bluuebunny/crossref_metadata_2025 huggingface dataset:
Interviewing older people by telephone following initial contact by postal survey
Authors: Wilson Kate , Roe Brenda
Published: March 2003

Although the use of the telephone for interviewing has become a commonly used and largely accepted research method, the literature on this subject makes it clear that certain reservations remain. Some of these relate to problems encountered when interviewing older adults by telephone and others concern the use of the telephone in interviews where there has been no prior face‐to‐face contact. The conclusions of others who have studied these two sets of problems in combination are that special difficulties exist. These conclusions are examined with reference to researchers’ experiences of conducting a study on continence care, in which a postal survey (as opposed to face‐to‐face contact) preceded telephone interviews. Interviews were conducted with adults of all ages, including a high proportion of older people. Researchers encountered few major difficulties and were satisfied with both response rate and response quality. Research to compare the effects of a variety of initial contact modes on telephone interviews with both younger and older adults is recommended.
The influence of psychological factors on the self‐management of insulin‐dependent diabetes mellitus
Authors: Coates Vivien E. , Boore Jennifer R.P.
Published: March 2003

This study investigated the influence of a number of psychological factors upon the practice and outcome of diabetic self‐management among young adults with insulin‐dependent diabetes mellitus. Health beliefs, perception of control and knowledge were assessed by scales and questionnaires and glycosylated haemoglobin results and clinic attendance records obtained for 263 patients. The results demonstrated that the sample members perceived that they were responsible for the control of their diabetes, that the benefits of following treatment were greater than any barriers and that they were knowledgeable about their diabetes. However, these factors were not predictive of the outcome variables of metabolic control or clinic attendance according to multiple regression analysis. Implications of these results for nursing practice and for future research are discussed.
Stress and the intensive care patient: perceptions of patients and nurses
Authors: Cornock Marc A.
Published: March 2003

This study was a replication of an earlier Cochran& Ganong study that investigated the perception of nurses and patients regarding the stressors faced by patients in the intensive care unit environment. As the original study was American in origin, one of the aims of the present study was to discover if the results would be replicated in a United Kingdom (UK) intensive care unit. Data collection was by the use of an environmental stress questionnaire that was an adaptation of the original data collection tool modified for use in a UK intensive care unit. The study was undertaken in two intensive care units producing a sample size of 71 patients and 71 nurses. There appears to be a wide variation in the perception of nurses and patients regarding the stress faced by patients in the intensive care unit. Similarities were noted between subject groups as to the nature of the stressors, although nurses tended to rate items over which they believed they had control as being more stressful than did the patients. Patients tended to rate items related to their illness and physical comfort as being most stressful. The results are in keeping with those from the Cochran & Ganong study.
Cancer patient and staff ratings of the importance of caring behaviours and their relations to patient anxiety and depression
Authors: Larsson Gunnel , Peterson Viveca Widmark , Lampic Claudia , Von Essen Louise , Sjödén Per‐Olow
Published: March 2003

Patient and staff ratings of the importance of caring behaviours (Caring Assessment Instrument, CARE‐Q) were studied and related to ratings of patient levels of anxiety and depression (Hospital Anxiety and Depression Scale) in 53 cancer patient–staff dyads. Both groups perceived anticipatory and comforting behaviours to be among the three most important. Patients considered staff explanation and facilitation as well as anticipation to be more important than did staff. Staff rated accessibility and comforting as more important than did patients. Patient and staff ratings of the importance of staff accessibility were negatively correlated. Thus, patient and staff did not agree strongly on the importance of several types of caring behaviours. Neither patient nor staff ratings of the importance of caring behaviours were associated with their ratings of the levels of anxiety or depression of specific patients. The results suggest that patient–staff communication requires specific knowledge and skills to make staff accurately judge what is important in making patients feel cared for.
Staff views on the Resident Assessment Instrument, RAI/MDS, in nursing homes, and the use of the Cognitive Performance Scale, CPS, in different levels of care in Stockholm, Sweden
Authors: Hansebo Görel , Kihlgren Mona , Ljunggren Gunnar , Winblad Bengt
Published: March 2003

