bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of postpartum stress and social support on postpartum women’s health status
Authors: Hung Chich‐Hsiu , Chung Hsin‐Hsin
Published: March 2003

The effects of postpartum stress and social support on postpartum women’s health status

Background. Eastern sociocultural systems differ in many ways from Western ones, and these differences influence many aspects of the postpartum period.

Aim. The purpose of this study was to determine postpartum women’s health status in the wider social context of the Taiwanese family after women return home from the hospital or clinic.

Method. A longitudinal study was conducted with data collected at the first, the third, and the fifth weeks of the postpartum period. Five hundred and twenty‐six postpartum women were included in the study using stratified sampling from clinics and hospitals in Kaohsiung City in the southern part of Taiwan. The Hung Postpartum Stress Scale (HPSS), Smilkstein’s Social Support Scale, and the Chinese Health Questionnaire were used to obtain information about the women’s postpartum stress, social support, and health status at each time point. Data were analysed with factor analysis, repeated measures MANOVA, and multiple logistic regression.

Results. Three factors associated with postpartum stress were identified by factor analysis: (1) maternity role attainment, (2) lack of social support, and (3) body changes. Furthermore, the level of postpartum stress at the third and the fifth postnatal weeks was higher than at the first. Social support scores at this postnatal week were the highest among the three points in time. In addition, 29%, 41% and 41% of the women at the first, third, and fifth weeks, respectively, had minor psychiatric morbidity.

Conclusions. Because the postpartum women’s self‐reported stress is relatively low whereas the social support is relatively high, especially from the family, this confirms Pillsbury’s conclusion regarding the significance of social support during the Chinese women’s postpartum period. The study also showed that the three factors associated with postpartum stress were important predictors of postpartum women’s health status. Future studies should compare the level of postpartum stress, social support, and women’s health status in both Western and Eastern cultures.
The effectiveness of music as an intervention for hospital patients: a systematic review
Authors: Evans David
Published: March 2003

The effectiveness of music as an intervention for hospital patients: a systematic review

Introduction. Over the past few decades there has been a growing interest in the use of music, which has seen it used to achieve a diverse range of outcomes. While music as an intervention for hospital patients has subject to considerable evaluation, many of these studies are small and findings are therefore often contradictory. This systematic review was conducted to investigate the effectiveness of music as an intervention for hospital patients.

Method. A comprehensive search was undertaken involving all major health care databases. For studies to be included in the review they must have investigated the effect of music, involved adult hospital patients and used a randomized controlled trial design. These studies must also have used outcome measures such as anxiety, satisfaction, pain, mood and vital signs. Identified studies were critically appraised, and then categorized according to whether music was evaluated during normal care delivery or during invasive and unpleasant procedures. When appropriate, studies were combined in a meta‐analysis.

Results. A total of 29 studies were identified that fulfilled the inclusion criteria, of which 10 were subsequently excluded following critical appraisal. Music played via headphones reduces anxiety of patients during normal care deliver, but it has no impact on the anxiety of patients undergoing procedures such as bronchoscopy, sigmoidoscopy or surgery with a spinal anaesthetic. Music produces a small reduction in respiratory rate during normal care delivery, but appears to have little effect on other vital sign parameters. It has no impact on the vital signs of patients undergoing procedures. Although the evidence is limited, music also appears improve the mood and tolerance of patients.

Conclusion. This review demonstrates the effectiveness of music for the reduction of anxiety during normal care deliver. Given the inexpensive nature of this intervention, and the lack of adverse events, it is recommended as an adjunct to normal care practices. This review also highlights the need for further research into many aspect of this intervention.
Minimizing side‐effects: the clinical impact of nurse‐administered ‘side‐effect’ checklists
Authors: Jordan Sue , Tunnicliffe Carol , Sykes Alan
Published: March 2003

Minimizing side‐effects: the clinical impact of nurse‐administered ‘side‐effect’ checklists

Background. For those with chronic illness, the adverse effects of medication are important causes of morbidity and distress which may not always receive due attention. Guidelines and checklists may be one strategy to focus professionals’ attention on long‐term problems. Therefore, client‐centred ‘side‐effect’ evaluation checklists were developed to be administered and actioned by nurses.

Aim. The purpose of this study was to explore the clinical impact of these checklists on long‐term users of antipsychotic medication.

