bluuebunny/crossref_metadata_2025 huggingface dataset:
The intake of nutrients by hospitalized pensioners with chronic wounds
Authors: Sitton‐Kent Lucy , Gilchrist Brian
Published: March 2003

Three issues concerning nutrition in hospital are frequently highlighted in nursing literature the risk of elderly patients becoming malnourished, the lack of adequate nutritional care provided by nurses and the importance of certain nutrients in the process of wound healing This detailed study of seven subjects on care of the elderly wards examined their intake of certain important nutrients The findings are discussed in relation to the Department of Health's Estimated Average Requirements (1991) and the achievement of an optimum wound healing environment The results add further to the evidence that many patients do not consume sufficient levels of nutrients and in some cases did not even receive adequate quantities of these nutrients on their plates Nurses’ nutritional care was limited in most cases and no subjects received an optimum nutritional environment for wound healing
Underpinnings of ethical reasoning in nursing
Authors: Gibson Cheryl H
Published: March 2003

Nursing is a manifestation of a value according to which it is morally good to promote physical and psychological well‐being Such a moral obligation involves making judgements Ethical judgements are the decisions a person makes on whether a particular act is right or wrong Ethical principles serve as the basis for ethical rules and as a framework for decision‐making Ethical theory provides a rationale that explains the principles and rules in order to provide a structured approach to ethical reasoning Although ethics is not a science with verifiable answers, a knowledge of ethical theory enables nurses to make decisions in a manner that is more comprehensive and well reasoned than is opinion or intuition In this paper, an overview of ethical theories, ethical principles and influences on ethical or moral reasoning is presented as well as the ethical decision‐making process
The characteristics and management of patients with recurrent blockage of long‐term urinary catheters
Authors: Getliffe Kathryn A
Published: March 2003

Encrustation and the subsequent blockage of indwelling urinary catheters is a common problem affecting up to 50% of long‐term catheterized patients For community patients, the resultant urinary bypassing or painful retention is particularly distressing since professional help is not immediately available Catheter blockage also places increased demands on nursing time and resources A prospective longitudinal studyof 47 community patients with long‐term catheters was conducted Demographic, dietaryand catheter‐care data were collected, and biochemical and microbiological urinalysis conducted Catheters were changed on three occasions, after 6‐week intervals, and the extent of encrustation examined The results indicated that patients can be classified as‘blockers’and‘non‐blockers’‘Blockers’produced two or more blocked catheters and were characterized by high urinary pH and ammonium concentration‘Blocker status’was also significantly associated with female sex and with poor mobility, but not with fluid intake and urinary output‘Blockers’were generally managed by‘crisis care’in response to leakage or retention, rather than by planned recatheterizations prior to catheter blockage Recognition of individual patients as‘blockers’and the establishment of a‘pattern of catheter life’would be useful to planning individualized care
Writing a philosophy of nursing?
Authors: Uys L R , Smit J H
Published: March 2003

Nurses in education and management settings are often required to write a philosophy for the facility In this paper, the use of the concept of‘philosophy’in nursing education and nursing management is explored The nature of philosophy is then outlined, with specific reference to its relationship with a special science such as nursing In the light of this discussion, the real nature of the document that nursing authors call a‘philosophy’is discussed The concepts of a life and world view and a mission statement are discussed in this regard Specific proposals are then made for nurses in approaching the task of producing this planning document
A philosophical analysis of the concept of reassurance and its effect on coping
Authors: Farced Asraf
Published: March 2003

The phenomenon of‘reassurance’ is an attribute of caring that is commonly used in the delivery of nursing care If caring is considered central to the concept of nursing, a case is made that the therapeutic value of reassurance needs to be analysed This paper addresses this issue from a phenomenological viewpoint Definition of the concept of reassurance is first analysed, highlighting the complexity of its meaning as it is commonly used in nursing practice, and an attempt is made at examining its effects on coping
Training and education for nurses working in neonatal care
Authors: Redshaw M E , Harns A
Published: March 2003

The issue of nurse education and training in the context of providing a high‐quality service for sick and small babies and their families is a paramount concern As part of a large‐scale study of neonatal nursing in the United Kingdom, data were collected on nurses’ educational background, professional qualifications, experience, orientation, appraisal and update The results reveal a qualification in specialty (QIS) rate for trained nurses of 53% and large variation not directly related to size or type of unit The proportion of nurses having appraisal interviews (47% in the last year) and professional development plans (19%) was low and a clear gap existed between policy and practice The implications of the findings are discussed and the need for management training, targeting of neonatal units with low QIS rates, and more flexible education programmes are emphasized
The process of social support: adjusting to life in a nursing home
Authors: Patterson Barbara J
Published: March 2003