Multidimensional functional assessment is the basis of individualized care. It is especially important in the care of elderly, with the complexity of symptomatology and often with cognitive impairment present. An assessment instrument for elderly persons, used in this study, is the Resident Assessment Instrument/Minimum Data Set (RAI/MDS) and its incorporated MDS Cognitive Performance Scale (CPS). The purposes of the study were to demonstrate the cognitive performance in elderly persons in different levels of care by using the CPS and to elicit the views of staff on use of the RAI/MDS. Cognitive impairment was found in 1276 elderly persons in six levels of care studied, an important factor to consider when organizing care of elderly. An intervention study was carried out for 1 year in three nursing home wards, with training and supervision in implementation of the RAI/MDS including individualized and documented care. Part of a questionnaire was used to evaluate staff (n=50) views on using the instrument. A majority of the staff thought that the RAI/MDS could contribute to the improvement of quality of care, documentation in nursing records, and in co‐operation and engagement. Further research is necessary to elicit more knowledge on the usefulness and benefits of the instrument.
The lived experience of patient prudence in health care
Authors: Larrabee June H. , Bolden Lois V. , Knight Marie Ray
Published: March 2003

The lived experience of patient prudence in health care The purpose of this phenomenological study was to describe the lived experience of patient prudence in health care. Prudence has previously been defined as good judgement in setting realistic personal goals and using personal resources to achieve those goals. Audiotaped interviews were conducted with 10 hospitalized adults for whom health care providers had previously recommended life style changes for health reasons. Data were analysed using Colaizzi's method. Seventy‐seven significant statements were identified and, from their formulated meanings, seven themes emerged that were integrated into a description of the fundamental structure of prudence. From the patient perspective, prudence in health care is a dynamic phenomenon that involves achieving well‐being and self‐perpetuation within the context of the patient's world of competing values and is experienced with emotions that range from harmony to fear and depression.
Hope, counselling and complicated bereavement reactions
Authors: Cutcliffe John R.
Published: March 2003

Hope, counselling and complicated bereavement reactions This paper examines the relationship between hope and complicated bereavement, and then considers if current bereavement counselling theory addresses this issue. Bereavement can be considered to have a number of phases or stages which need not occur in a linear fashion, but this does not make bereavement a mechanistic process. Whilst there are commonalities in people's experience of bereavement and loss, the experience of bereavement is unique to each individual. A person needs to reach a state of acceptance, to resolve conflicts related to grieving in order to complete the bereavement. Yet all individuals do not achieve this resolution naturally. Some individuals appear to experience delay in this process, and this can be described as a complicated grief reaction. Unequivocally bound up with bereavement are hope and hopelessness, with a completed bereavement process being bound up with the re‐emergence of hope and complicated bereavement process being bound up with continued hopelessness. There are many theories of bereavement counselling, and commonalities exist between these theories. Whilst the theories indicate implicitly the re‐emergence of hope in the bereft individual as a result of the counselling, there is a dearth of specific reference to how this inspiration occurs. Since the re‐emergence of hope appears to be linked to a person's movement towards a completed bereavement reaction, and this movement is facilitated by means of bereavement counselling, this paper concludes that there is a clear need to examine how this resolution occurs.
Relocating elderly people and nursing staff from the NHS to the independent sector
Authors: Lee Soo
Published: March 2003

Relocating elderly people and nursing staff from the NHS to the independent sector The results of the study reported here highlight the difficulties and potential problems facing re‐provision programmes of mental health services. Relocation of services affects not only patients and staff, it also has implications for the education of staff and managers. Without appropriate preparation for relocation, the potential negative effects for older patients could be life threatening. For the staff, relocation could mean new ways of working for which they may not have been prepared. The current educational format does not appear to be sensitive enough to adapt to the pace of policy changes. The management process of re‐provision programmes requires more than financial accounting. Preparation for relocation of patients and staff is of paramount importance to achieve the maximum benefits.
Testing the stress‐response sequence model in paediatric oncology nursing
Authors: Hinds Pamela S. , Sanders C. Ben , Srivastava Deo Kumar , Hickey Sherry , Jayawardene Deepthi , Milligan Mary , Olson Mary Sue , Puckett Patty , Quargnenti Alice , Randall Elizabeth A. , Tyc Vida
Published: March 2003

Testing the stress‐response sequence model in paediatric oncology nursing¶The causes and intensity of role‐related stress experienced by paediatric oncology nurses, the nurses’ ability to respond to the stressors, and the professional and personal consequences of those stressors for the nurses are issues of concern for administrators and staff. The concern evolves from the anticipated relationships among stressors, the ability to cope with role‐related stressors, and the expected negative outcomes such as resignation. However, the relationships among these components have not been previously measured concurrently in paediatric oncology nurses. The primary purpose of this study was to test the complete stress‐response sequence model in a sample of paediatric oncology nurses by obtaining concurrent measures of the model’s individual components: nurses’ stressors, reactions, mediators, and consequences. A total of 126 nurses completed six questionnaires (Stressor Scale for Paediatric Oncology Nurses, Perceived Stress Scale, Measure of Job Satisfaction, Organized Commitment Questionnaire, Group
Cohesion Scale, and Intent to Leave) and a demographic sheet. The majority of participating nurses were married, worked full‐time and had worked 5 or more years in oncology. Qualitative data were analysed using a semantic content analysis technique. Relationships among the components of the model were examined using a two‐stage least squares technique. The components were only weakly associated and unable to explain significant variation in each other. The combined qualitative and quantitative data indicate that an important explanatory variable — role‐related meaning — is missing in the content model.
Deconstructing the role of the public health nurse in child protection
Authors: Hanafin Sinéad
Published: March 2003