Methods. This study was undertaken with clients with enduring mental illness, in Community Mental Health Teams. In the first phase, 40 nurse–client interactions were observed. Following introduction of the evaluation checklists, 20 nurse–client interactions were observed with the checklists and 20 nurse–client interactions were observed for comparison. In addition, the views of professionals, service users and user groups on the value of the checklists were sought.

Findings. Amongst the 20 clients in the intervention group, the checklists highlighted several problems, two of which were urgent. In the intervention group, the mean number of problems actioned per client increased from 0·35 (range=0–4) with no checklists to 3 (range=0–6) with the checklists. The majority (51 of 59) of actions taken to alleviate adverse effects of medication concerned physical health problems. Nurses offered appropriate advice or encouraged clients to contact the relevant agencies. No such changes were observed in the comparator group. There were no differences between groups in the number of referrals to prescribers.

Implications. The usefulness of the evaluation checklists for detecting unattended problems, in conjunction with the responses of service users, suggests that it may be clinically effective to establish procedures to systematically monitor people with serious mental illness for adverse drug reactions (ADRs). However, larger studies are needed to confirm this.
The lived experience of waiting‐to‐know: Ebola at Mbarara, Uganda – hoping for life, anticipating death
Authors: Locsin Rozzano C. , Matua Amandu Gerald
Published: March 2003

The lived experience of waiting‐to‐know: Ebola at Mbarara, Uganda – hoping for life, anticipating death

Purpose of the study. The purpose of the study was to describe the phenomenon of ‘waiting to know’. It is a phenomenon uniquely experienced by persons who had been exposed to patients with Ebola Hemorrhagic Fever (Ebola) but who have not yet exhibited signs and symptoms of the disease.

Research method/analysis. The phenomenological human science approach was used using the four life worlds as guides for reflection. These are spatiality, corporeality, temporality, and relationality.

Participants. Seven health care personnel were selected through professional networking. They were preferred because of their exposure to patients with Ebola during the epidemic at Mbarara, Uganda.

Results/findings. Written descriptions of the experience of ‘waiting to know’ whether exposure to patients with Ebola causes these participants to be infected, were obtained and analysed. Through immersion with the written descriptions, the following themes emerged: helplessness in anticipation and fear of dying or premature death; agonizing and languishing over losing relatives, friends, and loved ones; trusting no one, and; helplessness and hopelessness with the persistence of time.
A critical review of the arguments debating the role of the nurse advocate
Authors: Hewitt Jeanette
Published: March 2003

A critical review of the arguments debating the role of the nurse advocate

Aims of the paper. This paper critically reviews the arguments for and against undertaking the role of nurse advocate.

Background. Advocacy has become a popular concept in nursing literature over the past two decades. By addressing issues of power and accountability, conclusions are drawn about the risks facing nurses who would practice patient advocacy.

Methods. Review and analysis of theoretical debate.

Results. Empirical evidence is sparse and philosophical arguments predominate in the field of patient advocacy. Humanistic arguments that promote advocacy as a moral imperative are compelling. However, in reality nurses appear to lack the power base to comply except by covert means. Informed consent with a knowledge of the consequences of undertaking such an intervention is as relevant to the nurse as it is to the patient.

Conclusion. Nurses need to be empowered first, if they are to empower their patients. There may however, be more suitable candidates for the role of patient advocate and nurses should recognize that they do not have a monopoly on ethical decision making.
Synergy towards health: a nursing intervention model for women living with fibromyalgia, and their spouses
Authors: Sylvain Hélène , Talbot Lise R.
Published: March 2003

Synergy towards health: a nursing intervention model for women living with fibromyalgia, and their spouses

Aim. The purpose of this study was to develop a consensus‐based nursing intervention model for women living with fibromyalgia, their spouses and nurses working in a community health centre in Québec, Canada.

Background. Fibromyalgia syndrome, a rheumatic disorder associated with severe chronic pain and fatigue, has a major impact on the lives of individuals and their family. To date, research results on effective interventions are somewhat limited and inconclusive. Few studies take into account the perspective of those who live with this health problem on a day‐to‐day basis.

Methods. Data were collected mainly in 1999, through in‐depth interviews and through group meetings using a qualitative research design, along the lines of the constructivist paradigm. The analysis plan aims for movement between the global and the specific: synthesis and thematic analysis. Analysed data were submitted to all participants throughout the data‐collection process, thus allowing for shared constructions.

