bluuebunny/crossref_metadata_2025 huggingface dataset:
The health meanings and practices of older Greek–Canadian widows
Authors: Rosenbaum Janet N
Published: December 2006

Folk health and illness beliefs and practices were abstracted from a large‐scale study of older Greek‐Canadian widows conceptualized within Leirunger's theory of Cultural Care Diversity and Universality using ethnographic, ethnonursing, and life health‐care history methods Data were collected using observation‐participation and interviews in three Greek–Canadian communities with 12 widowed key informants and 30 general informants Interview inquiry guides, Leirunger's Life History Health Care Protocol, and field journal recordings assisted data collection Data were analysed using Leirunger's phases of analysis for qualitative data A major health theme which was abstracted from the raw data and patterns was health for Greek–Canadian widows meant a state of well‐being, ability to perform daily role activities, and avoidance of pain and illness The findings, which also included folk health care and illness beliefs and practices, will stimulate future nursing research related to health and nursing care of people of diverse cultures
Coping and life satisfaction in elderly women with osteoarthritis
Authors: Downe‐Wamboldt Barbara
Published: December 2006

The relationships among illness‐related stress and emotions, coping strategies, socio‐economic status and life satisfaction of 90 elderly women with osteoarthritis were explored in this descriptive, correlational study Results of self‐report interview data indicated that the women expenenced both positive and negative emotions in relation to their day‐to‐day life with osteoarthritis The coping behaviours used to manage the perceived stress of osteoarthritis included confrontive, palliative and emotive strategies Path analysis supported a significant and positive relationship between coping and life satisfaction and between objective and subjective measures of life satisfaction
A reassessment of nurses' attitudes towards stroke patients in general medical wards
Authors: Gibbon Bernard
Published: December 2006

This paper summarizes a research study inquiring into the attitudes of qualified nursing staff and nursing auxiliaries towards stroke patients in general medical wards The survey was undertaken on eight mixed‐sex general medical wards in a large general hospital All wards are used for clinical nursing experience for nurses in training Each of the wards, despite having a particular interest in one or more medical specialities, regularly admit patients following stroke All nurses were therefore familiar and in regular contact with this particular client group A Likert scale with demonstrated reliability and validity was employed as the data collection instrument Results indicated that nurses were largely ambivalent in their attitudes towards stroke rehabilitation The patterns of responses indicate that the nurses who have the more positive attitudes about stroke patients consider that they have a role in stroke rehabilitation and that they value the nursing contribution The nurses with less positive attitudes towards stroke patients see stroke patients as unco‐operative and demanding The findings suggest the need for specific education for the role of the nurse as a rehabilitator
Models of nursing: their relevance to the care of elderly people
Authors: Reed Jan , Robbins Ian
Published: December 2006

The adoption of nursing models has become widespread throughout the profession with little empirical evidence of their usefulness or critical evaluation This paper gives an overview of the issues surrounding the development and use of models and presents research data which indicates that one model (Roper, Logan & Tierney's Activities of Living) is problematic in the long‐term care of the elderly. The characteristics of this model which are problematic are common to other models and have relevance for other areas of nursing
The sources of a practice code of ethics for nurses
Authors: Davis Anne J
Published: December 2006

Interviews with a convenient sample of 27 master's‐prepared nurses working in two clinical settings revealed that none of them knew the content of the American Nurses' Association Code for Nurses A content analysis developed four sensitizing experiences that were sources for their code of nursing practice These were categorized as (a) clinical, (b) personal, (c) research, and (d) professional socialization as a student
In defence of Cartesian dualism and the hermeneutic horizon
Authors: Holden Robyn J
Published: December 2006

In this paper, the author proposes to consider the intricate interplay between the art and science of nursing The caring role, intrinsic to the meaning of the word ‘nurse”, constrains nursing under the rubric of the arts, while nursing that embraces high technology constrains the discipline under the rubric of science Thus, the traditional dichotomy that obtains between the arts and sciences seriously complicates the notion of nursing As a science, nursing adopts the materialist theory of the mind that endorses the inseparability of mind and body However, as an art, nursing is more closely aligned with dualist interactiorusm which considers the mind and body to be separate, interacting entities Nursing is a caring profession, the mastery of which rests on the mastery of the therapeutic relationship which, in turn, implies mastery of holistic nursing care While the concept of holism implies caring for the ‘whole’ person in body, mind and spirit, such acknowledgement of the mental and spiritual components of personhood, immediately invites the entry of dualism into our theoretical discourse Thus, rejection of dualism consigns nursing to theoretical impoverishment and therapeutic emasculation The contentious question is therefore Is the theoretical destiny of nursing one of theoretical impoverishment, therapeutic emasculation, and permanent consignment to professional ignominy – and all for the sake of an inconvenient soul?
Using a manpower database to model nurse turnaround and return to service
Authors: McClean Sally , Reid Norma , Devine Colum , Gribbin Owen , Thompson Kate
Published: December 2006