This study was designed to explore the process of social support during the course of adjusting to life in a nursing home Qualitative data were gathered, through four sequential interviews of residents newly admitted to a nursing home, and from 12 months of participant observation in the setting Residents' perceptions of supportive and non‐supportive behaviours and their sources were identified and described The findings indicated negligible change in perceptions of type or source of support over time Emotional support and practical assistance emerged as the primary supportive and non‐supportive behaviours from others, mainly nursing staff Advice/guidance support was not mentioned Residents who had lived in the nursing home for more than 1 year differed from new residents in the ability to extend support to others Support interventions are suggested
Preserving self: from victim, to patient, to disabled person
Authors: Morse Janice M , O'Brien Beverley
Published: March 2003

Open‐ended, unstructured interviews were conducted with patients who had survived serious traumatic injury, and their experiences from impact to recovery analysed using grounded theory A four‐stage process of ‘vigilance’, ‘disruption’, ‘enduring the self, and ‘striving to regain the self was delineated The basic social psychological process of’ preserving self explained the strategies used in each stage, and required deliberate action, focused energy and tremendous effort and will The strategies used to preserve self changed in each stage of the model At the beginning, when physical survival was in jeopardy, the strategies were primarily physical Protecting self was a process of ‘taking time out’ and of shutting down, in the stage of disruption In the stage of enduring the self, it was passively learning to ‘take it’ and to bear the treatments Finally, in the stage of striving to regain the self, preserving the self was the work of regaining and redefining the self as a disabled person
Humpty Dumpty: reflection and reflective nursing practice
Authors: Richardson Rosemary
Published: March 2003

The recent increase in the amount of published work relating reflection and reflective practice to nurses and nursing practice suggests that nurses value the opportunities which this approach is believed to provide There also appears to be an underlying assumption that we all share the same concepts, hence the association with Humpty Dumpty Indications of attempts to mechanize the processes and to endow the perceived skills with an élitism are becoming evident In contrast, there are other attempts to foster the notion of accepting uncertainty, unpredictability and the opportunity for increased understanding to emerge In this paper, the roots of some of these concepts are traced The appropriateness of traditional values and assumptions, based on natural science perspectives, in relation to reflective processes and the practice of nursing is questioned The development of a multi‐faceted approach which takes account of differing contexts and the factors which influence them is suggested
Towards an individualized client's care: implication for education. The transcultural approach
Authors: Abdullah Suraya Noraidah bte
Published: March 2003

The nursing profession is faced with the challenging role of providing individualized client care within the context of the whole person Individualized care cannot be achieved without considering the factors associated with the personal being, such as culture, beliefs and tradition As nurses interact with clients from various cultural backgrounds, the need to consider and be aware of their own values is essential to enable them to provide unbiased care Nurse education plays a major role in developing individuals who are able to examine their own views with regards to cultural biases The importance of acknowledging other cultures as opposed to the nurses’ own is essential in order to ensure that the knowledge learnt will enhance the qualities of caring, competence and professionalism This is necessary because cultural context is viewed according to how it is perceived by the clients and the nurses themselves
The philosophy and physics of holistic health care: spiritual healing as a workable interpretation
Authors: Patterson Elissa F.
Published: March 2003

Holism is spoken of frequently in the nursing and medical press, linked with alternative or complementary practices, but on examination appears to have much greater depth. There would appear to be many interpretations of the term, many of which are not made explicit within an article. Holistic health care can only be interpreted in relation to an individual’s perception of holism. This discussion asks that thought be given to what we perceive as reality, and where ‘whole’ begins and/or ends, using a brief, simple review of quantum theory as the basis for the discussion. The concept of spiritual healing, without any religious basis, is introduced in support of a personal interpretation of holistic care.
Working with team midwifery: health visitors’ views of one team midwifery scheme
Authors: Farquhar Morag , Camilleri‐Ferrante Corinne , Todd Chris
Published: March 2003

The fragmented nature of maternity services in the UK has led to the introduction of various forms of team midwifery scheme. The aim of such schemes is usually to increase continuity through the provision of antenatal, intrapartum and postnatal care to women by a small team of midwives. Few published studies of this organization of midwifery care exist, and even fewer consider the impact of such schemes on related health professionals. This paper presents the results of an independent survey of health visitors working alongside one team midwifery scheme in the south‐east of England. Eighty per cent of the health visitors thought that team midwifery was a good idea in theory; however, just 27% thought it was working well locally and 70% reported that they would like to go back to working in the way they did before the introduction of team midwifery. The survey highlighted the health visitors’ concerns in relation to team midwifery locally. Two issues were paramount: firstly a reported deterioration in interdisciplinary communications, and secondly a perceived loss of continuity for the women. Thus team midwifery, as implemented in this locality, may not attain the goals aimed at by the organization of care in this way.
Embracing ambiguities and valuing ourselves: issues of validity in action research*
Authors: Waterman Heather
Published: March 2003