Findings. Results present the general consensus stemming from shared construction in all three groups. The nature of the intervention involves two major elements, support and teaching along with the fundamental importance of believing in the person. The timing of the intervention and the health and social context in which the intervention occurs also emerge as integral parts of the model. Synergy towards health in fibromyalgia emerges as the constitutive pattern composed of the following three elements: personal growth, spousal and professional support. The discussion addresses the model's components and uses an ecological perspective, in order to consider all the contexts that greatly influence the intervention. Empowerment is embedded in this intervention model.

Conclusions. This study shows that research based on partnership allows the integration of perspectives and skills of various actors so as to develop meaningful interventions for both those seeking care and health professionals.
Acute care nurses' perceptions of barriers to using research information in clinical decision‐making
Authors: McCaughan Dorothy , Thompson Carl , Cullum Nicky , Sheldon Trevor A. , Thompson David R.
Published: March 2003

Aim.  To examine the barriers that nurses feel prevent them from using research in the decisions they make.

Background.  A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self‐reported utilization behaviour; poor response rates and small, nonrandom sampling strategies.

Design.  Cross‐case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%).

Results.  Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, ‘academic’ and overly statistical; (2) Nurses who felt confident with research‐based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research‐based practice, rather than becoming directly involved themselves.

Conclusions.  Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy‐makers and the research community.
How prevalent is violence towards nurses working in general hospitals in the UK?
Authors: Wells John , Bowers Len
Published: March 2003

Background.  Violence in nursing is not a new phenomenon but in recent years much greater emphasis has been placed on the problem in the United Kingdom (UK). A number of official reports, media stories and national initiatives have focused attention on the problem in this country. However, it is not clear whether violence and abuse have in fact become more prevalent. At present little is known about the scale of the problem for general nurses working in general hospitals in the UK.

Aim of the study.  A realistic assessment of the scale of this problem should facilitate a meaningful debate about the interventions needed to counter it and support the requests for funding that will be required. This study aimed to establish the utility of existing research findings, to include relevant but previously unused sources and to synthesize the results.

Method.  A systematic search of the literature pertinent to the aim of the study was followed by a critical review. The focus was on research originating in the UK, including some general research on occupational violence which included data on nurses.

Findings.  Overall, the research findings are limited. The best available evidence suggests nurses as a whole do face a high level of risk compared with all workers and this excess risk holds for general nurses. The data support a figure of more than 9·5% of general nurses working in general hospitals assaulted (with or without injury) in any 1 year. Trends over time are impossible to identify at present.

Conclusions.  Efforts to combat the problem should include greater emphasis on the problem outside accident and emergency departments, prioritizing preregistration training in the management of aggression, and further research. Better reporting should also be a priority.
Nursing students' and clinical educators' perceptions of characteristics of effective clinical educators in an Australian university school of nursing
Authors: Lee Woo‐Sook (Christina) , Cholowski Krystyna , Williams Ann Katherine
Published: March 2003

Background . This study is a replication of research undertaken by Mogan and Knox in 1987, which investigated and described characteristics of ‘best’ and ‘worst’ clinical educators. They developed and used an instrument known as the Nursing Clinical Teacher Effectiveness Inventory (NCTEI), a 48 item checklist that describes discrete characteristics clustered into five subscales or categories: teaching ability; interpersonal relationships, personality traits, nursing competence and evaluation. The tool has since been used in several countries including Greece, Hong Kong, Israel and North America and is the instrument most frequently used to identify effective clinical teaching characteristics of clinical educators.

Aim . The aim of the present study was to administer the NCTEI to undergraduate nursing students and clinical educators in a school of nursing at an Australian university to explore the perceived characteristics of effective clinical educators as rated by students and educators, and the significant differences and commonalities between these perceptions.

Findings . Results indicate that the category of Interpersonal Relationships was the most highly valued characteristic rated by both Australian students and clinical educators, and both groups (students and educators) ranked the subset of personality as the lowest amongst five categories. In common with Mogan and Knox, this study found that students who had not been exposed to real clinical situations prior to commencing nursing studies ranked items related to interpersonal relationships more highly than students who had previous nursing experience. Although there were no statistically significant differences in the two groups, students were more concerned with evaluation while clinical educators were more concerned with nursing competence.