This paper argues that children who have been deemed to be ‘at‐risk’ need specialist intervention and that the Irish public health nurse (PHN) cannot provide this intervention. It is further argued that a failure to acknowledge and act on this is placing children at further risk and it is suggested that the mismatch between actual and perceived (or expected) roles leads to practices which undermine rather than support child protection. The PHN's remit in protecting children is situated within the following contexts: the variety of client groups with whom the PHN works, overall provision of child health services in the community, her education and training, and primary, secondary and tertiary protection of children. Two recent reports on enquiries into the failure of the services to protect children living with their families are used to explore the discontinuity. Existing evidence on how personnel involved (directly and indirectly) in community care services perceive or understand the PHN's role in child protection is described in the context of what the PHN's role actually is. The evidence suggests that the PHN fulfils a range of prescribed roles but that there is a perception or expectation among other service providers that she is also fulfilling additional roles. The paper concludes by suggesting some possible solutions to this discontinuity with a view to improving child protection services.
The experience of living with persistent pain
Authors: Carson M. Gail , Mitchell Gail J.
Published: March 2003

The experience of living with persistent pain¶ This article reports themes from a descriptive exploratory study conducted with 17 persons who live with persistent pain. The purpose of the research was to enhance understanding of what it is like to live with persistent pain from the perspectives of those who live the experience. Participant narratives of living with persistent pain included descriptions of physical pain as well as the pain of loss and restriction. The theory of human becoming provided the framework for guiding researcher–participant discussions and interpretation of findings. Three themes arose from the analysis: forbearance surfaces with the drain of persistent anguish; isolating retreats coexist with comforting engagements; and hope for relief clarifies priorities for daily living. The findings expand understanding about quality of life for persons who live with persistent pain. They also challenge nurses to begin focusing on the person who lives with pain as the messenger of how to endure. Recommendations, based on new understanding, are offered for practice and additional research.
Warrantable evidence in nursing science
Authors: Forbes Dorothy A. , King Kathryn M. , Eastlick Kushner Kaysi , Letourneau Nicole L. , Myrick A. Florence , Profetto‐McGrath Joanne
Published: March 2003

Warrantable evidence in nursing science¶ Consensus among nurse scholars has not been reached regarding suitable qualities for accepting or rejecting the evidence arising from various world views. The authors' purpose in writing the paper is to describe the qualities or warrants for evaluating scientific findings (the `evidence') of different research perspectives. The warrantable evidence pertinent to post‐positivist, interpretivist, critical social theorist, and feminist perspectives are described and common warrants are suggested. Three warrants common to these scientific perspectives are proposed: (a) scrutiny and critique of methodological rigor and findings by the scientific community; (b) corroboration and intersubjectivity; and (c) scope of the evidence. The identification of common warrantable evidence will assist nurses in developing some core values regarding the constituents of good science or good scholarship even in the face of pluralism in nursing science approaches.
A task‐based approach to defining the role of the nurse practitioner: the views of UK acute and primary sector nurses
Authors: Hicks Carolyn , Hennessy Deborah
Published: March 2003

A task‐based approach to defining the role of the nurse practitioner: the views of UK acute and primary sector nurses¶There exists within the United Kingdom considerable confusion relating to the definition and occupational boundaries of the nurse practitioner (NP). In consequence, the clinical practice and training of the NP remain unregulated, unstandardized and heavily dependent on local forces. Such a situation is regrettable, particularly in view of the potential value the nurse practitioner has for health care provision and also for influencing national policy decisions. It is conceivable that one reason for the current failure to reach agreement over the role definition of the nurse practitioner relates to the fact that their essential job functions depend upon the context in which the nurse practitioner operates, with primary‐based practice differing from acute sector service delivery in sufficient critical ways as to make a generic, inclusive definition impossible. To investigate the veracity of this view, two cohorts of United Kingdom nurses were sampled, one of which worked within the acute sector (n = 49) and the other in the community (n = 420). These groups were surveyed using a unique training needs analysis instrument that had been developed along formal psychometric principles. Both groups perceived advanced clinical activities, including examination and diagnosis, and a range of research activities to be central to the role of the nurse practitioner. The primary sample, however, reported business and management activities as essential tasks, while the acute sector nurses regarded high levels of communication skills, autonomy and risk management to be more important. The implications of the similarities and differences between the two data sets are discussed with reference to different clinical domains.
Towards understanding women's decisions to cease HRT
Authors: Bond Meg MA CQSW , Bywaters Paul
Published: March 2003