A manpower database for nurses employed by the Department of Health and Social Services in Northern Ireland has been developed This database contains information on all nurses employed between March 1977 and July 1988 and consists of data on all posts held in this period, including breaks in service The authors show how these data may be used to analyse the durations of spells in post and spells out of service prior to departure to a number of destinations for the sister and staff nurse grades The results are presented in a graphical format which enables us to evaluate the relative proportion of departures to each destination and at what stage in service these departures are likely to occur. Such a methodology provides a valuable tool for the nurse manpower planner, and utilizes personnel data which are routinely collected by most health authorities
Demographical, sociomedical and physical characteristics in relation to malnutrition in geriatric patients
Authors: Unosson Mitra , Christina Anna , Bjurulf Per , Larsson Jörgen
Published: December 2006

The purpose of this study was to describe and compare demographical, sociomedical and physical characteristics between protein‐energy malnourished and non‐malnourished geriatric patients on admission According to the International Statistical Classification of Diseases, 104 malnourished patients were age‐, gender‐ and diagnosis‐matched with 104 non‐malnourished patients Data were collected from patients' medical records The patient's condition was assessed by a modified Norton scale on admission No differences were seen in marital status, type of dwelling, previous need for help service, residence before admission, and dependence on assistance with ADL function The malnourished patients had a greater consumption of diuretics (47%,P< 0 05) and a lower consumption of analgesics (29%,P< 005) than the non‐malnourished patients (33% and 42% respectively) In the malnourished group, impaired conditions in activity (83%,P< 0 05), and general physical condition (78%,P< 0 01) were observed compared to the non‐malnourished group (69% and 60% respectively) The malnourished patients had less sufficient food intake (41% vs 21%,P< 0 01) and fluid intake (25% vs 10%,P< 0 01) than non‐malnourished patients This study indicates that demographical characteristics and primary ADL‐functions are of minor importance for the development of protein‐energy malnutrition in geriatric patients Observation of the patients' physical condition and drug consumption seemed more important on admission.
An evaluation of a paediatric home care scheme
Authors: While Alison E
Published: December 2006

The policy background of paediatric home care schemes is reviewed and an evaluation of such a scheme is described The home care scheme is shown to be a worthwhile service provision However, it is suggested that this service development can only represent an improved use of resources when there is a complementary reduction in hospital provision
Sleep medication in Dutch hospitals
Authors: Halfens RJG , Lendfers ML , Cox K
Published: December 2006

Insomnia is an important nursing problem in hospitals Although sleep medication is often criticized, it is one of the commonest interventions with regard to sleep problems In this study, the prescription and provision of sleep medication in three Dutch general hospitals is investigated Results show that on a random day 47% of all patients (n–1076) of the surgical and medical wards were prescribed medication Thirty‐four per cent actually received sleep medication that evening or night The prescription and provision of sleep medication was higher on medical than on surgical wards Furthermore, hospitals were shown to differ regarding the prescription and provision of as‐needed sleep medication The study also explores whether attitudes of nurses are related to the provision of as‐needed sleep medication Although their influence does not seem to be great, it is concluded that more attention has to be paid to possible effective nursing interventions in educational programmes
An evaluation of the Ulster Cancer Foundation's Nurses and Smoking Package and its impact on student nurses
Authors: Lazenbatt Anne , McEwen Alex
Published: December 2006

The Ulster Cancer Foundation's teaching package Nurses and Smoking was evaluated by testing nurses' knowledge and skills in the area of smoking‐related health education As smoking is still a major cause of mortality and morbidity, does the nurses' training equip them with an adequate knowledge of its consequences? Questionnaire data, together with material from in‐depth interviews, were analysed and pre‐ and post‐package results produced significant differences (P < 0 001) between the experimental and control groups, suggesting that a teaching package significantly improves a nurse's knowledge and expertise with regard to smoking and its effect on both patients and their environment
The recognition and non‐recognition of problem‐solving stages in nursing practice
Authors: Hurst Keith , MPhil Anne Dean , Trickey Stuart
Published: December 2006

