bluuebunny/crossref_metadata_2025 huggingface dataset:
Thinking of the future and walking back to normal: an exploratory study of patients’ experiences during recovery from lower limb fracture
Authors: Griffiths Howard , Jordan Sue
Published: March 2003

Thinking of the future and walking back to normal: an exploratory study of patients’ experiences during recovery from lower limb fracture¶ Admission to hospital following a traumatic lower limb fracture is undoubtedly a stressful life event; however, few studies have detailed this from the patient’s perspective. By exploring patients’ experiences of hospitalization with lower limb trauma, this study aimed to explicate some of the factors impinging on the recovery trajectory. Patients’ perceptions of the events influencing their strategies for coping with stress, hospitalization and temporary incapacity were investigated using a qualitative methodology. A convenience sample of nine patients was recruited from an orthopaedic ward in a district general hospital in Wales. The respondents used health diaries to document their recovery for up to 6 weeks after emergency surgery. These diaries were validated and supplemented by semi‐structured interviews. Following their traumatic injuries, our respondents were subjected to a variety of stressors and uncertainties. They coped with this period of uncertainty by positive attempts to gain control over their situations, guided by an over‐riding desire to ‘return to normal’ and assisted by the caring attributes of their nurses. From the experiences and events documented, this study was able to identify several stressors which could have been mitigated by optimization of the technical aspects of care, including the management of pain.
Protective steering: a grounded theory study of the processes by which midwives facilitate informed choices during pregnancy
Authors: Levy Valerie
Published: March 2003

Protective steering: a grounded theory study of the processes by which midwives facilitate informed choices during pregnancy¶ Helping women to make informed choices during pregnancy is an important and complex part of a midwife’s role that does not appear as yet to have been investigated in depth. The purpose of this study was to use a grounded theory approach to investigate the processes involved when midwives engage in facilitating the making of informed choices for women in the United Kingdom. Interactions between midwives and pregnant women were observed and recorded and focused interviews were conducted with the midwives. Data were analysed according to the grounded theory method. The core category was identified as protective steering, whereby midwives were concerned to protect the women in their care, as well as themselves, when choices were made. Substantive categories were orienting, protective gatekeeping and raising awareness.
Mentorship in nursing: a literature review
Authors: Andrews Margaret , Wallis Martha
Published: March 2003

Mentorship in nursing: a literature review¶ The recent increase in published work relating to the supervision of nurses and in particular mentorship suggests that nurses value the opportunities that such schemes present for developing practice. Much of the literature surrounding mentorship concerns the supervision of students in practice settings but more recently, especially following the changes to post‐registration education, attention has shifted to the supervision of qualified nurses. Although the principles of supervision for students and qualified nurses are the same, differences do occur in supervisory practices. This review examines the literature associated with the supervision of student nurses and focuses on the nature and practice of mentorship in practice settings. The literature reveals that confusion exists regarding both the concept of mentorship and the role of the mentor. Many authors propose models or frameworks for mentoring activities. These tend to outline the stages of the mentoring process and the relationship between mentor and mentee. No one model is seen as more appropriate than another and choice usually depends upon the mentor’s familiarity with a particular framework. It is also evident that there is inconsistency in the length and level of preparatory courses for mentors. As yet there is in the United Kingdom no national minimum requirement or common preparation route and in practice mentors are prepared by way of the appropriate National Board Teaching and Assessing module and/or short local 2‐day course.
Attitudes of university students towards HIV/AIDS
Authors: Serlo Kaijaleena L. , Aavarinne
Published: March 2003

Attitudes of university students towards HIV/AIDS¶ The purpose of this study was to assess, in one university in Finland, students' attitudes and feelings towards HIV/AIDS while they were studying for their first year at the University of Oulu. This study is part of a larger research project concerning HIV/AIDS in the Department of Nursing at the University of Oulu. The results can be used in planning and implementing health education for young people. The data were collected by using a questionnaire with both structured and open‐ended questions. The study group consisted of 245 students who had started their studies in the autumn of 1993. The data were analysed by using cross tabulation (chi‐square test) and inductively by content analysis. The most important source of knowledge concerning HIV/AIDS was television (84%) and 30% of the students had obtained their knowledge from a school nurse. Even when there was a lot of knowledge available to the students, they estimated their knowledge as insufficient and defined HIV more correctly than AIDS. Knowledge did not increase the use of safe sex but limited sexual behaviour. Religion had an importance for sexual behaviour. Female students were more sexually active than male students. The feelings towards HIV/AIDS were more often negative than positive or neutral and the students felt stronger negative feelings towards AIDS than HIV. The negative feelings were often based on fear. The differences between the faculties were minimal.
Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm)
Authors: Blackwood Bronagh
Published: March 2003