Towards understanding women's decisions to cease HRT¶Drawing upon an exploratory study into women's decisions to stop hormone replacement therapy, this paper discusses the patterns of information seeking and exchange between a convenience sample of 16 white European women and their doctors. Cessation was associated with confused and confusing diagnostic, prescribing and monitoring practices in a context of uncertainty about changing bodily states and the merits of medication. Enhanced openness to dialogue at critical points could enlighten health workers about why individual women stop treatment and enable women more easily to make informed decisions about continuing to take hormone replacement therapy.
`Listen, listen trust your own strange voice' (psychoanalytically informed conversations with a woman suffering serious illness)
Authors: Jones Alun
Published: March 2003

`Listen, listen trust your own strange voice' (psychoanalytically informed conversations with a woman suffering serious illness)¶This paper argues that the authentic voice of suffering can be denied to people with serious illness. Anguish and expressions of grief are sometimes replaced by joviality. Amid suffering, voices of anguish become strange inner voices that challenge defences of cheeriness and so are avoided, go unheard or are ignored. Bolstered by the everydayness of ward events and hospital life, suppression, repression and denial mean that people with serious illness can suffer without a voice. Listening to others requires the ability to listen to one's own inner voices and recognize how they might guide exchanges. By avoiding conducting conversations in ways dictated by our own fears, worries and fantasies we can listen, and in doing so allow shifts in awareness. Silent suffering can change to expressive suffering allowing a person to reach an autonomous self and so an authentic voice. The seriousness of a situation can be grasped and so life appreciated for what it is. Decisions can be made, business finished and relationships esteemed or otherwise. Through the format of brief therapeutic conversations, listening has a role to play in helping people with serious illness discover their autonomous and authentic voice. The discussion concludes with the suggestion that the need for throughput and roles and tasks demanded on nurses in general settings limits time and resources, and so liaison mental health nursing has a role to play. A specialist practitioner might offer conversational therapies, support nursing and medical staff and teach psychological concepts, thus contributing to an environment in which uncertainty is tolerated.
Students’ expectations of postregistration degree programmes
Authors: Gould Dinah , Smith Pam , Payne Susan , Aird Thomas
Published: March 2003

Students’ expectations of postregistration degree programmes

The needs of postregistration students pursuing degree‐linked clinical courses have received little attention and there are few insights concerning their aspirations when they enrol on such courses. Thus the aim of this study was to explore postregistration students’ perceptions of the specific needs of their patient/client group and to examine how they envisaged the course on which they had just enrolled might help them to meet these needs in addition to their own requirements for professional and personal development. Data were collected by group interview from 62 students enrolling on eight different postregistration courses, all employed in an acute hospital trust. The results were analysed inductively. They indicated that students had internalized the state of the healthcare market and were keenly aware of the need to fulfil the expectations of employers and the public, while fulfilling their own needs for education and pursuing their own professional and career trajectories. They appeared ambitious and yet appeared to demonstrate empathy for patients and their families and felt a tremendous desire to provide care of a high quality through the optimal development of technical expertise. Students’ emphasis on the importance of keeping abreast of technological developments should not be lightly dismissed considering its prominent position within the acute areas where they were employed, especially as it did not replace their desire to promote the caring aspects of their work.
The cooling‐suit: a study of ten multiple sclerosis patients’ experiences in daily life
Authors: Flensner Gullvi , Lindencrona Catharina
Published: March 2003

The cooling‐suit: a study of ten multiple sclerosis patients’ experiences in daily life