A requirement for high‐quality individualized nursing care is that nurses must recognize and attempt to solve patients' health problems In this study, it was decided to investigate problem solving using a model similar to the nursing process derived from the general literature Insight into nurses' perceptions and understanding of problem solving was gained by interviewing 116 nurses using vignettes of clinical problem solving Data analysis revealed that many informants failed to discuss some problem‐solving stages, in particular planning and evaluation Conversely, problem assessment and implementation attracted more comment The implications for these variations in nurses' problem‐solving behaviour are examined in relation to contemporary nursing issues
The concept of hope revisited for nursing
Authors: Stephenson Charlotte
Published: December 2006

The development of nursing knowledge and interventions involve understanding human responses and needs The human response of hope was identified as a concept in need of further clarification The purpose of this paper was to review definitions and contextual usage of the word ‘hope’ from the literature and answer the conceptual question ‘What is hope?’Literature from theology, philosophy, psychology and nursing was reviewed for contextual usage of the word ‘hope’ In the literature, hope was viewed as part of human development, a process, a theory and a source of meaning in life In addition, antecendents, attributes and outcomes of hope were identified from the literature that contributed to a clearer understanding of the concept
Mind the theory/practice gap in nursing
Authors: Cook Stephen H
Published: December 2006

The theory/practice gap is a recurrent theme in the nursing literature Numerous suggestions have been made about how this gap may be narrowed or even closed However, there appears to have been little attempt to date to examine the ways in which research conducted into the hidden curriculum, and philosophical analysis of the concepts involved, might inform our understanding of the reasons for the existence of the theory/practice gap This paper attempts to utilize some of the contributions from these areas of research, and as a result will argue that, while narrowing of the theory/practice gap may be a realistic goal, any attempt to close it completely will be doomed to failure
Sociological issues in the conceptualization of mental illness
Authors: Symonds Bob
Published: December 2006

This paper explores the conceptual knowledge base underpinning ‘mental illness type behaviour’ and offers a sociological and philosophical perspective The role of values in concepts of health and illness is presented as widespread not only within psychiatry, but also in regard to general/physical health The controversial nature of the psychiatric enterprise is believed to be due to the lack of consensus regarding notions of mental health and mental illness Psychiatry is presented as a form of social control, akin to the legal system, dictated by moral norms These are presented as value‐loaded and maintained in accordance with the dictates of particular interest groups Social control concepts are explored and Freud's psychodynamic model is presented as a legitimate model that incorporates a meaningful concept of ‘illness' No theory, though, is presented as value‐free Psychiatry is thus presented as being socially and politically constructed The implication for health care professionals is presented as that of trying to liberate professional work from the narrow responsibility of the ‘individual’, whilst also trying to create a more democratic enterprise
Nurse socialization: issues and problems
Authors: Wilson Ann , Startup Richard
Published: December 2006

A comparative study was conducted of the professional socialization process of student nurses in three nurse education centres in South Wales Patterns and problem areas can be identified of relevance to issues in role theory and with practical implications for the more effective implementation of Project 2000 Three cohorts of students were interviewed using a semi‐structured interview schedule whilst in the introductory block and at the end of the first year The teaching and ward staff directly involved in the socialization process were also interviewed so that their views could be compared with those of the students There were differences between the types of ward in the opportunities they offered for role modelling It was doubtful whether the three categories of students, teaching staff and ward staff were all employing a single conception of ‘the good nurse’ The student has to find her own pathway through the divergent and often conflicting values and philosophies of the teaching staff and those in authority on the wards It is recommended that a more unified approach be adopted to reduce the conflict which learners experience In accordance with Project 2000, the teaching staff should act as practitioners and thereby be perceived as a professional role model with clinical credibility
The idea of revolution in the development of nursing theory
Authors: Adams Trevor
Published: December 2006

This paper examines Thomas Kuhn's notion that theory develops by means of revolution and its pervasion within nursing theory Initially, the traditional, cumulative model of theory development is examined and then Kuhn's idea is explored The extent of its pervasion in nursing theory is outlined Finally, the value of Kuhn's model of theory development in nursing is evaluated It is argued that while Kuhn's model has set nursing theory free from logical empiricism, it needs to be understood in conjunction with the traditional cumulative model
Failure to immunize children under 5 years: a literature review
Authors: Lochhead Y J
Published: December 2006

