the applied stress management literature
Authors: Jones Martyn C. , Johnston Derek W.
Published: March 2003

Reducing distress in first level and student nurses: a review of the applied stress management literature

Following recent evidence of continuing high levels of distress in both trained and student nurses, a critical review of the stress reduction and stress management literature targeting both trained and student nurses is presented. Using a systematic approach, some 36 studies dating from 1980 until the present day were identified adopting either pre‐experimental, quasi‐experimental or experimental designs. While many work‐site programmes in this series were successful in terms of adaptive changes in problem‐solving, self‐management skills including relaxation and interpersonal skills, affective well‐being, and work performance, a number of design and evaluation inadequacies were identified. The relative lack of home–work interface or organizational level programmes to reduce work‐related distress, and the scarcity of interventions targeting aspects of the work environment likely to contribute to such outcomes may have contributed to continuing high levels of distress in trained and student nurses. Recommendations regarding the future design, provision and evaluation of such work‐site interventions include the further clarification of the structure of perceived stressors, and development of causal models of the stress process to identify the job characteristics ‘causing’ work‐related distress. Such an approach would inform the design and implementation of evidence‐based organizational level interventions augmenting strategies to target the health behaviour, lifestyle/risk factors and self‐management skills of practitioners and students with attempts to amend problematic elements of the psychosocial work environment.
Exploring reflective thinking in nursing practice
Authors: Teekman Bert
Published: March 2003

Exploring reflective thinking in nursing practice

While it is claimed in the nursing literature that reflective thinking is the approach par excellence for learning and advancing the art and practice of nursing, few empirical studies have been undertaken in this area to date. Sense‐Making, a qualitative research method, was utilized to obtain and analyse data from interviews with 10 registered nurses in order to study reflective thinking in actual nursing practice. Ten non‐routine nursing situations were analysed for the presence of reflective thinking. Time‐line interviews of the events resulted in a total of 59 micro‐moments, each of which was explored in terms of the thinking processes utilized to make sense of the situation as well as the focus of their thought. ‘Pre‐perceptions’ played an important part in how the respondents perceived their situation. Reflective thinking was extensively manifest, especially in moments of doubt and perplexity, and consisted of such cognitive activities as comparing and contrasting phenomena, recognizing patterns, categorizing perceptions, framing, and self‐questioning in order to create meaning and understanding. Self‐questioning was identified as a significant process within reflective thinking. By exploring and analysing the type of questions respondents were asking themselves, the study uncovered three hierarchical levels of reflective thinking. Respondents most often engaged in reflective thinking‐for‐action which centred on the here and now in order to act. Reflective thinking‐for‐evaluation focused on creating wholeness and contributed to the realization of multiple perceptions and multiple responses. Reflective thinking‐for‐critical‐inquiry could not be demonstrated in the study sample. The findings of this study resulted in the development of a model of reflective thinking, which is discussed in terms of the implications for learning in nursing practice.
Asthma and dualism
Authors: Paley John
Published: March 2003

Asthma and dualism

The rejection of Cartesian dualism can be taken to imply that the mind is implicated in health and illness to a greater degree than conventional medicine would suggest. Surprisingly, however, there appears to be a train of thought in antidualist nursing theory which takes the opposite view. This paper looks closely at an interesting example of antidualist thinking — an article in which Benner and her colleagues comment on the ways in which people with asthma make sense of their condition — and concludes that it places unduly stringent and arbitrary limits on the mind’s role. It then asks how antidualism can lead to such a dogmatic rejection of the idea that states of the body are clinically influenced by states of mind. The answer to this question is that Benner assimilates very different philosophical theories into the same ‘tradition’. On this occasion, she has combined Descartes, Kant and the Platonist ascetics into a single package, misleadingly labelled ‘Cartesianism’, and this move accounts for her unexpected views on the relation between mind and body in asthma.
Cognitive ability and functional status
Authors: Knight Margaret M.
Published: March 2003

Cognitive ability and functional status

Significant confusion exists in the literature about functional status. Despite its importance, little attention has focused on developing and substantiating frameworks that detail the underpinnings of functional status, which has resulted in lack of agreement about its definition and dimensions. The purpose of this literature review was to examine the development of functional status and to describe the inclusion of its cognitive dimension. Cognition is one key dimension of functional status. One must ‘know how’ to perform to be successful in an activity. While cognitive capacity is generally considered in relation to functional status, the nature of the cognitive dimension is poorly described and poorly understood. Three databases were selected for review: Citations in Nursing and Allied Health (CINAHL), Psychology Literature (PsychLit), and the Medical data base known as MedLine. Key word searches identified thousands of sources. This analysis includes an extensive sampling of these sources from the 1960s through to 1998. The sources sorted into four primary categories and demonstrate a growing recognition of the cognitive dimension of functional status in the literature. Despite this recognition, the lack of conceptual clarity of both the term functional status and its cognitive dimension limits communication among disciplines and limits comparisons of functional status outcomes across studies. Functional status models are needed that include cognition as a core dimension. Population specific descriptions of the cognitive dimension should be guided by knowledge in the neurosciences.
Psychiatric care as seen by the attempted suicide patient
Authors: Samuelsson Mats , Wiklander Maria , Åsberg Marie , Saveman Britt‐Inger
Published: March 2003