Conclusion.  This study is the first research to be reported in Australia, which has simultaneously compared both students' and educators' perceptions and the first to replicateMogan and Knox's seminal work. Findings point to the need forclinicaleducators tovalue interpersonal relationships with students as well as clinical competence.
Comfort: exploration of the concept in nursing
Authors: Malinowski Ann , Stamler Lynnette Leeseberg
Published: March 2003

Background.  Comfort is a substantive need throughout life. However, the rise of technological influence coupled with a desire to embrace the medical concept of cure has frequently relegated the importance of nursing comfort interventions to simple tasks that can be provided by non‐professional caregivers rather than an integral part of health promotion at all levels.

Definition.  Comfort is a concept that has been explored by a number of authors. Various definitions have included comfort as an outcome of nursing, a function of nursing, a basic human need, and a process. No consensus on a definition of comfort was found in the literature.

Theory.  This investigation attempts to link the ideas of comfort presented in the literature with the theories of Watson (Human Care) and Leininger (Culture Care), and discovers the existence of an integral locus for comfort in both.

Implications.  Theory‐based strategies for nursing education are offered. Further research is clearly required, research methodologies based on Watson and Leininger would be appropriate for additional exploration of this concept. Practice implications include reflecting on the meaning of comfort to the patient in the context of his/her cultural values, and using this one as one of the factors in planning and implementing nursing care.

Conclusion.  Given the current emphasis on health promotion and the importance of comfort to the process of healing, comfort is an indispensable element of holistic, culturally congruent human care.
Motivation for health behaviours: a systematic review of the nursing literature
Authors: Carter Kimberly F. , Kulbok Pamela A.
Published: March 2003

Aims and rationale.  This research review examines nursing and allied health studies exploring motivation for health behaviours to identify the state of understanding of this construct within nursing. This review contributes to nursing science by synthesizing nursing research regarding motivation for health behaviour.

Methods.  Integrative research review methodology.

Findings.  Problems of existing research include nonprobability sampling of heterogeneous populations, low statistical power, and colinearity. Studies identifying predictors of motivation explained large proportions of variance using regression. Motivation was not a significant predictor of health behaviours for over one‐third of the studies. Overall, the studies suggest that either motivation is not being effectively measured because of a lack of conceptual clarity or that motivation is not an essential determinant of health behaviours. The latter cannot be verified until psychometric research advances current measurement of motivation to a higher level.

Limitations.  The literature for this review was accessed through the Cumulative Index of Nursing and Allied Health Literature (CINAHL) database. Databases for other disciplines were not included in this search. This work represents a first step towards understanding motivation for health behaviour as it is currently defined in the literature. Future studies are necessary to broaden this understanding beyond nursing.

Conclusions.  Motivation is a frequently cited rationale underlying the adoption and maintenance of health behaviours in research and practice. Motivation is complex and multidimensional, and clearer definitions for motivation are needed. Populations that have been underrepresented in motivation research need to be targeted in future research. Researchers and practitioners are challenged to examine carefully the role of motivation for health behaviours and explore other factors that may more strongly influence health behaviours.
Sociological and psychological theories of self‐neglect
Authors: Lauder William , Anderson Isobel , Barclay Aileen
Published: March 2003

Background. Self‐neglect can be defined as the failure to engage in those self‐care actions necessary to maintain a socially acceptable standard of personal and household hygiene and/or a failure to adequately care for one's own health. It is generally acknowledged that research and practice in the area of self‐neglect has been hampered by a lack of theoretical development. Socio‐psychological theories, such as ‘social constructivism’ and ‘negotiated interactionism’ can contribute to a deeper understanding of the phenomenon and to the further development of self‐neglect theory.

Aims. This paper seeks to apply social and psychological theories to understanding self‐neglect. Self‐neglect is an underconceptualized phenomenon, which requires to be studied within a broader theoretical context than is at present the case.

Implications. Sociological and psychological theories offer radically different ways of looking at self‐neglect, as opposed to the medical model, as they seek to explain and understand, rather than simply classify it as a medical disorder caused by some form of underlying psychopathology. These theories emphasize the dynamic and interpretative nature of self‐neglect and illustrate the arbitrary way in which this label is applied.
Nursing knowledge and assessment skills in the management of patients receiving analgesia via epidural infusion
Authors: Bird Annette , Wallis Marianne
Published: March 2003

Background.  In Australian hospitals, epidural infusions are commonly used for the management of post‐operative pain in maternity and surgical patients, with little research evidence to indicate the efficacy of the educational preparation of nurses undertaking pain management.

Aims.  To describe nurses' assessment skills and knowledge related to the management of a patient with an epidural infusion and to explore relationships between these variables and the levels of education/clinical experience of the nurses.