This paper aims to provide a critical review of the current literature related to immunization default in children under 5 years of age The author has used a health belief model as the framework for analysis, examining each area in detail The principle recommendations for practice are addressed and critically evaluated with a concluding summary of the main points raised and the author's recommendation for practice
Preventive work with families: issues facing public health nurses
Authors: Kristjanson Linda J , Chalmers Karen I
Published: December 2006

This paper examines the issues that nurses experience when entering the family system to work preventively The theoretical basis of family‐centred nursing is analysed and the need for empirical work is identified in order to develop a knowledge base for this practice Some unique characteristics of the public health nursing role are discussed with emphasis on territorial issues, power relationships and accountability problems The need for public health nurses to function as advanced generalists across different system levels is recommended and family skills necessary for effective family nursing are examined The authors identify the unique role of public health nurses because they have access to healthy families and families dealing with early stages of health concerns The authors support the general structure of public health practice as of value for preventive work with families However, clarity regarding referrals, contracting and the rights of clients is called for to facilitate collaborative family‐centred nursing
Use and effectiveness of psychiatric nursing care plans
Authors: Aidroos Nafees
Published: December 2006

Nursing administrators require that bedside nurses should use nursing care plans, which also serve the purposes of auditors, educators and others They are time consuming, they are not uniformly liked by bedside nurses, and they are not used with equal rigour everywhere Their efficacy as enhancers of quality of care given has seldom been investigated and never demonstrated In an attempt to repair this deficiency, the author documented 158 transactions between psychiatric nurses and their patients over a 5‐month penod In each instance, the quality of the care given was judged and scored Subsequently, the author determined whether nursing care plans existed and, by comparing them with the transactions, determined whether or not they had been followed These nurses did not generally follow the care plans, though usually they thought they had Transactions done where a nursing care plan existed were not better than those done in the absence of nursing care plans In transactions following an existing nursing care plan, the quality of care given was judged to be lower than in those where an existing nursing care plan was not followed, a result which was statistically highly significant These findings are discussed, and the author notes the dear implication of this study that nursing care plans are less than helpful to bedside nursing
Cultural and political limitations within a rational approach towards educational change
Authors: Gibbs Andy
Published: December 2006

This paper considers the use of a rational curriculum planning model within nurse education It suggests that the process of change within the model is oversimplified and mechanistic As such it denies or ignores the experience of individuals involved in the change process by reducing their personal, cultural and political realities to a level of ideological control The unrestrained or unmodified application of a rational approach may, by this control, inhibit the development of change arising from subjective experiences It may further be viewed as a political strategy which benefits powerful groupings within the school thus institutionalizing this power and maintaining the status quo in terms of power and influence
Reducing the leakage of body‐worn incontinence pads
Authors: Clancy Bridget , Malone‐Lee James
Published: December 2006

The aim of this research was to evaluate the effect of various absorbent matenals (fluff pulp and superabsorbent) on the leakage performance of incontinence pads A shaped pad‐and‐pant system was used as the basic design and four pad types made to different specifications were compared using a double‐blind technique Forty‐five elderly hospital residents who were incontinent of urine used all four pad types in a randomly allocated order Data were recorded on more than 5000 pads over a 2‐month period Leakage was reduced by adding a second layer of fluff pulp and, whilst the addition of a superabsorbent material tended to reduce leakage further, we found no clear relationship between the amount of superabsorbent and the reduction in leakage Other data indicated the importance of securing the pad in place with the appropriate net pants and the leakage rates of pads in relation to the amount of urine they contained This research suggests that superabsorbent matenals have great potential for reducing the leakage rate of incontinence pads but that the way in which they are incorporated into the pad, the amount of fluff pulp and the design of the pad also play an important part
The development of the Intersystem Model
Authors: Artinian Barbara M
Published: December 2006

A nursing model has been developed which guides curriculum development and nursing practice at Azusa Pacific University School of Nursing, the Intersystem Model It is a model which focuses on the interaction between nurse and patient/client and requires that the nurse assess the knowledge base, the values and the behaviours that are brought to a specific patient situation by both the nurse and the patient/client Using the system concepts of supra and subsystems, person can be defined as the individual, the family or the community An intrasystem assessment of the biological, psychosocial and spiritual subsystems of the person is carried out, as well as an assessment of the developmental environment The developmental environment consists of all the events, factors and influences which have made the person what he is at the time he enters a specific encounter requesting nursing action for an illness situation he is unable to resolve independently Positive and negative variables are identified and a score on sense of coherence is assigned Sense of coherence is a construct which includes three components comprehensibility, meaningfulness and manageability In using the model, each component is scored from low to high Through a collaborative process, a joint plan of care is developed in order to increase the sense of coherence the patient/client experiences about the health problem and the plan is evaluated by rescoring on sense of coherence An example of how the Intersystem Model has been used with a diabetic patient in the community is presented, as well as diagrams illustrating the way the nursing process is earned out in intersystem interaction
Attitudes and interests of students and applicants from two branches of the British nursing profession
Authors: Clarke Liam
Published: December 2006