Normal saline installation with endotracheal suctioning:

primum non nocere(first do no harm)¶ Normal saline instillation, in conjunction with endotracheal suctioning, is purported to be beneficial in removing thick and tenacious secretions for patients receiving mechanical ventilation. Guidelines for this routine procedure are inconsistent and its efficacy is unsupported by research‐based evidence. This discussion paper highlights that the procedure produces no physiological benefits for the patient and, indeed, may have detrimental effects on the patient's psychological wellbeing. It is proposed that after 25 years of inconsistent practice in trying to remove thick and tenacious secretions, it is time to focus on techniques to prevent thick and tenacious secretions.
Creating effective nursing partnerships: relating community development to participatory action research
Authors: Lindsey Elizabeth , Sheilds Laurene , Stajduhar Kelli
Published: March 2003

Creating effective nursing partnerships: relating community development to participatory action research

The purpose of this article is to demonstrate the importance of creating effective partnerships between nurses practising community development (CD) and nurses engaged in participatory action research (PAR). To that end, an overview of the theoretical principles of CD and PAR is provided and the central tenets of each methodology explored. This is followed by a discussion of the similarities and differences inherent in CD and PAR which derive from the same theoretical and philosophical foundation; that of critical social theory. Examples of two research projects highlight the relationship between CD and PAR and demonstrate the value of creating effective practitioner/researcher partnerships. Finally, some of the lessons learned in creating these important partnerships will be presented. Although this call for practitioner/researcher alliance is not new, what is new is the central role the practising nurse could take in research. Creating partnerships between practising nurses and nurse researchers advances the opportunity to actualize responsive and effective PAR and to fulfill nursing's social contract.
Recording skills practice on videotape can enhance learning — a comparative study between nurse lecturers and nursing students
Authors: Minardi Henry A. , Ritter Susan
Published: March 2003

Recording skills practice on videotape can enhance learning — a comparative study between nurse lecturers and nursing students

Video recording techniques have been used in educational settings for a number of years. They have included viewing video taped lessons, using whole videos or clips of tapes as a trigger for discussion, viewing video recordings to observe role models for practice, and being video recorded in order to receive feedback on performance from peers and tutors. Although this last application has been in use since the 1960s, it has only been evaluated as a teaching method with health care professionals in the past 10 years and mostly in the areas of medical and counsellor education. In nurse education, however, use of video recording techniques has been advocated without any empirical evidence on its efficacy. This study has used nursing degree students and nurse educationalists to categorize statements from four cohorts of students who took part in a 12‐day clinical supervision course during which their interpersonal skills were recorded on videotape. There were two categories: positive and negative/neutral. Analysis of the data showed that between 61% and 72% of the subjects gave an overall positive categorization to the statements in the questionnaire. Chi‐square tests were significant for all groups in both categories. This suggests that both nursing students and nurse lecturers thought that course participants’ statements expressed a positive belief that video tape recording is useful in enhancing students’ ability to learn effective interpersonal skills in clinical supervision.
Nurses’ perceptions of collaborative nurse–physician transfer decision making as a predictor of patient outcomes in a medical intensive care unit
Authors: Higgins Linda W.
Published: March 2003

Nurses’ perceptions of collaborative nurse–physician transfer decision making as a predictor of patient outcomes in a medical intensive care unit

This prospective correlational study examined nurses’ perceptions of collaborative nurse–physician transfer decision making as a predictor of patient outcomes in a medical intensive care unit, adjusting for risk. The convenience sample consisted of 175 patient transfer decisions. Charts and computerized databases were used to collect patient information, and a questionnaire developed by the investigator was used to obtain demographic data from the 42 medical intensive care nurses. An adapted version of the Decision About Transfer scale served to measure the nurses’ perceptions of collaboration and satisfaction with respect to specific patient transfer decisions, as well as decision task complexity, and the Acute Physiology and Chronic Health Evaluation was utilized to adjust for patient risk. Information Processing Theory guided the study.