Methods.  This descriptive correlational study used a convenience sample of surgical and obstetric unit registered nurses to explore relationships between the knowledge and skill in epidural management and the educational preparation of the nurse. Data were collected via survey and observation, using instruments developed by the research team.

Results.  The nurses had a good knowledge base for the performance of sensory blockade assessment but scored less well in motor blockade assessment and clinical decision‐making. Nurses who had clinical experience, had completed a self‐ directed learning package and who worked in surgical areas scored higher on the survey than other nurses. Observation scores revealed a range of performance outcomes. There was only a weak correlation between knowledge and skill performance. There were no differences in scores for the observation exercise for different groups of nurses.

Conclusion.  The results of this study indicated that the nurses' theoretical knowledge outweighed their clinical skill performance and clinical decision‐making. Education for nurses regarding the management of epidural infusions needs to be comprehensive, context specific and have the capacity to develop the nurse's autonomous critical thinking and clinical decision‐making skills. Strategies for this include self‐directed learning packages best supplemented by a demonstration of clinical skills and supervised practice.
Decision‐making in primary care: outcomes from a study using patient scenarios
Authors: Offredy Maxine
Published: March 2003

Background.  Various documents emphasize the importance of new roles and new ways of working to modernise delivery of health service and improve the public's health. In particular nurse practitioners are seen as crucial in the modernization process.

Aim.  This paper reports the outcomes of a study conducted in 1998 to ascertain the differences, if any, in the decision‐making processes of nurse practitioners and general practitioners for diagnosis and treatment when given the same patient scenarios.

Methods.  Information processing theory together with ‘think aloud’ approach were used to understand the cognitive processes of the 22 participants, 11 general practitioners and 11 nurse practitioners, in the study. A reference model was developed for each of the six scenarios of the study; three medical photographs were also used. The data were analysed using NUD*IST computer software.

Results.
 The outcomes of each scenario are presented and comparisons are made with general practitioners. The results show that there were more similarities than differences in the decision‐making processes of the two groups. Hypothesis evaluation appears to be
the critical component in the decision‐making process. Explanations given by the two groups at the end of their ‘think aloud’ procedure justify their diagnoses and treatment/management plans.

Conclusions.  The research adds to existing evidence that encourages health care providers to use nurse practitioners more flexibly and to develop service‐based approaches to the delivery of health care as set down in government policies. It also adds to the body of literature using information processing theory because it demonstrates that the two groups use similar decision‐making processes to arrive at similar diagnoses and treatment options.
Implementation of the pain and symptom assessment record (PSAR)
Authors: Bouvette Maryse , Fothergill‐Bourbonnais Frances , Perreault Annie
Published: March 2003

Background.  Symptom control is a major component of care for the terminally ill patients. Although uncontrolled pain is distressing for patients and families, there are other symptoms that can be distressing such as dyspnea and fatigue. Determining methods to consistently assess and manage pain and other symptoms is a challenge for nurses, physicians and other health care professionals. In the Ottawa Region of Canada, health care providers raised concerns related to inconsistencies in pain assessment due to a variety of formats used, as the patient moved through the health care system. Recognizing the need for a common assessment tool, a working group was formed composed of 14 nurses associated with institutions and agencies delivering palliative care services in the Ottawa region, as well as a faculty member of the School of Nursing of the University of Ottawa. The mandate of the working group was to develop a consistent method to assess patients' pain and symptoms in order to facilitate communication among health care professionals within various health care settings. The Pain and Symptom Assessment Record (PSAR) was developed over 24 months.

Aim.  To determine the feasibility of implementing the PSAR in a variety of settings.

Methods.  This exploratory study used focus groups and chart audits to gather data related to the utility of the PSAR. Education sessions were used to introduce the tool to nurses in the various settings.

Results.  The tool was implemented in 12 settings. Thirty‐seven education sessions were given to nurses prior to use of the tool and the feedback revealed that this is an important process in tool introduction. The results of the chart audits indicated that pain was assessed 93% of the time. Symptoms were less documented but fatigue was most prominent. Overall, patients were satisfied with their pain and symptom control. Data from the focus groups were analysed using content analysis and the two themes that emerged related to the tool were ‘structure’ and ‘process’.