The attitudes and interests of psychiatric students and applicants are compared with general nursing students and applicants using the Attitudes to Treatment Questionnaire (ATQ), the Wilson‐Patterson Attitude Inventory (WPAI) and the Direction of Interest Questionnaire (DIQ) The student groups are also examined in respect of changes in attitude (ATQ) and interests (DIQ) during their training Results indicate significant differences between nurse applicants for attitudes to treatment and direction of interest, the psychiatric applicants being more liberal in their attitudes to treatment and less practical in their interests Similarly, psychiatric students demonstrated more liberalism in their attitudes to treatment as well as less conservatism than general students No differences emerged for students in terms of direction of interest Differences within groups occurring during training were complex The implications of these findings are discussed and some suggestions made for further research.
Self‐care: chore or challenge?
Authors: Rourke Anne M
Published: December 2006

Traditionally, nursing has been viewed as a paternalistic profession steeped in ritualistic practice However, the current upsurge of interest in holistic and client centred nursing has challenged this ritualism The move is away from paternalism and the Medical Model of Care towards individual pahent‐centred practice in which mutuality of rehabilitative purpose is derived through bipartite negotiation This article attempts to explore the relationship between Orem's Self‐Care Model of Nursing and the challenges it suggests for traditional nursing practice and belief
Nursing care plans for people with HIV/AIDS: confusion or consensus?
Authors: Holzemer William L , Henry Suzanne Bakken
Published: December 2006

Examination of four standardized nursing care plans for people with AIDS (PWAs) from four agencies with extensive experience with caring for PWAs revealed that there is little agreement about the nursing care problems of PWAs Differences in language, conceptual clarity, and level of complexity related to problem identification have implications for nursing practice, quality assurance and research Without consensus about patient problems, it is impossible to communicate effectively about nursing care problems for PWAs Research is needed to validate patient problems that can serve as the basis for standards of care and provide guidance for nurses inexperienced in caring for PWAs
Stigma, AIDS and quality of nursing care: state of the science
Authors: Siminoff Laura A. , Erlen Judith A. , Lidz Charles W
Published: December 2006

Reports of fear and psychological distress on the part of nurses when caring for AIDS patients have drawn attention to the real possibility that care for this very sick group of patients may be less than adequate This paper reviews what is currently known about the attitudes of nurses and the care provided to HIV‐infected individuals The authors reveal the paucity of empirical data concerning quality of care and how the concept of stima might serve to aid our understanding The need for more research documenting the quality of care provided to HIV‐infected patients is discussed
Taking care of the caretakers: a partial explanation of clinical nurse specialist practice
Authors: Schaefer Karen Moore
Published: December 2006

The purpose of this study was to describe the clinical practice of clinical nurse specialists (CNSs) Data were collected from three recorded case studies and interviews from a theoretical sample of 17 masters‐prepared CNSs who had functioned in the CNS role for a minimum of 1 year Using the constant comparative method, transcribed interviews were line‐coded and clustered to form groups of data that could be labelled as constructs Caring was validated as the basic psychological process Scientific caring included investigating and teaching, humanistic caring included creating the new, showing the way, working with others, and taking care of the environment It was found that CNSs took care of the caretakers as well as the patients and their families
An evaluation of approaches to assessing the quality of nursing care using (predetermined) quality assurance tools*
Authors: Harvey Gillian
Published: December 2006

This paper examines the implementation of four of the most common approaches to nursing quality assurance in England, namely Monitor, Qualpacs, Nursing audits and a patient satisfaction questionnaire entitled ‘What the Patient Thinks’ The primary aim of the study was to look more closely at the context, processes and outcomes of selecting and implementing specific quality assurance tools ls Data were analysed at three distinct levels The findings are presented around the structure of this three‐level framework and indicate that the process of implementing a quality assurance tool is more important than the tool itself It is suggested that a bottom‐up approach to implementation, which locates ownership and control of the quality assurance tool with practitioners, is seen to result in more favourable staff responses and positive programme outcomes The implementation of Qualpacs is used to illustrate some of the tensions that can occur between the inherent principles of the tool and the method of implementation In studing the factors that might influence the method of implementing a quality assurance tool, a number of organizational and managerial factors are identified
The experiences of new fathers during the first 3 weeks of life
Authors: Henderson Angela D , Brouse A. Jenise
Published: December 2006