Hierarchical logistic regression analyses first showed that the nurses’ perceptions of collaboration were not a significant predictor of patient outcomes. Furthermore, the analysis also showed that decision task complexity and the nurses’ years of critical care experience did not significantly moderate the contribution of nurses’ perceptions of collaboration to patient outcome prediction. Finally, a Pearson product moment correlation coefficient of 0·28 revealed a statistically significant (P = 0·000), positive relationship between the nurses’ perceptions of collaboration and their satisfaction with the decision making process about decisions to transfer.
Social support: factors to consider when designing studies that measure social support
Authors: Hutchison Catherine
Published: March 2003

Social support: factors to consider when designing studies that measure social support

Research into the area of social support has been associated with confusion and concern. Much of the previous work in this area has inherent and serious difficulties, especially with regard to measurement issues surrounding the concept and with study design. However, it is paramount that social support research is further developed to allow effective interventions by health care professionals to influence positive outcomes in patient care. It is only by adopting a rigorous approach to social support research that its full potential can be achieved, that it can result in the positive promotion of recovery from mental and physical illness and that it can then become an important tool for the health care professional. This paper aims to clarify research issues relating to social support definition, measurement and study design, including methodology, selection of instruments and analysis. Guidance will be provided concerning the important factors to consider to achieve a well‐designed study to measure social support.
Still attractive after all these years? Magnet hospitals in a changing health care environment
Authors: Buchan James
Published: March 2003

Still attractive after all these years? Magnet hospitals in a changing health care environment

This paper examines the research base for ‘magnet hospitals’— hospitals that have a good reputation for recruitment and retention of registered nurses. It also assesses the extent to which the concept of the magnet hospital continues to have relevance to nursing in the United Kingdom (UK). The study reviews previous research, examines recent trends in nursing employment, and reports on case studies conducted as fieldwork research. The early research on magnet hospitals, conducted in the 1980s in the United States of America (USA), is reassessed in the light of subsequent cost containment driven changes in the USA nursing labour market and in the organization of USA hospitals. Many of these changes have impacted on nursing staff, with increases in workload, and with changes in skill mix, particularly as a result of increased use of care assistants. Similar developments have been happening in the UK. The paper examines the extent to which the concept of the magnet hospital can retain validity in this changing health care environment. Case studies in 14 USA magnet hospitals were conducted in 1997. The results highlight that, as a result of hospital reorganization and merger, some of these hospitals no longer exhibit core characteristics of ‘magnetism’, whilst others have retained these characteristics despite organizational change. The paper concludes by cautioning that the concept of the magnet hospital continues to have a relevance to the management of nursing resources, but that the research base, with some notable exceptions, continues to be weak and that there is a need for monitoring and a process of re‐ accreditation to maintain a ‘live’ register of magnet hospitals.
The impact of seclusion on the treatment outcomes of psychotic in‐patients
Authors: LeGris  , Walters  , Browne
Published: March 2003

The impact of seclusion on the treatment outcomes of psychotic patients

The controversial practice of seclusion for the treatment of the acutely emotionally ill continues despite a lack of proven effectiveness. This retrospective cohort study examined the impact of seclusion alone and in combination with other important patient‐centred treatment variables (medications), disease severity variables, psycho‐social and demographic variables that best predicted outcome (as defined by length of hospital stay and reduced pathology at discharge) for a group of consecutively admitted psychotic in‐patients. Comparisons of baseline and outcome measures for secluded and non‐secluded cohorts were made via t‐test analysis, and patient‐related variables were entered as groups for stepwise regression analysis to determine those factors that could best predict outcome. Data were collected via a comprehensive chart review of 85 patients with psychosis, who were consecutively admitted over an 8‐month period to a psychiatric in‐patient unit of a general community hospital in southern Ontario, Canada. Bigelow’s Psychiatric Symptom Assessment Scale (PSAS) was applied to the chart admission and discharge data to determine both initial pathology scores and pathology change scores. Investigator‐developed global rating scales measured the early pharmacological and psycho‐social variables of interest. Although seclusion itself did not appear to be associated with any more or less improvement in mental status at discharge, seclusion was associated with a 12‐day increase in length of hospital stay, raising additional questions about its therapeutic effectiveness. Early medication response together with seclusion predicted 16% of the total variance of length of hospital stay (P = 0·0011) while baseline pathology, being married and being employed together predicted 66% of reduced pathology at discharge (P = 0·00001). Secluded subjects experienced an earlier age of illness onset, were employed or full‐time students, exhibited poorer attitude towards hospital, were more likely to be substance or drug abusers, received greater doses of chlorpromazine‐equivalent medications, and had longer lengths of hospital stay than their non‐secluded cohorts. Two predictive regression equations were formulated on the basis of these results. This study has raised several questions for further prospective investigation, has validated previous findings in the literature, and has produced new findings that may be of interest to administrators and clinicians providing quality care to this high‐risk population.
‘Coming out’ as a life transition: homosexual identity formation and its implications for health care practice
Authors: Taylor Bridget
Published: March 2003