Further elucidation is required on the validity of action research. The tendency of nurse action researchers to rely on perspectives of validity from qualitative or ethnographic research only gives a partial picture. Three categories of validity regarding action research are proposed in order to develop understandings and to stimulate debate: dialectical, critical and reflexive. Tensions and processes, moral responsibilities, reflexivity and accounts of action research are discussed to illuminate the validity of action research. The complexity and contradictions inherent even when attempting to demonstrate its validity are highlighted and illustrated with reference to examples of action research.
Allowing and assisting patients to die: the perspectives of oncology practitioners
Authors: Pierce Susan F.
Published: March 2003

Allowing and assisting patients to die: the perspectives of oncology practitioners

The moral distinctions between prolonging life, allowing for a dignified death, and assisting patients to die (hastening death) are troublesome to health practitioners. On 26 June 1997 the United States Supreme Court ruled that individuals do not have a constitutional right to physician‐assisted suicide, but that individual states can legislate their preferences. Given this ruling it becomes important to ascertain the opinions of practitioners caring for persons who are at the end of their life. The data from interviews with 11 nurses and 10 physicians, who practice in the field of oncology, revealed issues associated with the care of dying persons. How health professionals integrated their perspectives of science/data with their perspectives on persons and personal goals affected the vigour with which they would institute treatment for the terminal patient. Further, ethical uncertainty dominated the decision making of all participants in this study when they were confronted with the question of assisting/hastening patients’ dying.
Experiential learning: issues for supervision
Authors: Dewar Belinda Jane , Walker Esther
Published: March 2003

Experiential learning: issues for supervision

This paper reports on an evaluation of work‐based learning within a postregistration community health nursing degree programme. Work‐based learning is primarily concerned with the process of learning and with encouraging the individual to be explicit about how and what they learn so that their experiential learning may be assessed and accredited. The methodology of Illuminative Evaluation was adopted, with case studies (n=6) used as the means of exploring in depth the different perspectives of the major stakeholders (that is, the students, their workplace supervisors and their academic supervisors). The data comprised documentation, participant and nonparticipant observation, interviews and focus groups. The initial aim was to examine the potential benefits of work‐based learning to students and to describe its impact on their practice. However, what emerged through the course of inquiry was a gap between the educational philosophy of work‐based learning and the way in which work‐based learning was delivered within the department concerned. Work‐based learning provides educators with an opportunity to debate openly fundamental issues about the nature of educational practice; in particular, about the role of the supervisor in facilitating students’ learning. As the evaluation highlights, if this debate does not occur, existing educational practice remains unchanged and the potential benefits to students of this new educational philosophy are not realized. Furthermore, it is by engaging in a reflective process in relation to their own experience that educators can begin to understand how to facilitate that process in others.
Critical thinking and nursing scripts: the case for the development of both
Authors: Greenwood Jennifer
Published: March 2003

Critical thinking and nursing scripts: the case for the development of both

It is argued that contemporary nursing education’s emphasis on the conscious development of nurses’ critical reasoning skills fails to take account of the complexity of both human cognition and clinical nursing practice. Human cognition centrally includes unconscious or tacit processes and clinical nursing practice is typified by the simultaneous presentation of clinical and non‐clinical cues and competing clinical goals. Contemporary emphases on conscious critical thinking are largely consistent with the differing theoretical frameworks which have informed the study of nurses’ clinical reasoning in the last 30 years, most of which permit the use of simulated case study. These frameworks, that is, decision theory, information processing and skills acquisition theory, are described and their limitations highlighted. In addition, an alternative theor‐ etical framework, that of schema or script theory, which does take account of the complexities of cognition and practice, is discussed. Its implications for nursing practice and education are also outlined.
School nursing: costs and potential benefits
Authors: Cotton Linda , Brazier John , Hall David M.B. , Lindsay Geoffrey , Marsh Peter , Polnay Leon , Williams T. Sim
Published: March 2003

School nursing: costs and potential benefits

Background. Previous reports that variations in school nursing resources across the UK had no relationship to deprivation; controversy about the changing role of the school nursing service.

Objectives. To measure the resources allocated to school nursing, determine whether the variations can be explained by deprivation, and assess whether the allocation of school nursing time to a range of tasks is in line with current evidence and perceptions of changing needs.