Approximately 60%–80% of all multiple sclerosis (MS) patients are heat sensitive. The aim of this study was to gain information on the effects of an assistive device, the cooling‐suit, on MS‐patients’ self‐care ability and also practical implications. A single‐case approach was adopted in a quasi‐ experimental before‐and‐after study. The cooling‐suit was used in their own homes by 10 individuals with diagnosed MS in different stages from relapsing–remitting to chronic progressive. Data collection procedures were self‐assessment through a structured assessment‐instrument, an open‐ended interview before and after the intervention and a diary written during one week. The selected instrument, the MS Self‐Care ADL Scale, has been developed for persons with MS and was translated into Swedish. The results showed increased self‐care ability during and after use of the cooling‐suit. However, different aspects of daily life activities were improved and to a varying extent. It is concluded that the study participants were supported and empowered in different activities of daily life such as walking and transfer and reduced voiding problems by using the cooling‐suit. Some difficulties in handling the cooling‐suit were also reported.
Taking care as a relationship: a phenomenological view
Authors: Sadala Maria Lúcia Araújo
Published: March 2003

Taking care as a relationship: a phenomenological view

The purpose of this study was to understand and analyse the meanings given to caring of patients on the isolation ward by nursing students, focusing particularly on the aspects of communication and interpersonal relationships. The data were collected from individual interviews with 18 nursing students who were performing nursing practice on the isolation ward. The results, analysed and interpreted according to existential phenomenology, describe the structure of the phenomenon ‘taking care on the isolation ward’ from a relational perspective. The students described their difficulties and anxieties, as well as their willingness to take care of isolated patients, resulting in the overcoming of obstacles and in contacting and becoming involved when taking care of these patients.
Critical review of R. R. Parse’s The Human Becoming School of Thought. A Perspective for Nurses and Other Health Professionals
Authors: Edwards Steven D.
Published: March 2003

Critical review of R. R. Parse’s

The Human Becoming School of Thought. A Perspective for Nurses and Other Health Professionals

This paper attempts a critical review of Parse’s recent book The Human Becoming School of Thought. A Perspective for Nurses and Other Health Professionals. The claimed philosophical foundations of the approach are described, as are key assumptions and principles of the human becoming school of thought. Following this, four areas of criticism are identified. These focus on: the key concepts of health and quality of life; Parse’s appeal to human ‘universals’; and the problem of shrouding descriptions of lived experience within the terminology of the human becoming school of thought.
The patient and the primary care team: a small‐scale critical theory
Authors: Timpka
Published: March 2003

The patient and the primary care team: a small‐scale critical theory

For increasing the understanding of team‐based delivery of primary care, ratings of care satisfaction and stimulated‐recall interviews were used to compose a small‐scale critical theory. Three teams and 24 patients at a community health care centre participated in the study. It was found that the multiprofessional team was vulnerable to discrepancies between the health service policy and the available care resources. If pre‐paid patients arrive with too high expectations and demands on the service, a significant part of the team’s attention is used for economizing with care procedures. When health and economics are entangled for the team, the patients are not invited to share decisions about their health. The patients’ concerns are instead turned to the social arena, which is separated by language and context from the health analysis. Simultaneously, when the teams are led to solve the health problems without involving the patients in the process, the team members convert these to their own personal distress when they fail. The conclusion is that the discrepancy between care policy and factual resources is an important cause of imbalance in patient–primary care team interaction. If service strategy and team organization and resources are not continuously adjusted to each other, the effects will continue to obstruct communication during consultations.
The information content of the nurse change of shift report: a comparative study
Authors: Lamond Dawn
Published: March 2003

The information content of the nurse change of shift report: a comparative study

This study examines the role which the nursing change of shift report may have in aiding nurses to process information and plan care. It also aims to identify whether any of the information found in the shift report can be considered as ‘forceful feature’ information, the key features of a situation which allow an individual to access appropriate knowledge within their long‐term memory store. The content of the medical notes, nursing documentation and shift reports for a total of 60 patients, selected from two acute medical and two acute surgical wards across two National Health Service Hospital Trusts in south‐east England were subjected to content analysis. The types and amount of information contained in each source were examined, along with the order of information given in the shift reports. A multidimensional scalogram analysis (MSA) was also carried out on the data to examine the patterns of information content across sources. In general, more information was recorded in the patients’ notes than communicated during the shift report. However, both the frequency data and the MSA plots indicated that particular types of information (identified here as global judgements) were often communicated in the shift report but not recorded in the patient notes. The results suggest that there is evidence that the change of shift report contains ‘forceful feature’ information. The presence of such ‘forceful features’ may facilitate the processing of patient information during the shift report communication, leading to more efficient care planning.
The incidence of smoking amongst nurses: a review of the literature
Authors: Rowe Kathy , Clark Jill Macleod
Published: March 2003