‘Coming out’ as a life transition: homosexual identity formation and its implications for health care practice

This paper explores the formation of homosexual identity through the complex transitional process of ‘coming out’. Linear developmental models are discussed as is the influence of societal norms on identity formation. In considering the implications for professional practice the author challenges the heterosexism in health care and suggests ways in which health care professionals can provide a supportive environment for gay men and lesbians.
Help or hindrance? Single, unsupported mothers’ perceptions of health visiting
Authors: Knott Mary , Latter Sue
Published: March 2003

Help or hindrance? Single, unsupported mothers’ perceptions of health visiting

Although there have been studies of clients’ perceptions of health visiting, the views of single, unsupported mothers about the health visiting service have been under‐researched. Therefore, this study investigated their views using semi‐structured interviews with 12 single, unsupported mothers identified by health visitors within one National Health Service Community Trust. The data were analysed using Burnard’s (1991) thematic content analysis, which enabled a number of identifiable themes to emerge. Findings showed that the participants perceived the health visiting service as being concerned almost exclusively with babies and there was a general lack of understanding about the broader role of the health visitor. Clinics were seen as places to visit to weigh the baby but not as a contact point with a health visitor. Some health visitors were perceived as being judgemental in attitude and not necessarily interested in the clients as individuals. Participants considered that health visitors should be friendly, interested, able to promote their confidence and offer individualized advice. Overall the study suggests that health visitors may not be utilizing all dimensions of their role with single, unsupported mothers and may not be communicating effectively with them about this. The study also shows that single, unsupported mothers wish to be treated in the same way as other mothers but at present some feel that they are stigmatized and treated differently. The paper concludes with an outline of the implications of the findings and recommendations for practice and future research.
Clinical supervision and managerial supervision: some historical and conceptual considerations
Authors: Yegdich Tania
Published: March 2003

Clinical supervision and managerial supervision: some historical and conceptual considerations

The current lack of consensus among authors in the United Kingdom on the concept of clinical supervision continues unabated, although enthusiasm for its implementation is being questioned by those who would be supervized. The literature now reports confusion among practitioners on the differences between clinical and managerial supervision, and supervision and therapy. This paper addresses the differences between clinical and managerial supervision by revealing nursing’s history of clinical supervision. It is argued that until the current underlying conceptual ambiguities are identified and corrected, clinical supervision remains at risk of deteriorating into managerial supervision.
An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer
Authors: Balneaves Lynda G. , Long Bonita
Published: March 2003

An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer

Treatment decision making by women with breast cancer has been recognized to be an inherently stressful process. However, past decisional theory and research has failed to fully elucidate the personal, transactional, and relational nature of choice behaviour. The purpose of this paper is to explore an embedded decisional model of stress and coping that locates key assumptions ofJanis & Mann’s (1977) conflict‐theory model of decision making withinLazarus & Folkman’s (1984) transactional framework. Through combining decisional and stress and coping theories, a model is developed that addresses the theoretical limitations of the conflict‐theory model and provides greater specificity within decision‐making research. The paper examines the complexity of treatment decision making within the context of the constructs of causal antecedents, primary appraisal, secondary appraisal, coping, and adaptational outcomes. Examples specific to women with breast cancer are provided to illustrate the potential application of the embedded model. The implications of this inclusive and comprehensive decisional theory for future knowledge development and research in the area of treatment decision making are also discussed.
Improving continuity of care across psychiatric and emergency services: combining patient data within a participatory action research framework
Authors: Heslop Liza , Elsom Stephen , Parker Nyree
Published: March 2003

Improving continuity of care across psychiatric and emergency services: combining patient data within a participatory action research framework