Conclusion.  There were many challenges in this project and lessons learned will be discussed. Based on the results, the tool has been modified and is currently utilized in diverse settings.
Patient injury and physical restraint devices: a systematic review
Authors: Evans David , Wood Jacquelin , Lambert Leonnie
Published: March 2003

Objective.  To investigate physical restraint‐related injuries. Areas of interest were the prevalence of injury, types of injuries, risk of sustaining an injury and specific restraint devices associated with injury.

Definitions.  Injury in the context of this review was considered to be either direct injury, such as lacerations and strangulation, or indirect injury considered to be an adverse outcome such as increased mortality rates or duration of hospitalization.

Method.  A comprehensive search was undertaken that involved all major databases and the reference list of all relevant papers. To be included in the review studies had to involve people in acute or residential care settings and report data related to injury caused by restraint devices. A number of different types of research designs were included in the review. The findings of studies were pooled using odds ratio and narrative discussion.

Results.  The search identified 11 papers reporting the findings of 12 observational studies. These studies were supplemented with the findings of a number of other types of studies that reported restraint‐related data. The review highlights the potential danger of using physical restraint in acute and residential health care facilities. Observational studies suggest that physical restraint may increase the risk of death, falls, serious injury and increased duration of hospitalization. However, there is little information to enable the magnitude of the problem to be determined.

Discussion.  Many of the findings highlight the urgent need for further investigation into the use of physical restraint in health care facilities. Further research should investigate the magnitude of the problem and specific restraint devices associated with injury. However, given the limited nature of the evidence, this association should be investigated further using rigorous research methods.
Living on dialysis: concerns of clients in a renal setting
Authors: Polaschek Nick
Published: March 2003

Background.  This article reports a study that sought to understand the experience of a group of Caucasian men with end stage renal failure managing their own haemodialysis therapy in their homes.

Methodology.  The study used a critical interpretive methodology. The renal setting was critically viewed as a specialized health care context constituted by several interrelated discourses. Although established by the dominant professional discourse, it also includes a number of others, in particular an obscure client discourse that is a response to the dominant discourse.

Methods.  Initially participants' own interpretations of their individual experiences were outlined. These were then collectively reinterpreted by contextualizing them in terms of the critical view of the renal setting, in order to discern their own views as renal clients that were obscured by the language and ideas of the dominant discourse with which they had been enculturated.

Findings.  From an analysis of the set of accounts derived from interviews with six participants, four concerns of the renal client discourse were identified. Together these model their shared perspective, which underlies each of their individual accounts of their experience of illness and therapy. These concerns were: (1) suffering from continuing symptoms of end stage renal failure and dialysis; (2) limitations resulting from negotiating dialysis into their lifestyle; (3) ongoingness and uncertainty of life on dialysis; and (4) altered relationship between autonomy and dependence inherent in living on dialysis.

Conclusion.  One specific implication of this study is that the distinctive potential of the nursing role in renal settings lies beyond the performance of a range of technical tasks, in addressing the experience of people living on dialysis, described here as the concerns of the renal client discourse.
Older people in persistent pain: nursing and paramedical staff perceptions and pain management
Authors: Blomqvist Kerstin
Published: March 2003

Background. Persistent pain is a common problem for older people. Knowledge about how nursing and paramedical staff perceive these people and what they do to relieve the pain seems scarce.

Aim. To explore nursing and paramedical staff perceptions of older people in persistent pain and their day‐to‐day management of pain.

Methods. Interviews in Swedish with 52 nursing auxiliaries, Registered Nurses, physiotherapists and occupational therapists were collected from February to May 2000. The analysis was based on their stories (n = 150) about older people in persistent pain who received help in their own homes or in special accommodation. A typology of staff perceptions of pain in older people was developed. Activities to manage pain were examined using content analysis.

Results. Respondents perceived the pain as real, exaggerated, trivial, care‐related, endured, concealed, self‐caused or inarticulate. Older people perceived as exaggerating the pain, those with care‐related and self‐caused pain evoked frustration in the staff, while those perceived as enduring their pain evoked satisfaction. Various strategies to manage pain were used: no activity, medication, mediating contacts, distracting activities, physical therapies, mobility, work in a gentle way, rest or relieving pressure on body part, and communication concerning pain. The activities differed between the types, as well as between staff with different professional backgrounds.