Study design. Quantitative economic analysis; qualitative descriptive study.

Setting. Detailed study of four English districts with diverse characteristics; staffing and service questionnaire and telephone survey of 62 districts.

Main measures. Staff resources and their salaries; measures of population and deprivation; activity statistics.

Results. There were wide variations in the cost of the school nursing service, but in contrast to previous reports 24% of the variance was explained by deprivation. There were no clear associations with any other social or educational variables. The greatest allocation of time was in routine screening and surveillance tasks. Relatively little time was allocated to other activities such as health promotion, support of special needs or unwell children, or teenage clinics. The expenditure on school nursing is only loosely related to deprivation and the results of this study offer guidance on what districts should spend to achieve equity of provision.

Conclusions. The current allocation of resources to school nursing in between districts comparisons is not equitable and the use of school nursing time is out of step with current evidence of need and effectiveness.
Disability, nursing research and the importance of reflexivity
Authors: Northway Ruth
Published: March 2003

Disability, nursing research and the importance of reflexivity

Reflexivity has been viewed as a way of promoting quality within the research process. Its importance is highlighted in both the literature concerning nursing research and that which relates to disability research. However, whilst disabled people comprise a key client group for nurses the need for nurse researchers working in this field to adopt a reflexive approach to their work has not been explored in depth. In this paper the relevance of reflexivity to nursing research is discussed and current debates concerning disability research are explored. It is argued that there are particular reasons why it is necessary for nurse researchers to adopt a reflexive approach when focusing on disability. First, there is a need to examine closely the definitions of disability which underpin our research and practice. Second, it is noted that nurse researchers may be viewed as part of a system which disables people with impairments. Finally, it is important to reflect critically upon whose interests are served by such research. Some strategies for promoting reflexivity are also explored. It is concluded that a failure to address these issues via a process of critical reflection may mean that nursing research is viewed as unhelpful by disabled people. This in turn has implications for nursing practice.
Nurses and whistleblowing: the ethical issues
Authors: Wilmot Stephen
Published: March 2003

Nurses and whistleblowing: the ethical issues

Whistleblowing – the public exposure of organizational wrongdoing – presents practical and ethical dilemma for nurses, and needs to be seen as part of a spectrum of increasingly confrontative actions against miscreant organizations by their employees. The ethics of whistleblowing can only be understood in relation to its moral purpose, whether that is to achieve a good outcome (a consequentialist view) or fulfil a duty (a deontological view). The consequentialist perspective is unable on its own to resolve problems arising from the balance of good and harm resulting from the act of whistleblowing (where considerable harm might be caused) or of responsibility for that harm. A deontological approach provides an analysis of these problems but raises its own problem of conflicting duties for nurses. However, a strong argument can be made for the precedence of the nurse’s duty to the patient over her duty to the employer. Although both duties are based on an implicit or an explicit promise, the promise to a person (the patient) must take precedence over the promise to an organization. It can even be argued that duty to the employer may in fact justify whistleblowing by nurses in some circumstances. However, the consequences of whistleblowing are forced upon nurses in a different way by the fact that the danger of reprisals acts as a deterrent to whistleblowers, however justified their actions may be. A more robust approach to the protection of whistleblowers is needed on the part of the government and the National Health Service (NHS) to remedy this situation.
Development of a theoretical framework describing relatives’ involvement in palliative care
Authors: Andershed Birgitta , Ternestedt Britt‐Marie
Published: March 2003

Development of a theoretical framework describing relatives’ involvement in palliative care

Background. The present study is based on four earlier studies in which the authors classified the relative’s involvement in palliative care into different categories and described the involvement as ‘involvement in the light’ or ‘involvement in the dark’.

Aim. The aim of the study was to develop a theoretical framework concerning the involvement of relatives based on an in‐depth analysis of the results of the four earlier studies.

Method. Walker & Avant’s (1995) strategies for theory construction were used for development of the framework. A number of different concepts, assumptions and statements about relatives’ involvement were penetrated in an in‐depth analysis.

Results. From the concepts two theoretical ‘blocks’ of the relatives’ involvement were developed and these constitute the foundation for the framework. One is based on concrete descriptions of the concepts ‘to know’, ‘to be’ and ‘to do’. The other describes how the concepts of ‘involvement in the light’ and ‘involvement in the dark’ differ. Factors that promoted involvement in the light were professional care based on humanistic values, a stronger sense of coherence on the part of relatives, an appropriate illness trajectory, and other available resources. The opposite was the case for those who were involved in the dark. Five assumptions successively developed which together form the theoretical framework.