Presented with the concerns of emergency department nurses about providing appropriate and co‐ordinated care for patients seeking mental health services, a Monash University School of Nursing, Victoria, Australia, research team chose a participatory action research strategy. Jointly executed with staff from the Peninsula Health Care Network, the research process brought together in a number of fora multiple disciplines involved in the care and management of psychiatric patients. The participatory action research process itself was the first step in remedial action. Through it, participants and management gained a firmer view of the issues facing Frankston Hospital Emergency Department staff in dealing with psychiatric patients, and in securing their access to suitable pathways of care. Other research outcomes included: a compilation of summary statistics showing patterns of use by psychiatric patients of Frankston Hospital’s Emergency Department; beginning discussions about pathways of care for these patients; and the development of a screening tool to be used by the triage nurse for at‐risk psychiatric patients presenting to the Emergency Department.
Research utilization and attitudes towards research among learning disability nurses in Northern Ireland
Authors: Parahoo Kader , Barr Owen , McCaughan Eilis
Published: March 2003

Research utilization and attitudes towards research among learning disability nurses in Northern Ireland

The current emphasis on evidence‐based practice has focused attention once again on the research activities of health professionals in general and their research utilization in particular. While there has been a limited number of studies on research utilization in the United Kingdom, these have tended to concentrate on general nurses and midwives. Little is known about the research activities, research utilization and the attitudes to research of learning disability nurses. This paper reports on data from a survey of a convenience sample of 87 nurses from three learning disability hospitals in Northern Ireland. The results show that while these nurses generally held positive attitudes to research, a substantial minority (18·3%) believed that ‘research is not relevant to the day to day work in nursing’. Only a quarter of the sample reported using research ‘frequently/all the time’ in their practice. The extent of research utilization among these disability nurses must be considerably improved if evidence‐based practice is to become a reality in their field of nursing.
The ‘cues’ to diagnosis: describing the monitoring activities of women undergoing diagnostic investigations for breast disease
Authors: Poole Karen , Lyne Patricia A.
Published: March 2003

The ‘cues’ to diagnosis: describing the monitoring activities of women undergoing diagnostic investigations for breast disease

Waiting to ascertain the nature of an undiagnosed breast abnormality is an intensely stressful experience for many women. Uncertainty surrounding the aetiology of symptoms is underpinned by the threat of malignancy, and the ‘need to know’ the diagnosis is of primary concern at this time. Seeking out threat‐relevant information through a process known as ‘monitoring’ attempts to fulfil this need. This paper details the qualitative phase of a multimethod research study that investigated the psychological impact of diagnosing breast disease. This involved focus interviews with a subset of 40 women from the original study cohort. Several types of threat‐related cues were identified by respondents and were categorized as temporal, interpersonal, procedural and spatial. In the context of uncertainty (and in some cases suspicion) these cues were interpreted as ‘indicators’ of the pending diagnosis. The manner in which particular aspects of the environment are identified, interpreted and designated as ‘threat‐relevant’ cues is discussed. Furthermore, the implications for health professionals working with patients during this stage of ‘pre‐diagnosis’ are considered.
An evaluation of information cards as a means of improving communication between hospital and primary care for women with breast cancer
Authors: Luker Karen , Beaver Kinta , Austin Lynn , Leinster Samuel J.
Published: March 2003

An evaluation of information cards as a means of improving communication between hospital and primary care for women with breast cancer

This paper describes an intervention study aimed at improving communication between hospital services and the primary health care team. A series of information cards were developed by breast specialist secondary care professionals for members of the primary health care team. Women with breast cancer were involved in the communication pathway and were asked to take the information cards to their own general practitioner (GP) practice. It was envisaged that women would be more likely to utilize the primary health care team for information if they were aware that the primary health care team was in receipt of information specific to the treatment they had received. Women newly diagnosed with breast cancer were allocated to either an intervention (n=38) or non‐intervention (n=38) group. Patient interviews were carried out around the time of diagnosis and at 4 months from diagnosis. Interviews were also carried out with 31 GPs to ascertain their views on the provision of information for women with breast cancer, and on the information cards if relevant. The study findings were interesting although not significant in terms of the direction anticipated. The cards did not impact on the utilization of the primary health care team and women in the intervention group were no more likely to utilize primary care sources of information than women in the non‐intervention group. Factors such as the long‐standing relationship women had with their GP, the perceived lack of specialist knowledge on the part of GPs and district nurses, and the women’s perception that information seeking was not a tangible reason for primary care contact had an impact on information‐seeking behaviour.
Psychosocial experiences of cardiac patients in early recovery: a community‐based study
Authors: Dixon Tracy , Lim Lynette L.‐Y. , Powell Heather , Fisher Janet D.
Published: March 2003