Conclusion. Care and treatment provided by staff should be based on older people's needs rather than on staff attitudes and preferences. The typology revealed that staff perceived older people in pain as a heterogeneous group and that their perceptions affected the pain‐relieving activities that were offered. It seems urgent to address how to handle pain in older people who never complain and those who complain a great deal, as well as how to handle pain in people with impaired communicative ability. Reflective discussions on feelings related to different individuals are needed.
Nurse cadet schemes in the British NHS – challenges and opportunities
Authors: Culley Lorraine , Genders Nicky
Published: March 2003

Rationale. Nurse cadet schemes are locally developed initiatives which prepare participants for entry to preregistration nurse education. The paper discusses the political context in which modern day nurse cadet schemes have developed in the British National Health Service and explores the diversity of schemes currently operating in the United Kingdom (UK).

Background. Nursing recruitment is a high priority for the National Health Service in the UK which, in common with many countries, is facing a nursing shortage. In addition, the government is committed to increasing flexibility in the education and recruitment of staff. The entry gate to health professional education needs to be widened to improve access for hitherto under‐represented groups.

Methods. The paper provides a critical commentary on key issues in the development of nurse cadet schemes as discussed in a range publications, together with information gathered from ‘grey’ literature and personal contacts in nurse education. A wide range of health care and social science databases was used to collect material for the discussion.

Findings. Approximately 800 cadets are currently engaged in around 60 cadet schemes in a number of localities in Britain, and it is proposed that these will be expanded to over 2000 nurse cadets by 2004. Nurse cadet schemes have developed to meet local needs and priorities and, in the absence of a strong national framework, a wide diversity of participants, curricula and funding arrangements have emerged.

Conclusions. Serious consideration needs to be given to further standardization in the structure and funding of schemes to reduce the degree of inequality which currently exists for cadets, together with development of national benchmarks to ensure that a set of minimum standards is met. Any future development must be built on a systematic evaluation of current schemes, which has yet to be undertaken.
Population dynamics of the Indian meal moth: demographic stochasticity and delayed regulatory mechanisms
Authors: Bjørnstad Ottar N. , Begon Michael , Stenseth Nils ChR. , Falck Wilhelm , Sait Steven M. , Thompson David J.
Published: March 2003

1.  Laboratory populations of the Indian meal moth [Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae)], undergo sustained periodic fluctuations in abundance. The period is just longer than the generation time. The fluctuations are accentuated in the presence of the P. interpunctella granulosis virus (PiGV).

2.  Time series spanning 8–10 generations from three replicate populations of the virus‐free (VF) system and three from the virus‐infected (VI) system are investigated using nonparametric autoregressive time series models.

3.  The dynamics are concluded to correspond to a third order process consistent with interactions in a three‐dimensional stage‐structured model for both systems. The functionally different interactive stages are believed to be the egg stage (preyed upon by larvae), small larvae (competing for resources and cannibalized by large larvae) and large larvae (competing for resources).

4.  The virus is seen as a modulator of the host vital rates more than an independent agent in a trophic host–pathogen interaction. The virus increases developmental time and decreases fecundity of the moths.

5.  A significantly nonlinear additive autoregressive model of order 3 appears to give a parsimonious description of the series.

6.  The demographic (birth and death) nature of the stochasticity inherent in the system is explicitly incorporated in the statistical model for the time series by assuming an overdispersed Poisson process. The variability around the skeleton is found to conform closely to this assumption. The demographic nature of the stochasticity cannot be fully understood on the basis of Gaussian (least‐squares) models on transformed (variance‐stabilized) data.

7.  Significant density dependencies are found at a 1‐week lag, a 2‐ to 3‐week lag and at a 6‐ to 7‐week lag. These are argued to be the signatures of within‐stage competition, between‐stage interactions and reproduction, respectively. Negative and statistically significant density dependence is apparent for the first two of these. No significant negative density dependence is apparent in the lag corresponding to reproduction.

8.  The fluctuations in both the VF and VI system appear to represent limit cycles or weakly dampened cycles clothed by Poisson demographic stochasticity.

9.  The enhanced cycles of the VI system are demonstrated to be consistent with a situation where the functional forms for the interactions are nearly the same as for the VF, but with delay structure shifted by just less than a week.
Non‐geographically based population structure of South Pacific sperm whales: dialects, fluke‐markings and genetics
Authors: Whitehead Hal , Dillon Mary , Dufault Susan , Weilgart Linda , Wright Jonathan
Published: March 2003

1.  This study addresses the issue of structure in sperm whale (Physeter macrocephalus Linnaeus) populations and whether it is geographically based.