Psychiatric care as seen by the attempted suicide patient

This study highlights the experiences of patients during in‐patient psychiatric care in Sweden following a suicide attempt. Eighteen patients were interviewed as close to being discharged as possible. Each respondent was asked to narrate his/her experiences of the care received. An interview guide concerned the following areas: admission to the hospital, feelings and reactions, and positive as well as negative experiences during the hospital stay. The interviews were transcribed verbatim and a qualitative content analysis concerning the meanings, intuitions, consequences and the context of the data was performed. Three central categories were identified: being a psychiatric patient, patients’ perceptions of the caregivers and the care provided, as well as important aspects of the psychiatric care received. The importance of being well cared for and receiving understanding and confirmation was emphasized. Lack of confirmation may have contributed in some cases to a feeling of being burdensome, demands for discharge or even another suicide attempt. Verbal contacts with the staff were seen as essential for the process of healing and for the desire to go on living.
Korean nurses’ adjustment to hospitals in the United States of America
Authors: Yi Myungsun , Jezewski Mary Ann
Published: March 2003

Korean nurses’ adjustment to hospitals in the United States of America

Due to shortage of nurses, more nurses from other countries are employed in health care settings in the United States of America (USA). Little attention has been paid to understanding how culturally different international nurses adjust to USA hospitals. The purpose of this study was to investigate how Korean nurses adjust to USA hospital settings. Grounded theory method was used for sampling procedure, data collection and analysis in order to describe Korean nurses’ experiences from their perspective and to develop a substantive theory that explains their process of adjustment. Data were collected using semi‐structured formal interviews with a purposive sample of 12 Korean nurses. The interviews were audio‐taped and transcribed. Analysis of data, using the constant comparative method, revealed ‘adjustment to USA hospitals’ as the basic social psychological process. Five categories composed the process: (1) relieving psychological stress; (2) overcoming the language barrier; (3) accepting USA nursing practice; (4) adopting the styles of USA problem‐solving strategies; and (5) adopting the styles of USA interpersonal relationships. These five categories capture the essential aspects of the adjustment process and each category contains a set of sub‐categories that describe Korean nurses’ day‐to‐day experiences that are critical and also problematic to their adjustment. The process evolves in two stages. In the initial stage, the first three of the five categories greatly influenced the nurses’ adjustment. From the perspective of the nurses in the study, the initial stage lasts about 2 to 3 years. The remaining two categories are principal components of the later stage. It takes an additional 5 to 10 years to complete this stage. This model highlights both distress and accomplishments of Korean nurses during their adjustment to USA hospitals. The results of the study may help USA nurses gain insight in designing and implementing orientation programmes to facilitate and support Korean nurses’ adjustment to USA hospitals.
Quality in health care and ethical principles
Authors: Huycke LaRae , All Anita C.
Published: March 2003

Quality in health care and ethical principles

The last three decades have seen rapid changes in the way United States of America (USA) health care has been delivered, financed and regulated. Four major stakeholders have emerged in the health care debate: patients, providers, payers and public regulatory agencies. These groups do not agree on a definition of quality health care. This paper suggests five ethical principles — autonomy, justice, beneficence, non‐maleficence, and prudence — be included in the framework of quality health care. A framework that outlines possible relationships among these ethical attributes and four major stakeholders is presented.
Developing and testing an instrument for the measurement of individual care
Authors: Suhonen Riitta , Välimäki Maritta , Katajisto Jouko
Published: March 2003

Developing and testing an instrument for the measurement of individual care

This paper describes a preliminary study in which an instrument was developed for the measurement of individual care in adult patients and in which the reliability and validity of the instrument were evaluated. Individual care was defined in terms of how patient individuality was taken into account and how patient participation in decision‐making was facilitated. The purpose here is to describe the process by which the individual care instrument (IC) was developed, the preliminary testing of the instrument and psychometric evaluation of the instrument in a sample of adult patients discharged from a Finnish general Hospital (n=203). Item analyses showed an acceptable level of internal consistency reliability and homogeneity in each scale of the IC, and Cronbach α values were high in every measurement. Exploratory factor analysis supported a three‐factor solution. The psychometric evaluations suggested that the instrument is worthy of further development.
Experiences of coercion in psychiatric care as narrated by patients, nurses and physicians
Authors: Olofsson Britta , Norberg Astrid
Published: March 2003

Experiences of coercion in psychiatric care as narrated by patients, nurses and physicians

Aim. The aim of the study was to increase understanding of psychiatric patients’, nurses’ and physicians’ experience of coercion, in relation to their own and the other parties’ experiences.

Methods. Seven triads of patient, nurse and physician narrated their experiences of the same coercive event. The 21 interviews were analysed focusing on narrative elements.

Results. The nurse and physician narratives revealed that they felt unable to connect with the patients, while the patients told us that they wanted more human contact with nurses and physicians. All three parties expressed the belief that interpersonal relationships and the human contact were important. The nurses and physicians stated that knowing the patient made them feel easier about using coercion and that their actions were less violating for the patient. The patients stated that human contact alleviated their feeling of discomfort and made them feel more secure when subjected to coercion.

Conclusion. The salient aspect described by all three parts was the importance of human contact and having a mutual relationship. These findings indicate a need for more dialogue between patients and staff. The dialogue should aim at making staff understand patients’ feelings better regarding coercion and at informing the patients about the coercive measures.