Psychosocial experiences of cardiac patients in early recovery: a community‐based study

Objective To report on the nature, incidence and severity of problems commonly experienced by cardiac patients in the early months of recovery, and to test the hypotheses that there exist differences in the incidences of these problems depending on age and sex. Methods 1124 emergency cardiac patients discharged from hospital with acute myocardial infarction, unstable angina, stable angina pectoris, chronic ischaemic heart disease or heart failure were surveyed 4 months after discharge. They were asked to indicate how often during the previous 2 weeks they had experienced each of a range of feelings and problems common to cardiac patients. Results A large proportion of patients reported experiencing problems in the areas of emotional reactions (70%), physical condition (79%), convalescence (67%) and relating to family and friends (63%). Severe problems were experienced especially in the physical and convalescence areas (43% and 44%, respectively). A greater proportion of patients diagnosed with heart failure experienced problems than those with other diagnoses, and these problems were more severe. Amongst myocardial infarction patients, a greater proportion of females than males reported severe problems in the emotional and physical areas, and patients 65 years and over were more likely than younger patients to report experiencing severe problems with physical condition. Conclusions Many cardiac patients are experiencing psychosocial problems 4 months after hospital discharge, especially with physical activities and convalescence. A knowledge of the incidence and nature of these problems may help nurses to assist patients to validate their experiences.
Respondent‐generated quality of life measures: useful tools for nursing or more fool’s gold?
Authors: Macduff Colin
Published: March 2003

Respondent‐generated quality of life measures: useful tools for nursing or more fool’s gold?

Within health services research the quest for better ways of measuring quality of life as an outcome variable continues apace. Recent developments in this area have seen increasing attempts to incorporate individually generated content and values into quality of life measures while retaining valid psychometric measurement properties. Following a brief overview of current conceptual approaches to quality of life measurement, this paper reviews the development of two leading Respondent‐generated instruments: the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and the Patient Generated Index (PGI). The relative strengths and weaknesses of these tools and their potential applications for nursing and nursing research are appraised. These measures both address and manifest a number of fundamental conceptual and methodological problems, and represent an innovative attempt to square the quantitative–qualitative circle. As such they offer challenging opportunities for nursing at a number of levels. Their elicitation and quantification of individual components of quality of life offer opportunities for nurses to plan care and goal set with patients. As yet, however, the validity, reliability, responsiveness and practicality of these instruments as outcome measures are debatable and require further testing. Nurse researchers could contribute to this process by using Respondent‐generated measures as an adjunct to existing, established tools in outcome studies. Moreover, nursing is well placed to investigate and debate the validity of the conceptual assumptions underpinning these new instruments.
Training programme in techniques of self‐control and communication skills to improve nurses’ relationships with relatives of seriously ill patients: a randomized controlled study
Authors: De Lucio Luisa García , López Fernando J. García , López María Teresa Marín , Hesse Blanca Mas , Vaz María Dolores Caamaño
Published: March 2003

Training programme in techniques of self‐control and communication skills to improve nurses’ relationships with relatives of seriously ill patients: a randomized controlled study

The interpersonal relationships with relatives of seriously ill patients may cause anxiety on the part of nurses and the need for adequate communication and self‐control skills. To assess the efficacy of training nurses in self‐control techniques and communication skills when they interact with relatives of seriously ill patients we planned a randomized, controlled trial in two parallel groups: an experimental group, with immediate training, and a control group, with training delayed for 6 months. We recruited 61 nurses from the nursing staff of a university hospital of 500 beds. The intervention consisted of training in relaxation, cognitive restructuring and some communication skills. The outcome variables were communication skills measured under simulated conditions using an observation instrument of our own, administered by observers masked with respect to the study groups, and the levels of state‐anxiety measured with the self‐assessment questionnaire the State‐Trait Anxiety Inventory, under imaginary conditions. The two groups initially had similar scores in the scales of communication skills, and state and trait‐anxiety. After intervention, compared with the control group, the experimental group showed significant improvements in the skills of listening, emphasizing, interrupting and coping with emotions (P < 0·05). State‐anxiety levels did not show any changes. In conclusion, the joint training in self‐control and communication improves some communication skills in nurses when they interact with relatives of seriously ill patients under simulated conditions.
Coronary artery disease patients’ perception of their health and expectations of benefit following coronary artery bypass grafting
Authors: Lindsay Grace M. , Smith Lorraine N. , Hanlon Philip , Wheatley D.J.
Published: March 2003