2.  During a survey around the South Pacific Ocean, we collected sloughed skin for genetic analyses, recorded coda vocalizations, and photographed fluke markings.

3.  Groups of female and immature sperm whales had characteristic mitochondrial haplotypes, coda repertoires, and fluke‐mark patterns, but there was no clear geographical structure in any of these attributes.

4.  However, similarities of coda repertoire and mitochondrial haplotype distribution were significantly correlated among pairs of groups in a manner that was not geographically based. There was also a significant canonical correlation coefficient between coda repertoire and fluke‐mark patterns.

5.  These results suggest that attributes (such as vocal repertoire and techniques of predator defence) which are acquired matrilineally, and probably culturally, are conserved during the fission and dispersal of groups.
Non‐interactive fish communities in the coastal streams of North‐western France
Authors: OBERDORFF THIERRY , HUGUENY BERNARD , COMPIN ARTHUR , BELKESSAM DJAMILA
Published: March 2003

1.  Spatial patterns of freshwater fish species at regional and local scales were investigated to explore the possible role of interspecific interactions in influencing distribution and abundance within communities occupying coastal streams of North‐Western France.

2.  Nine sites from nine streams situated in the same biogeographical region were sampled annually over the 6‐year period from 1990 to 1995.

3.  Similar habitats (sites) with richer regional colonization pools exhibited proportionally richer local communities in terms of number of species, total density and total biomass of individuals. Furthermore, no negative relationships were found between density and biomass of each of the most common species and local species richness.

4.  Results of dynamic regression models (applied to the above‐mentioned species) suggest an absence of strong competition between all pairs of species.

5.  The evidence on lack of density compensation for species‐poor communities and absence of perceptible interspecific competition between species suggest that the communities studied are non‐interactive.

6.  Two main explanations can be advanced. First, the local abundance of species in the communities studied could be determined through differential responses to unpredictable environmental changes, rather than through biological interactions. Second, as a result of historical events, the communities studied are reduced in congeneric species which can limit, in turn, the influence of interspecific competition in structuring these communities.

7.  These results underline the strong influence of regional processes in shaping local riverine fish communities and minimize the possible influence of species interactions in governing these communities.
Local trophodynamics and the interaction of marine mammals and fisheries in the Benguela ecosystem
Authors: YODZIS PETER
Published: March 2003

1.  A method for finding the consequences of long‐term generalized press perturbations in multispecies ecological communities, with relatively modest requirements for data, is explicated. The approach uses energetic and allometric reasoning to set some parameter values for which data are not available. The remaining unknown parameters are treated as random variables, enabling the calculation of probability distributions for the outcomes that are of interest.

2.  The method is used to investigate the effect of a cull of fur seals on fisheries in the Benguela ecosystem, using a 29‐species foodweb for that system. In the case of Cape fur seals treated here, it is found that a cull of seals is more likely to be detrimental to total yields from all exploited species than it is to be beneficial.

3.  The influence of weak links on the effects of a cull is investigated. Using both consumption by each species and consumption of each species to define link strength, a clear threshold in link strength is found, indicating that 44% of all links could be deleted from the foodweb without affecting the predictions significantly. Even using a criterion based on consumption by each species alone (conventional dietary proportion data), about the same number of links can be deleted without seriously affecting the predictions of the model. This is a very helpful (and encouraging) result for the design of an observational protocol for systematic efforts to gather data for multispecies modelling.
Sampling effort, regression method, and the shape and slope of size–abundance relations
Authors: Griffiths David
Published: March 2003

1. Despite a substantial body of work there remains much disagreement about the form of the relationship between organism abundance and body size. In an attempt at resolving these disagreements the shape and slope of samples from simulated and real abundance–mass distributions were assessed by ordinary least squares regression (OLS) and the reduced major axis method (RMA).

2. It is suggested that the data gathered by ecologists to assess these relationships are usually truncated in respect of density. Under these conditions RMA gives slope estimates which are consistently closer to the true slopes than OLS regression.

3. The triangular relationships reported by some workers are found over smaller mass and abundance ranges than linear relations. Scatter in slope estimates is much greater and positive slopes more common at small sample sizes and sample ranges. These results support the notion that inadequate and truncated sampling is responsible for much of the disagreement reported in the literature.

4. The results strongly support the notion that density declines with increasing body mass in a broad, linear band with a slope around −1. However there is some evidence to suggest that this overall relation results from a series of component relations with slopes which differ from the overall slope.