Conclusions. An important conclusion that can be of importance in palliative care is that the manner in which the staff act toward the patient and relatives influence relatives’ possibilities for involvement, patients’ possibilities for an appropriate death, and the possibilities the staff have to give good care.
Expanding the enablement framework and testing an evaluative instrument for diabetes patient education
Authors: Stamler Lynnette Leeseberg , Cole Mary M. , Patrick Linda J.
Published: March 2003

Expanding the enablement framework and testing an evaluative instrument for diabetes patient education

Background. Strategies to delay or prevent complications from diabetes include diabetes patient education. Diabetes educators seek to provide education that meets the needs of clients and influences positive health outcomes.

Aims. (1) To expand prior research exploring an enablement framework for patient education by examining perceptions of patient education by persons with diabetes and (2) to test the mastery of stress instrument (MSI) as a potential evaluative instrument for patient education.

Method. Triangulated data collection with a convenience sample of adults taking diabetes education classes. Half the sample completed audio‐taped semi‐structured interviews pre, during and posteducation and all completed the MSI posteducation. Qualitative data were analysed using latent content analysis, descriptive statistics were completed.

Results. Qualitative analysis revealed content categories similar to previous work with prenatal participants, supporting the enablement framework. Statistical analyses noted congruence with psychometric findings from development of MSI; secondary qualitative analyses revealed congruency between MSI scores and patient perceptions.

Conclusions. Mastery is an outcome congruent with the enablement framework for patient education across content areas. Mastery of stress instrument may be a instrument for identification of patients who are coping well with diabetes self‐management, as well as those who are not and who require further nursing interventions.
Self‐reported health and glycaemic control in Tanzanian and Swedish diabetic patients
Authors: Smide Bibbi , Lukwale Jane , Msoka Agnes , Wikblad Karin
Published: March 2003

Self‐reported health and glycaemic control in Tanzanian and Swedish diabetic patients Aims of the study.

Aims of the study. To investigate self‐reported health in adult Tanzanian and Swedish diabetic patients in relation to the general population in the two countries and to investigate whether diabetic patients with poor glycaemic control also rated their self‐reported health to be impaired.

Design/methods. The study design was cross‐sectional and comparative. One hundred and fifty Tanzanian patients were age‐ and gender‐matched with Swedish diabetic patients. Self‐reported health was measured using the generic SF‐36 health questionnaire, measuring eight different health domains. Glycaemic control was measured by testing glycosylated haemoglobin (HbA1c).

Results. The main results were that Tanzanian diabetic patients had poorer health in comparison with general Tanzanian population living in the same geographical area. In contrast, diabetic patients in Sweden did not markedly differ from the Swedish general population. Furthermore, Tanzanian patients had poorer glycaemic control. In both countries poor glycaemic control did not associate with impaired self‐reported health, with one exception. Tanzanian patients with unsatisfactory or poor glycaemic control had significantly poorer reported health in the mental health domain.

Conclusions. The results indicated that patients’ health should be assessed using a specific health measure in addition to general medical measures.
Efficacy of the Shinki bioclean room for preventing infection in neutropenic patients
Authors: Shinjo Kaori , Takeshita Akihiro , Yanagi Mitsuaki , Yokota Kazuko , Hirano Kazumi , Suzuki Mieko , Ohnishi Kazunori , Ohno Ryuzo
Published: March 2003

Efficacy of the Shinki bioclean room for preventing infection in neutropenic patients

Aim of the study. To investigate the effectiveness of a new type of bioclean room named Shinki bioclean room (SBCR) for the prevention of infection during neutropenia after intensive chemotherapy in comparison with a standard laminar air flow room (LAFR).

Background. Recently, a new industrial technology, wherein a dust‐free and aseptic environment is created by circulating air containing nanometre order ultra fine water droplets with abundant negative air ions, has been developed in Japan.

Methods. The air cleanliness of SBCR was examined by measuring airborne particles and microorganisms. Bacteriological samples for environment culture were taken by means of exposed settle‐plates. In addition, the frequency of pneumonia and fever higher than 38°C were examined in 34 patients with acute leukaemia who received intensive chemotherapy in SBCR or LAFR.

Results. The number of airborne particles (≥0·5 μm) was 70 particles/ft3, and that of airborne microorganisms was 0·00 colony forming unit/ft3 in SBCR, and neither bacteria nor fungi were detected. The numbers of colonies of bacteria and fungi on air settle‐plates were fewer in the SBCR than in the LAFR regardless of the presence of patients or the nurse entering. The frequency of pneumonia during chemotherapy for acute leukaemia was lower in the SBCR group (0%, 0/19 cases) than in the LAFR group (27%, 4/15 cases) (P=0·0294) and the frequency of fever higher than 38°C also tended to be lower in the SBCR group (53%, 10/19 cases) than in the LAFR group (80%, 12/15 cases) (P=0·0973).