Coronary artery disease patients’ perception of their health and expectations of benefit following coronary artery bypass grafting

This prospective descriptive study has analysed 214 patient interviews before and 1 year after coronary artery bypass grafting (CABG). The preoperative interview explored issues related to the impact of coronary artery disease upon health and expectations of benefit from the patients’ perspective. The postoperative interview examined patients’ accounts of the experience of operation and its impact on their health. A thematic analysis of the interview data was undertaken. The main factors relating to health status preoperatively were described in terms of ‘dependency’ on others and medication, and ‘impending doom’ of some major life threatening event. Benefits to health postoperatively were viewed in terms of ‘removal of a death sentence’ and ‘freedom of choice’. Expectations of benefit from operation were varied and included ‘freedom and independence’, ‘hope, chance and uncertainty’ and ‘addition of years to life and life to years’. Undergoing the operation was described by themes of the ‘enormity of the experience’ and ‘the importance of lay support’. These findings provide a greater understanding of the ‘lived experience’ of both coronary artery disease and undergoing coronary artery bypass grafting. Unrealistic expectations of the benefits of CABG highlights the need for improvement in the way patients are informed about risks and benefits of interventions. In addition, the views and insights suggest that CABG operation is regarded as a significant major life event; thus more information, advice and counselling might help support patients before, during and after surgery.
The paediatric diabetes specialist nurse and diabetes education in childhood
Authors: Llahana Sofia V. , Poulton Brenda C. , Coates Vivien E.
Published: March 2003

The paediatric diabetes specialist nurse and diabetes education in childhood

Aims of the study.  The aim of this study was to identify the job title, work setting, qualifications and training of the paediatric diabetes specialist nurse (PDSN) as well as to examine the composition of the multidisciplinary diabetes team. It also aimed to determine who is involved in diabetes education and to explore the teaching methods, approaches, tools and materials that the PDSN uses in the educational process.

Design and methods.  A survey design was used. Questionnaires, which combined quantitative and qualitative approaches, were sent to 80 participants from eight opportunistically selected regions of the United Kingdom (UK). Access to names and addresses was gained through the directory of diabetes specialist nurses (DSNs). The selection criteria were nurses working full‐time with children with diabetes or having children with diabetes on their caseloads. The overall response rate was 66 (82·5%).

Findings.  The study findings showed that the majority of the respondents were based in both hospital and community, held paediatric qualifications and had undertaken further training to prepare as diabetes specialists. Respondents used a wide range of teaching methods and materials in the educational process. A substantial number of individuals and voluntary organizations were also involved in diabetes education.

Conclusions.  The findings of this study support the belief that the PDSN, as a member of the multidisciplinary paediatric diabetes team, has a key role in the education of children with diabetes and their parents/carers. However, the importance of the team approach as a whole should not be underestimated.
Nursing in the public sphere: health policy research in a changing world
Authors: Scott Cherill , West Elizabeth
Published: March 2003

Nursing in the public sphere: health policy research in a changing world

Aims of the paper.  To identify recent trends in the academic field of health policy, setting them in the context of wider changes in the socio‐political and research environments and considering their implications for nursing research.

Background.  Health policy is a well‐established field of academic study and research in the United Kingdom (UK). The 1990s have seen some important intellectual developments in this field, as well as some major changes in the context of health‐related research.

Design.  A selective review of the relevant literature.

Conclusions.  The Department of Health’s new Research & Development strategy can be understood as part of a wider trend, moving away from the traditional, university‐based model of knowledge production towards a new one which involves other groups, such as employers, practitioners and patients. This may increase the opportunities for health care professionals in general – and nurses in particular – to influence the research agenda and to participate as researchers in the critical evaluation of health policy.
The nurse’s workload in care situations
Authors: Nuikka Marja‐Liisa , Paunonen Marita , Hänninen Osmo , Länsimies Esko
Published: March 2003

The nurse’s workload in care situations

Aim.  The aim of this study was to describe the nurse’s workload in care situations and on different work shifts on surgical and medical wards. Changes in heart rate, shoulder–neck muscle tension and perceived exertion were measured in these care situations.