Research has consistently demonstrated that the transition to parenthood is a stressful event As well, the literature recognizes that the role of the father in North American society is in the process of change The purpose of this qualitative study was to clarify our understanding of the experience of new fathers during the first 3 weeks postpartum Twenty‐two fathers were interviewed in their homes using a semi‐structured interview format Findings suggest that new fathers go through a predictable three‐stage process during the transition to fatherhood In addition, factors were identified which affect the transition Nursing interventions were suggested to facilitate this process and implications for future study included
Patient assessment in psychiatric nursing
Authors: Savage Peter
Published: December 2006

This paper examines the literature on patient assessment in nursing, with particular reference to assessment in psychiatric nursing It finds that most nursing assessment is concerned with gathering physiological information about patients while effectively ignoring psychosocial indices This phenomenon, it is argued, is due to historical factors in the socialization of nurses, the particular version of nursing process imported into the UK, and an oversimplification of the concept of ‘need’ which has encouraged nurses to focus on patient disabilities but has ignored their capabilities It is proposed that nursing assessment should be a relatively lengthy process, increasing in specificity, involving gathering and analysing information from a holistic perspective about individuals'/families' health concerns Then, by applying concepts from appropriate conceptual models, a nursing diagnosis to those health concerns is proposed. This proposal is supported by a discussion of the process, functions and methods of nursing assessment Finally, while recognizing the importance of social causation theories in psychiatric care, it is argued that community health assessments are beyond the scope of individual nurses
Alternative health care as a control strategy
Authors: Montbrand Muriel J , Laing Gail P
Published: December 2006

What does it mean when a patient desires to be in control of an uncontrollable illness or an uncontrollable hospital situation? This paper explores the theme, desire for control, a theme emerging from a recent ethnographic study on the use of alternative health care in a hospital setting While it may be argued that choosing an alternative practice may be a patient's strategy to control a perceived uncontrollable situation, there are many other ways of looking at the control issue The data derived from the conceptual reality of the informants in this study are examined in the light of research and theories of perceived control, locus of control and illusion of control
Why does nursing need theory?
Authors: Ingram Richard
Published: December 2006

The last 25 years have witnessed a growing support for and recognition of the importance of nursing theory, both in education and practice This paper seeks to explore this movement and also the issues in theory development, study and application Definitions of theory are reviewed, and linked to the purpose of theory and theory development in nursing The origins and motivation for developing nursing theory are identified, and arguments for the use of theory in nursing are raised Further questions from the discussion of these issues are identified, questions likely to provide continued debate and investigation within the profession for decades to come
Quality of care assessed: using the Senior Monitor index in three wards for the elderly before and after a change to primary nursing
Authors: MacGuire Jillian M
Published: December 2006

Assessments of quality of care using Senior Monitor in three matched wards for elderly patients were carried out on three occasions The first assessment was carried out in June 1987 as a trial of the measurement tool The instrument allows for a maximum score of 100 All three wards scored above 60, with two wards scoring above 70 Primary nursing was introduced in one of the wards in January 1988 and the assessment was repeated in June 1988 All ward scores were above 70, with one ward, not the primary nursing ward, scoring above 80 A third assessment was carried out in June 1989 Again, all three wards scored above 70 but this time the primary nursing ward scored 86, the highest ward score of the series The results for the sub‐sections of the assessment are explored in the paper and issues about validity, reliability and inter‐rater reliability are discussed It is argued that Senior Monitor is a useful tool for assessing changes in the quality of care delivered to patients in wards for the elderly but that its full value only becomes apparent with repetition over an extended time period It may be less appropriate for assessing the impact of a change in the organization of care, not because of any inherent fault in the test but because the very process of using it makes staff look at their practice more critically It is this critical re‐appraisal rather than the change in organization per se which stimulates the improvement in the quality of care
Developing and documenting a qualitative methodology
Authors: Reid Brigid
Published: December 2006