Conclusion. The SBCR is equal or superior to LAFR in preventing infection during neutropenia. Other advantages for SBCR are a low level of noise (40 dB), easy control of temperature and humidity, and efficient removal of odour. In addition to the quiet and comfortable atmosphere, expected favourable effects of negative air ions may give higher quality of life for patients in SBCR than those in LAFR. Further studies will be needed to examine the safety, benefits and effects of the negative ion exposure.
Elisions in the field of caring
Authors: Deary Vincent , Deary Ian J. , McKenna Hugh P. , McCance Tanya V. , Watson Roger , Hoogbruin Amandah Lea
Published: March 2003

Background.  Contemporary research into caring in nursing was criticized in the pages of this journal by John Paley. He charged that the study of caring has not been advanced by research which, he reckoned, merely generates endless lists of terms to describe caring. He also argued that research in the field was largely flawed by confusion over the difference between things said about caring and the act of caring itself.

The present paper.  We have analysed Paley's criticism. Essentially, he is criticizing the whole field of survey research. The scientific process is underpinned by the implicit understanding that any field moves forward cautiously. In the social sciences multiple perspectives enrich understanding of phenomena and often confirm previous perceptions. The lack of any alternative approach from Paley is evident. Examples from psychology, where seemingly endless lists of descriptors have led through rigorous concept and statistical analysis to genuinely useful psychological and clinical data, are expounded. In contrast to Paley's assertions, the study of caring in nursing to date has also produced information which is useful within nurse education and practice.

Conclusion.  There is no confusion concerning the things said about and the things done in the name of caring in our minds. We acknowledge that studying the actual phenomena of caring is difficult. However, in the absence of definitive descriptions of caring and precise methods to study it, the search for perfection has not paralysed action. Much has been learned about caring and much remains to be learned.
A descriptive study of registered nurses' experiences with web‐based learning
Authors: Atack Lynda , Rankin James
Published: March 2003

Aims.  To describe the experiences of registered nurses (RNs) who enrolled in a web‐based course from either their home or the workplace.

Rationale.  In order to maintain competency in rapidly changing health care systems, and meet the challenge of overcoming traditional barriers to continuing education, RNs need access to innovative educational delivery methods. As yet, little is known about the web‐based learners' experience, particularly when courses are accessed from the nursing practice setting.

Methods.  The article focuses on the results from questionnaires conducted with 57 RNs enrolled in a web‐based, postdiploma course. These findings emanate from a larger study using survey method and focus group interviews. Nurses' experiences were measured using the Online Learner Support Instrument which was developed and tested for use in the study.

Results.  Most nurses found the course highly satisfactory. Not all experiences were positive however, and a number of challenges were faced. Access to the course from home was reported as very satisfactory for the majority, while work users encountered a number of serious barriers such as insufficient time and limited computer access. The RNs made significant gains in their learning with e‐mail, Internet, keyboarding and word processing skills during the 16‐week course. Lack of computer skills, erroneous perceptions of course workload and inadequate preparation for web learning were largely responsible for the majority of withdrawals.

Conclusion.  Web‐based learning can be an effective mode of delivery for nursing education. Advance preparation by educational institutions, employers and prospective students is essential. Teachers, peers, technology, course design and the learning environment are key variables that influence the learners' experience and success.
Voices from the Gila: health care issues for rural elders in south‐western New Mexico
Authors: Averill Jennifer B.
Published: March 2003

Background and rationale.  A goal of the Healthy People 2010 initiative is to reduce or eliminate health disparities in vulnerable populations, including populations from rural and minority ethnic backgrounds. Rural communities, including elderly populations, experience lower rates of personal income, educational attainment, health‐insurance coverage, access to emergency and specialty care services, and reported health status than do urban communities. A need exists to address identified research priorities, such as the perceptions of rural elders, their family members, and health care providers.

Aims.  The purposes of this study were to explore the health care perceptions, needs, and definitions of health for multicultural rural elders in one county of south‐western New Mexico, and to consider practice implications.

Ethical issues and approval.  Informed consent procedures followed the University of New Mexico Health Sciences Center Human Research Review Committee guidelines.

Research methods.  This critical ethnography incorporated ethnographic interviews, ethnographic participant observation, photography, review of pertinent documents, and analysis of contextual factors. The sample consisted of 22 participants.