The incidence of smoking amongst nurses: a review of the literature

Over the years there has been an ongoing debate about the implications of the smoking behaviour of nurses in relation to their own health and in the context of their professional role and responsibilities. However it is difficult to determine with any degree of accuracy the current incidence of smoking amongst nurses and most of the available research is based on small samples which embrace nurses of different levels and status. Very few recent studies in the United Kingdom or elsewhere have focused on this issue. A confused picture therefore emerges. This paper presents a critical overview of the literature and where appropriate provides data about the incidence of smoking in comparable groups of the general population.
Differences between men and women on the waiting list for coronary revascularization
Authors: Bengtson Ann , Karlsson Thomas , Herlitz Johan
Published: March 2003

Differences between men and women on the waiting list for coronary revascularization

This study aims to examine the situation for patients on the waiting list for possible coronary revascularization in terms of waiting time, treatment and various aspects of well‐being in relation to gender. Patients on the waiting list for coronary angiography, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in September 1990 were approached with a questionnaire dealing with various aspects as described above. Of the 831 patients who participated in the evaluation, 174 (21%) were women. Although age was similar for men and women, men had a higher prevalence of previous myocardial infarction and a lower prevalence of previous hypertension. In terms of medication, women were more frequently treated with diuretics and sedatives than men. Women reported a higher frequency than men with regard to the following symptoms: chest pain at rest and at night, dyspnoea when walking, tachycardia, tiredness, headache, dizziness and sweating. Women also suffered more frequently from difficulty going to sleep, difficulty waking up, repeated awakening and insomnia. Men, on the other hand, suffered more frequently from restlessness, inability to act and irritability. Among patients on the waiting list for possible coronary revascularization, women differed from men by being more frequently treated with diuretics, reporting a higher frequency of various cardiovascular symptoms including chest pain and dyspnoea and, furthermore, reporting more sleeping disorders. Gender differences were found but they were not consistent.
The introduction of a routine monitoring system in primary care for patients with a first episode of cardiovascular disease
Authors: McCarney Rob , Shapley Mark , Goodwin Rosemarie , Croft Peter
Published: March 2003

The introduction of a routine monitoring system in primary care for patients with a first episode of cardiovascular disease

A study at a group general practice in the English midlands found that health promotion advice had not been routinely provided to some patients with cardiovascular disease and stroke. The purpose of this project therefore was to introduce a monitoring system to ensure that health promotion issues were covered systematically with patients following a first episode of cardiovascular disease. Patients with a first episode of a relevant condition would be identified by an automated search on the practice database, and contacted by the health visitor. A checklist would ensure that all appropriate issues were covered. The system was easily introduced at the practice and no difficulties were experienced with its administration. A total of 62 patients were seen during the year. A substantial number of secondary prevention issues were addressed through advice and information leaflets. The project was felt to be a useful addition to care by the workers involved. Although some of the issues may have been addressed in routine care, early organized nurse contact ensures systematic coverage and early referrals where necessary, as well as potential psychological benefit to patients.
Is there a concept of autonomy that can usefully inform nursing practice?
Authors: Aveyard Helen
Published: March 2003

Is there a concept of autonomy that can usefully inform nursing practice?

This paper examines evidence that the contemporary use of the term autonomy is interpreted differently by different nurses. This is important because an understanding of autonomy is crucial to our approach to informed consent prior to nursing care procedures. There are many theories of autonomy. This may account for various interpretations of the term amongst nurses. In this paper it is argued that clarity may be achieved by commitment to one particular theory of autonomy. It is suggested that this commitment should be the subject of further debate within the nursing profession. It is argued that the ambiguous use of the term autonomy should be replaced by a concept that has specific meaning for nurses and which gives a working definition to a concept that is central to respect for patient choice and independence.
Do parents or surrogates have the right to demand treatment deemed futile? An analysis of the case of Baby L
Authors: Clarke Clare M.
Published: March 2003

Do parents or surrogates have the right to demand treatment deemed futile? An analysis of the case of Baby L

The purpose of this discussion paper is to address and analyse the ethical issues arising from the following questions: Do parents or surrogates of newborn infants have the right to demand treatment deemed ‘futile’? Should the religious beliefs of the infant's parents be given special consideration when deciding on the correct course of action? The case of Baby L, an infant born with severe disability will be used to aid the analysis. It is argued that health care providers have no obligation to provide ‘futile’ treatment based on the surrogates’ right to autonomy, but an obligation may arise from a duty of benevolence. However, acting from a duty of benevolence can ignore considerations of justice and fairness and does not always prompt the right course of action. Any decision regarding treatment options will involve ranking the beliefs and values of the parents or surrogate against the integrity of the health care team and the interest of society as a whole. The consequences of continuing or discontinuing life‐sustaining treatment for the infant, the parents and the health care team will also be considered and examined.
Understanding beliefs and meanings in the experience of cancer: a concept analysis
Authors: Richer Marie‐Claire , Ezer Hélène
Published: March 2003