Using an ethnographic approach, the phenomenon of the routine of ‘doing the obs' (nursing observations of vital signs) was examined with particular reference made to its rationale This involved a period of fieldwork in a ward which consisted of non‐participant observation of the nurses at work and short interviews with them The experience of the study raised awareness of the research process for the researcher and is explored in detail in this article The dissemination of such an account offers valuable insight for future researchers and occupies a vital role in determining the validity and reliability of qualitative work
Affective neutrality and involvement in nurse–patient relationships: perceptions of appropriate behaviour among nurses in acute medical and surgical wards
Authors: May Carl
Published: December 2006

This paper explores ideas about the appropriate basis for nurse–patient relationships which underwrite the nursing practice of experienced staff nurses on the acute surgical and medical wards of a Scottish general hospital Three central features of involvement with patients are identified, knowledge, reciprocity and investment, and these are related to three general models of the nurse–patient relationship, characterized as primary, demonstrative and associational The implications of the nursing practice on which these models are based are discussed in the context of issues of quality of care and orientation to work
Institutional loss: an examination of a bereavement reaction in 22 mental nurses losing their institution and moving into the community
Authors: Massey Paul
Published: December 2006

Grief has distinctive characteristics Mental nurses working in a hospital due for closure in 15 months were assessed, and it was found that nurses with long service experienced an anticipatory bereavement in response to the expected loss of their hospital This reaction is different from the uncomplicated grief which follows the death of a loved person, and is therefore called institutional loss Twenty‐two nurses were assessed, including 13 nurses who were still working in the hospital and nine ex‐hospital nurses now working in the community A sentence completion form was used, together with a measurement of feeling and observed emotion for each sentence Participants had no prior knowledge about the study Feelings identified included initial disbelief, personal anxiety and anxiety about community care, physiological symptoms of anxiety, guilt, anger, feelings of internal loss, avoidance and searching behaviours, acknowledgement of grief, idealization, and identification phenomena Institutional loss is characterized by anticipatory grief, an acute stage of mourning in nurses who are physically distanced from the hospital, a refusal to accept closure as ‘right’, and a strong identification with the old hospital Institutional loss in nurses has important implications for the successful rehabilitation of large numbers of patients, and this research suggests that additional support and counselling should be offered
An investigation into why qualified nurses inappropriately describe their own cardiopulmonary resuscitation skills
Authors: Crunden Edward J
Published: December 2006

Recent studies have indicated that significant numbers of nurses are ineffective in performing cardiopulmonary resuscitation (CPR) Furthermore, the studies indicate that many nurses are unable to appraise realistically their own CPR performance This study sought to ascertain the reasons why qualified nurses are unable or unwilling to appraise themselves realistically with regard to resuscitation skills The investigation employed both quantitative and qualitative methods to establish the existence of the phenomenon and facilitate its analysis The findings of the study suggest that unrealistic self‐appraisal arises out of poor and infrequent resuscitation training, nurses’ attempts to identify with roles which they perceive they should fulfill and past expenence of cardiac arrests The data suggest that current resuscitation training is inadequate, inappropnate and inconsistent for the needs of practising nurses
Ethnographic traits in the writing of Mary Breckinridge*
Authors: Ruffing‐Rahal Mary Ann
Published: December 2006

Mary Breckinridge, founder of The Frontier Nursing Service, employed ethnographic methodologies—partiapant observation, interviewing and fieldwork—as foundation efforts toward construction of highly responsive health‐service systems, developed under circumstances of duress, eg after World War I and pre‐industrial Appalachia In culturally representing the Appalachian, she drew upon two vast resources, her first‐hand field experience as well as her considerable rhetorical skill She narrated and described an enormity of selected ‘realities’ of Appalachian life with immediacy of detail and nonpatronizing sensitivity for ‘insider’ perspectives In an era of transition with few indigenous cultural writers, Breckinridge capitalized on her family heritage in Appalachia, which further underscored the intimacy and authenticity of her accounts As portrayed in her autobiography, crosscultural encounters of one kind and time or another supplied an infrastructure of longstanding meaning throughout her life The final and lasting impression is that, in both skills and orientation, Breckinridge's were essentially those of the ethnographer
Researching needs in district nursing
Authors: Ong Bie Nio
Published: December 2006

This paper describes the first stage of a research project aimed at understanding the needs of clients (and their carers) of district nursing services The project applies a pluralistic research design, combining qualitative and quantitative methods Through the use of an ethnographic approach, concepts of needs are generated which are related to how clients and carers perceive themselves and the role of the district nurse The study attempts to formulate needs within a contextual framework against which an activity analysis of district nurses' work (stage 2) can be evaluated
Caring versus empowerment: considerations for nursing practice
Authors: Malin Nigel , Teasdale Kevin
Published: December 2006