Design.  Nurses’ physical fitness was tested using a clinical exercise test.

Results.  Transportation of a patient to the operating theatre was the most strenuous care situation on morning and evening shifts. Primary care, and situations related to practical nursing procedures were the second most strenuous situations regardless of the shift. Workload in primary care situations and in transporting the patient can be classified as medium heavy based on heart rate and relative workload, whereas in other situations it can be classified on average as moderate or light. The nurse’s good physical fitness was reflected in relative workload in care situations so that in primary care and practical nursing procedures there was a statistically significant difference between those who scored high on a fitness test and those who scored low. Transferring tasks and practical nursing procedures involved more shoulder–neck muscle tension than other care situations.
Occupational stressors and coping as determinants of burnout in female hospice nurses
Authors: Payne Nicola
Published: March 2003

Occupational stressors and coping as determinants of burnout in female hospice nurses

Aims.  Stressors, coping and demographic variables were examined as predictors of burnout in a sample of hospice nurses. The study aimed to investigate the level of burnout among hospice nurses; to ascertain which aspects of nursing work were positively or negatively related to burnout; to examine the relative contributions made by these different variables and to suggest individual and organizational interventions to reduce levels of burnout.

Methods.  Eighty‐nine female nurses from nine hospices completed a battery of questionnaires comprising the Maslach Burnout Inventory, Nursing Stress Scale, Ways of Coping Scale and a demographic information form.

Results.  In general, the level of burnout (characterized by high emotional exhaustion, high depersonalization of patients and low personal accomplishment) was found to be low. In multiple regression analyses, ‘death and dying’, “conflict with staff’, ‘accepting responsibility’ and higher nursing grade contributed to emotional exhaustion. ‘Conflict with staff’, ‘inadequate preparation’, ‘escape’ and reduced ‘planful problem‐solving’ contributed to depersonalization. ‘Inadequate preparation’, ‘escape’, reduced ‘positive reappraisal’ and fewer professional qualifications contributed to lower levels of personal accomplishment. Overall, stressors made the greatest contribution to burnout and demographic factors contributed the least.

Conclusions.  The importance of not labelling individuals as good and bad ‘copers’ was discussed, as the effectiveness of a strategy may depend on the situation. It was concluded that the investigation of problem‐focused and emotion‐focused coping in relation to burnout, was oversimplifying the coping‐burnout relationship. Suggestions for stress management included staff training in counselling skills, monitoring staff conflict, implementing stress inoculation training to teach appropriate use of coping skills and finally, monitoring particularly vulnerable groups of hospice staff such as unqualified nursing assistants and qualified nurses in management positions. It was concluded that despite the difficult nature of hospice work, the hospice is a positive environment in which to work.
Bridging theory and practice in the supervisory relationship: a sociocultural perspective
Authors: Spouse Jenny
Published: March 2003

Bridging theory and practice in the supervisory relationship: a sociocultural perspective

Aim of the paper. This paper proposes alternative theoretical frameworks for conceptualizing supervisory relationships in clinical settings where professional development is the key activity. In discussing findings from the research, paradigm examples of students’ mentor experiences will be used to illustrate socio‐cultural theories of learning and their relevance to professional education in clinical settings.

Background rationale. The concept of a theory‐practice gap dominates approaches to preparing professionals for their future role. With increasing emphasis on work‐based learning one of the many strategies designed to support students and professionals is supervision. This strategy has had mixed success. In many instances this is because of insufficient numbers of suitably experienced and prepared staff. Another factor is how supervision has been conceptualized. In professional education the term mentorship is often used synonymously with preceptorship and supervision. These terms are all concerned with activities intended to foster professional and educational development, and in many instances the learner is a novice working in an unfamiliar setting over a predefined period of time.

Research aims and design. This longitudinal study using a Constructivist/Naturalistic paradigm was designed to investigate factors influencing the professional development eight preregistration nursing students’ during their practice experiences. A multimethod approach to data collection was used. An extensive literature review of nurse education texts was conducted.

Research findings. The most significant influence was found to be effective mentorship. Characteristics of successful mentorship are best explained using frameworks derived from socio‐cultural theories. Concepts of sponsorship, legitimate peripheral participation, scaffolding and zone of proximal development (ZPD) offer a more effective means to understand and implement an educational partnership for work‐place learning.