Understanding beliefs and meanings in the experience of cancer: a concept analysis

Although the concepts of belief and meaning are commonly used in the cancer literature, there is often an overlap in the use of the terms. Some consider the two terms as synonyms while others link them as successive elements in adjustment. Using an adaptation of the methods of concept analysis, this article differentiates belief and meaning, and also suggests that meaning exists at two levels. The defining attributes and antecedents of these closely related concepts are identified and a model case illustrating each is presented. Clarity in the conceptual definitions of beliefs and meanings can help researchers select measures that accurately reflect the phenomenon of interest. Similarly, differentiation between the concepts can help practitioners in planning focused interventions that explore clients’ existing beliefs and situational and existential meanings.
Diary data enhancing rigour: analysis framework and verification tool
Authors: Clayton Ann‐Marie , Thorne Terry
Published: March 2003

Diary data enhancing rigour: analysis framework and verification tool

This paper outlines a stage‐by‐stage framework for the analysis of data obtained from qualitative semistructured diaries. As the framework for analysis was developed, it became apparent that the methodological problem of verifying the initial analysis, required serious consideration. The research literature available was found simply to identify the difficulty, but offered no solutions. Recognizing that trustworthiness is a hallmark of qualitative research, a data analysis verification tool (DAViT) was designed. This proved to be extremely effective in enhancing the trustworthiness of a qualitative study in a number of ways. The analysis framework and verification tool together offers an eclectic approach for qualitative diary data analysis. It is further advocated that they are amenable to the analysis and verification of qualitative data obtained from semistructured interviews.
Gender differences of parental distress in children with cancer
Authors: Yeh Chao‐Hsing
Published: March 2003

Background.  Reports published over the last few decades present contradictory findings about the psychological distress and coping patterns of parents whose children have cancer. Although an increasing number of studies have focused on psychological distress and the adjustment process that parents experience when their children are diagnosed with cancer, few of these studies have been conducted in Taiwan.

Aims.  Gender differences of parental distress experienced by Taiwanese mothers and fathers (164 couples) whose children were undergoing treatment for cancer were investigated.

Methods.  Parenting stress, psychological distress, somatization, as well as marital satisfaction were compared between mothers and fathers whose children had cancer.

Results.  Mothers averaged significantly higher levels than fathers for all forms of distress. Mothers and fathers whose children had been diagnosed within the previous 2 months reported higher levels of depression, anxiety, and global stress than those in the other groups. Both mothers and fathers whose children had been diagnosed within the past 2 months reported greater marital dissatisfaction than parents whose children were in the other treatment groups.

Conclusions.  This finding indicates the need for a thorough psychiatric consultation at the time of diagnosis for children who have cancer and their families. Ongoing psychosocial support and education should have been integral components of the treatment program when relapse occurred.
A longitudinal study of perceived level of stress, coping and self‐esteem of undergraduate nursing students: an Australian case study
Authors: Lo Ruth
Published: March 2003

Aim.  The aim of this study was to investigate the perception and sources of stress, coping mechanisms used, and self‐esteem in nursing students during 3 years of their undergraduate nursing programme.

Methods.  The sample consisted of a cohort of nursing students going through 3 years of a nursing programme. The method was a descriptive corelational design. The questionnaire consisted of demographic data, the General Health Questionnaire (GHQ‐12), Self‐esteem Scale, and the modified Ways of Coping Scale. Data were analysed using frequency distributions, content analysis, and measures of correlation.

Results.

 Results indicated that students in year 1 experienced significantly less transient stress as compared with year 2; students in year 3 had more positive self‐esteem than year 2 students. There were no significant differences with regard to chronic stress, avoidance and proactive coping, and negative self‐esteem. Chronic and transient stress, as measured by GHQ, were significantly correlated (
P

 < 0·01) with avoidance coping behaviours, and negative self‐esteem. Positive self‐esteem was significantly correlated (
P  < 0·01) with proactive coping behaviours. The four main stressors in the last three years for this cohort of students, in descending order are nursing studies, finance, family and health. They coped by using both problem‐focused and emotion‐focused coping skills. There is a need to review the nursing curriculum and evaluate what impacts on students' stress levels, and also introduce strategies to reduce the stress levels of nursing students.
The validity of Antonovsky’s Sense of Coherence measure in a sample of schizophrenic patients living in the community
Authors: Bengtsson‐Tops Anita , Hansson Lars
Published: March 2003

The validity of Antonovsky’s Sense of Coherence measure in a sample of schizophrenic patients living in the community

Aim of the study. To examine the construct and predictive validity of Antonovsky’s Sense of Coherence (SOC) concept in a sample of schizophrenic persons living in the community.