The authors argue that there is a tension between the concepts of caring and empowerment This tension appears in political and managerial debates over how best to run a health service, and it reappears in the clinical situation in nursing dilemmas over the presentation of information to patients The authors review the major contributions to theory from health care literature, and use case studies to explore some of the clinical implications of these theories for nursing practice
The size of the pressure‐sore problem in a teaching hospital
Authors: Dealey Carol
Published: December 2006

A senes of three prevalence surveys were undertaken in a teaching hospital (where medical students are taught) in the West Midlands of England to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure‐relieving equipment All in‐patients were assessed using the Waterlow score Full details of all pressure sores and any pressure‐relieving equipment in use was recorded There was a mean pressure sore prevalence of 7 32%, the prevalence for each survey being 8 77%, 5 1% and 8 1% respectively Grades 2 and 3 were the most commonly reported grades and the sacrum was the most frequent position It was anticipated that there would be a difference in dependency between the patient populations in each of the three surveys This was not so and, when using the Waterlow score, the numbers of patients found to be at no risk, at risk and at high risk remained remarkably stable Only those in the very high risk category fluctuated It is postulated that the difference between the prevalence in the three surveys is related to the difference in the numbers of patients seen to be at very high risk. These surveys have provided a basis for selecting pressure‐relieving equipment and baseline information for monitoring the efficacy of the prevention programme
Relaxation: episiotomy incisional pain and overall discomfort
Authors: Lorenzi Elizabeth A
Published: December 2006

The primary purpose of this study was to determine the effect of a simple relaxation technique on postpartum patients' episiotomy incisional pain and overall discomfort This study was earned out through the use of a posttest‐only experimental design A total of 40 subjects (20 in the experimental group and 20 in the control group) participated in the study Only the experimental group was taught the relaxation technique and told to use it whenever they had pain or discomfort in their episiotomy incision Within 24 hours after delivery, all subjects rated their episiotomy pain and overall discomfort on the scales of pain and discomfort Twenty‐four hours after delivery, a chart review was done on each subject to further measure pain by amount and frequency of analgesic use Paired t‐tests were used to examine the differences between the means of the experimental and control groups for subjects' pain as measured by amount of pain and amount of analgesic use, and amount of overall discomfort Chi‐square analysis was utilized to examine the differences between the experimental and control groups for subjects' amount of pain as measured by frequency of analgesic use Results of the analyses demonstrated that for the subjects who used the relaxation technique, there was a general trend for decreased pain and discomfort
Immigrant women speak of chronic illness: the social construction of the devalued self*
Authors: Anderson Joan M
Published: December 2006

This inquiry into the existential experience of chronic illness by immigrant women begins from a phenomenological perspective, and proceeds to examine the context in which women's expenences are embedded It is argued that multiple factors influence the ability to manage illness Not least among them are the emotions that are an integral part of daily existence, and the sense of self that is constructed during the course of a chronic illness These emotions, and the definitions of self embodied within the illness experience, are produced in ongoing social interactions For the immigrant woman, the difficulties in living with a chronic illness are exacerbated by the experience of uprooting from her homeland and resettling in a new country She must deal with her marginality, social isolation and alienation in a foreign culture The feeling of being devalued arises not only from the chronic illness expenence, but also from the definition of self that is constructed in dealing with the migration expenence The implications that this research study has for the profession of nursing are discussed.
In search of more complete answers to research questions. Quantitative versus qualitative research methods: is there a way forward?
Authors: Corner Jessica
Published: December 2006

This paper presents an overview of research methods utilized in nursing to date and traces the origins of the schism in nursing research which has led to the development of the quantitative‐qualitative research‐methods dichotomy The philosophical and technical characteristics which distinguish these apparently opposing methodologies are described and critically discussed The use of triangulation of different methods and types of data is suggested as an alternative research strategy A study which used triangulation as a research approach which examined newly registered nurses' attitudes and educational preparation to care for patients with cancer, and developed and evaluated an educational intervention for nurses on cancer care, is described. This illustrates how the use of different research methods within a single study can provide a richer and deeper understanding of the area under investigation than would otherwise be possible This paper also discusses the notion that nursing research has arrived at a watershed in which competing methodologies serve to divide and separate nurse researchers on the grounds of philosophical approach, a division which a neophyte discipline such as nursing can ill afford Nurse researchers need to gain skills and understanding of different approaches to capitalize on the strengths and benefits of each in order to develop a more complete understanding of nursing practice in all its complexity