Results/findings.  Definitions of health varied with socioeconomic status, encompassing avoidance of contact with the health care system, obtaining needed medications, remaining independent, a sense of spiritual belonging, eating wisely, and exercising moderately. Three major concerns emerged from the analysis: the escalating cost of prescription drugs, access‐to‐care issues, and social isolation.

Study limitations.  The primary limitation was the small sample size. Although the researcher's position as an outsider to local communities may also have affected the outcome, it provided fresh insight to regional problems.

Conclusions.  The study addressed national research priorities for a vulnerable group of rural elders. Nursing implications include the need for expanded knowledge and educational preparation regarding elder issues and community‐level services, inclusion of elders' perspectives in the planning and delivery of health services, and the need for community‐level, interdisciplinary collaboration and advocacy.
Two‐year follow‐up of a randomized controlled trial of a clinical nurse specialist intervention, inpatient, and day patient team care in rheumatoid arthritis
Authors: Tijhuis Gerhardus J. , Zwinderman Aeilko H. , Hazes Johanna M.W. , Breedveld Ferdinand C. , Vlieland P.M. Theodora Vliet
Published: March 2003

Aim.  To compare the long‐term effectiveness of care delivered by a clinical nurse specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations.

Background.  The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long‐term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co‐ordinated care, such as multidisciplinary team care, are lacking.

Methods.  Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND‐36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures.

Results.
 No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow‐up, except that visits to nurse specialists were more frequent and home help was less frequent in the CNS group. A comparison of clinical outcomes among the three groups and a comparison between the nurse specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly (
P < 0·05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study.

Conclusion.  Care provided by a CNS in an outpatient rheumatology clinic has a similar long‐term clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.
Models of mental health nurse–general practitioner liaison: promoting continuity of care
Authors: McCann Terence V. , Baker Helen
Published: March 2003

mccann t.v. & baker h. (2003)Journal of Advanced Nursing 41(5), 471–479

 Models of mental health nurse–general practitioner liaison: promoting continuity of care

Aim and rationale. Community mental health nurses and general practitioners share a pivotal role in the provision of mental health care in the community. The focus of this study was to identify models of general practitioner collaboration used by these nurses, and analyse the implications of these models for promoting continuity of care. The study was derived from a larger study of how community mental health nurses promote wellness with clients who are experiencing an early episode of psychotic illness.

Methods. This qualitative study used interviews and observation to collect data. The study took place in 1999 in regional and rural New South Wales, Australia and involved community mental health nurses.

Findings. The findings show that two models of nurse and general practitioner (GP) collaboration emerged from the data: Shared Care and Specialist Liaison. In the Shared Care model, nurses maintain close contact with GPs throughout the episode of acute care. In the Specialist Liaison model, the community mental health team assumes overall responsibility for care and treatment throughout the acute episode of illness. Contact with GPs throughout the episode of care by the community mental health team is, at best, intermittent.

Conclusion. The findings suggest that the Shared Care model is more consistent with supporting personal and organizational continuity of care, whereas the Specialist Liaison model is limited to encouraging personal continuity of care but further study is needed.
Large‐scale climatic fluctuation and population dynamics of moose and white‐tailed deer
Authors: POST ERIC , STENSETH NILS CHR.
Published: March 2003

1.  Mech et al. (1987) documented cumulative, negative effects of previous winters’ snow on rates of population increase in moose (Alces alces) and white‐tailed deer (Odocoileus virginianus), but noted no effect of predation by wolves (Canis lupus). Those results were contested by Messier (1991), who analysed smoothed versions of the original abundance data and reported no effect of snow accumulation on population dynamics of either species, but strong effects of wolf predation and food competition.

2.  McRoberts, Mech & Peterson (1995) contended that the conclusions reached by Messier (1991) were an artefact of the use of smoothed data. In a subsequent re‐analysis of the smoothed data, Messier (1995) argued that the lack of an effect of snow after one year precluded the potential for a cumulative effect beyond one year.

3.  We re‐analysed original and smoothed data on dynamics of moose and white‐tailed deer densities using the same methods as Mech et al. (1987) and Messier (1991), but we used a measure of global climatic fluctuation, the North Atlantic Oscillation (NAO) index. The NAO is the atmospheric process determining most interannual variation in snowfall and winter temperatures in northern latitudes, and its phases drive decadal trends in wintertime precipitation.

4.  We observed that rates of increase of moose and white‐tailed deer in both the original and smoothed data were influenced by global climatic fluctuation at 2‐ and 3‐year lags, as well as by delayed density‐dependent feedback and wolf predation.
Does development mode organize life‐history traits in the parasitoid Hymenoptera?
Authors: Mayhew Peter J. , Blackburn Tim M.
Published: March 2003

1. Several authors have proposed that inter‐specific variation in parasitoid life histories can be classified according to a dichotomy of development modes: ectoparasitoids and idiobionts with one suite of traits, and endoparasitoids and koinobionts with an opposing set of traits.