Background. The salutogenic model of Antonovsky proposes that the individual’s sense of coherence, which is a personal orientation towards life, determines the health experience. The salutogenic perspective might in several advantageous aspects contribute to the care and support for patients with a long and persistent mental illness like schizophrenia.

Design. The study is a 18‐month follow‐up study. Structured interviews were used to interview 120 patients with a diagnosis of schizophrenia or a schizoaffective disorder. Pearlin’s mastery scale, Rosenberg’s self‐esteem scale, the Interview Schedule for Social Interactions (ISSI) and the Brief Psychiatric Rating Scale (BPRS) were used as construct validity measures of the SOC scale. Health related measures such as quality of life, global well‐being, satisfaction with health assessed by the Lancashire Quality of Life Profile (LQOLP) and global psychosocial functioning (GAF) were used in calculations of the predictive validity of SOC.

Results. The SOC was positively related to mastery, self‐esteem and social support but negatively associated to psychopathology. In total, mastery, self‐esteem and adequacy of social integration explained 61·1% of the variance in SOC, and mastery contributed with the greatest part of the variance, 46·3% SOC was positively associated to all health related measures and changes in SOC during an 18‐month follow‐up was positively correlated to changes in overall subjective quality of life, general health, global well‐being and global psychosocial functioning.

Conclusion. The results gave support to the construct and predictive validity of the SOC measure in individuals suffering from a diagnosis of schizophrenia.
Forced externalization of control in people with diabetes: a qualitative exploratory study
Authors: Gillibrand Warren , Flynn Maria
Published: March 2003

Forced externalization of control in people with diabetes: a qualitative exploratory study

Aim. The purpose of this study was to explore and describe the patients’ perceptions of the Diabetic Disease State and its complications using an ethnographic method.

Background. Diabetes mellitus is an extensively researched and studied disease, however, relatively little attention has been given to the lived experience of chronic illness.

Methods. A purposive sample of 18 people with diabetes was derived from a diabetes register database. Data were collected by semistructured interviews, which were tape‐recorded and transcribed. The transcripts were analysed together with the researchers’ observational notes, using open coding procedures to identify main categories. Discussion of the results is made in the theoretical context of the locus of control (LOC) framework.

Findings. Three main categories emerged from the data: information‐knowledge of illness; the psychological burden of diabetes; rationalizing. A further subcategory, reality avoidance, was identified. The findings showed that these people with diabetes experience and describe complex psychological effects and coping mechanisms in having a chronic illness.

Conclusions. The findings also suggested that participants in this study might have felt that the control of their chronic condition had been externalized to the health care professionals responsible for their care.
The concept of care in male nurse work: an ontological hermeneutic study in acute hospitals
Authors: Milligan Frank
Published: March 2003

The concept of care in male nurse work: an ontological hermeneutic study in acute hospitals

Aims. The aims of the study were to facilitate reflection upon an aspect of practice chosen by the participants, to explore and analyse these experiences and compare them with current literature on the concept of care in nursing practice.

Background. The concept of care is commonly used in the attempt to define what is unique about the role of the nurse, and both nursing and the concept of care are frequently associated with womanhood. Little research has been undertaken in relation to male nurse experiences and views on the concept.

Methods. The study used ontological hermeneutics to explore the concept of care in male nurse work in the acute general hospital setting. Eight male voluntary subjects from acute general hospital areas participated in the study and were asked to complete a summary of an experience from their practice that they felt exemplified care. Data for the study included the participants choice of practice experience, their subsequent reflections, the interview itself, the field journal and relevant literature and research.

Results. Six of the participants selected positive experiences in which they felt that their performance was satisfactory even though the events chosen for reflection were difficult and/or sad. The remaining two participants chose to reflect further on the difficulties they had within the experience. A conceptual model was constructed showing that the meeting of needs, effective communication and information giving were central to these nurses’ explanations of care within their practice. All but two of the participants broadened their gaze to include the significant others of the patient.

Conclusions. The reflections of these participants emaphsise the emotional load of practice and a sensitivity on their part to the male stereotype of being able to cope with such pressures. It is suggested therefore that those providing and managing clinical supervision take into account the possible reluctance of male nurses to seek such support. Issues of gender should be emphasized in nurse education, as these nurses were sensitive to the impact of gender on their practice, both with patient/clients and their significant others, and with colleagues.