2. The factual evidence for such a dichotomy is presently scant. Here, 10 predictions of the dichotomous hypothesis are assessed using life history data from 474 species of parasitoid Hymenoptera.

3. A degree of support for the dichotomy is found. As predicted, koinobiosis is associated with endoparasitism, and idiobiosis with ectoparasitism. Endoparasitism and/or koinobiosis are also associated with a shorter adult lifespan, a shorter window for parasitism, smaller eggs, a longer pre‐adult lifespan and, in larval parasitoids, a greater oviposition rate and fecundity than ectoparasitism/idiobiosis.

4. However, several predictions are not upheld by the data. No significant relationship is found between development mode and either body size, the degree of host concealment or the stage of host attacked. Some trends are only found amongst larval parasitoids, and others do not hold for both endoparasitism and koinobiosis.

5. We conclude that there is at least some merit to the dichotomous hypothesis, though the most extensive depictions go beyond the present data. As a step towards formulating the dichotomy in a more rigid theoretical base, we discuss the selective pressures and constraints that are likely to account for the observed trends.
Determinants of local recruitment in a growing colony of Audouin's gull
Authors: Oro Daniel , Pradel Roger
Published: March 2003

1. Local recruitment of Audouin's gull (Larus audouinii Payraudeau) was studied between 1988 and 1997 at the Ebro Delta colony (north‐western Mediterranean). Since its establishment in 1981, the colony has dramatically grown to include, in 1997, 65% of the total world population. Several hypotheses were tested, involving the effects of a badger predatory event in 1994, and sex, age and cohort (year of birth) on recruitment.

2. Results supported the prediction that colony size influenced recruitment: the probability for any individual to have previously bred increased throughout the study, together with colony size. At the end of the study, 90% of breeders aged 4 years had already been recruited at age 3, the age of first reproduction by Audouin's gulls. As expected by the dramatic increase of breeding numbers, most local recruitment occurred at very young ages, especially when compared with other Laridae.

3. Neither food availability nor reproductive success affected recruitment. Recruitment was not affected by high nest predation by the badger, although after the event, the proportion of Ebro Delta birds nesting on the nearby Columbretes Islands tripled.

4. Probability of first reproduction depended on age: it was the highest at ages 3 and 4, and then decreased sharply with age to stabilize beyond age 6 to a value depending on the year and cohort but always very low (< 5%). Cohort and sex did not influence local recruitment.

5. Annual resighting rates ranged between 35% and 82%, and were higher for females. This may represent a sex‐dependent suspension of breeding, probably as a trade‐off between early recruitment and future survival.
Differences in trappability of European badgers Meles meles in three populations in England
Authors: Tuyttens F.A.M. , Macdonald D.W. , Delahay R. , Rogers L.M. , Mallinson P.J. , Donnelly C.A. , Newman C.
Published: March 2003

1. Many ecological studies on the European badger Meles meles, as well as certain programmes to control bovine tuberculosis, would benefit from a greater understanding of the factors that influence the probability of capturing this animal in cage‐traps. We therefore investigated some of the factors that could explain differences in trappability between three badger populations in England: the high‐density protected populations of Wytham Woods and Woodchester Park, and the low‐density culled population of North Nibley.

2. Trappability (the percentage of all individuals known alive that were actually captured) did not differ between sexes or adult age classes, but significant differences were found between cubs and adults, study areas, seasons and years, and various interactions between these variables.

3. Circumstantial evidence suggests that the culling of badgers in North Nibley may have resulted in a decrease of adult trappability in the following year.

4. Adult badgers at Wytham Woods and Woodchester Park were significantly more likely to be trapped zero times (‘trap‐shy’) or all three times (‘trap‐happy’) in 1996 than predicted by the estimated capture probabilities under the assumption of equal trappability.

5. Wytham Woods differed from the other study areas in that trappability of its badgers was positively related to their body weight and its adult badgers were more likely to be trapped than cubs. These differences could be a consequence of differences in trapping procedures that were followed at Wytham (no prebaiting and fewer traps per badger).

6. Trappability of badgers was not associated with social group size. Although it is difficult to determine precisely the movement and tuberculosis status of badgers based on mark–recapture data, our analyses did not suggest that either variable affected the likelihood of being trapped.

7. Studies that compare demographic, biometric and epidemiological parameters based on data collected from badgers captured at different times or places ought to account for the observed differences in trappability.