bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary health care in Saudi Arabia: applying global aspects of health for all, locally
Authors: Littlewood Jenny , Yousuf Shadia
Published: March 2003

Primary health care in Saudi Arabia: applying global aspects of health for all, locally

This paper describes the application of primary health care principles in the Islamic Kingdom of Saudi Arabia. It arose from a doctoral supervisory experience on a joint programme for women students, operating between a British and Saudi Arabian University. The research looked at nutritional advice given by diploma‐level nurses to pregnant women attending primary health care centres in Saudi Arabia. The supervisor supported research that drew on internationally recognized trends in nursing research (the reflexive learner) whilst attending to local requirements and conventions of the culture. The student was encouraged explicitly to site the research within the framework of Islamic teaching and Saudi culture. The Qur’an was used as an overarching framework within which the tenets of primary health care were explored. This was seen to be crucial in addressing World Health Organisation and the International Council of Nurses’ views on contextualizing nursing for the greatest benefit of the population. This was of particular relevance in Saudi Arabia where research carried out in the community by women is novel, and as yet there are no nurse theorists from within Saudi culture.
Does the duration of postnatal stay influence breast‐feeding rates at one month in women giving birth for the first time? A randomized control trial
Authors: Winterburn Susan , Fraser Robert
Published: March 2003

Does the duration of postnatal stay influence breast‐feeding rates at one month in women giving birth for the first time? A randomized control trial

The aim of the study reported in this paper was to examine the effect of postnatal stay on breast‐feeding rates at one month using a randomized control trial. Participants were recruited during parentcraft classes at a large teaching hospital in the north of England. Nulliparous women in the last trimester of pregnancy were randomly allocated to a short hospital postnatal stay (6–48 hours), or a longer stay (more than 48 hours). The mothers were contacted at one month following the birth to ask about the method of feeding. The study was approved by the hospital ethical committee, and participation was voluntary. The results demonstrated no significant effect of postnatal stay on breast‐feeding rates at one month. The main limitation of the study was the reluctance of the mothers in the long stay group to stay in hospital for longer than three days. This resulted in only a small difference between the lengths of hospital stay of the two interventions. The overall breast‐feeding rate for the study group had increased significantly when compared with local city wide rates. This increase may be as a result of a sampling bias or a Hawthorne effect.
The development and evaluation of a health education programme for pregnant women in a regional hospital, southern Thailand
Authors: Thassri Jeranoun , Kala Napaporn , Chusintong Ladda , Phongthanasarn Julianna , Boonsrirat Salee , Jirojwong Sansnee
Published: March 2003

The development and evaluation of a health education programme for pregnant women in a regional hospital, southern Thailand

The maternal mortality rate (MMR) in Thailand is higher than neighbouring developing countries including Malaysia and Singapore. The 1993 MMR of Thailand was 249 per 100 000 livebirths which was four times higher than the rates in Malaysia and Singapore (World Health Organization 1995). The major causes of these deaths were haemorrhage, toxaemia of pregnancy and sepsis which were likely to be prevented by adequate prenatal care (Thailand Ministry of Public Health 1996). A large proportion of Thai pregnant women have poor health. Between 1994 and 1995, a national study conducted by Thailand Ministry of Health showed that 39% of pregnant women were anaemic, defined as haemoglobin concentration lower than 33% (Supamethaporn 1997). Another study conducted in the southern region also indicated that 13·8% of pregnant women were anaemic caused by iron deficiency (Phatthanapreechakulet al. 1997). Other behaviours which increased risks associated with child birth included non‐antenatal care (ANC) attendance, undertaking physically demanding tasks and failure to increase nutritional intake during their pregnancy period (N. Phiriyanuphong et al. 1992, unpublished report). These factors emphasize the importance of a health education programme which could facilitate women to, for example, increase protein and iron intake during pregnancy which would reduce complications from their poor health status. This study was conducted in a regional hospital in Thailand where there was no systematic and well‐planned health education programme for pregnant women. The initial aim was to design a health education programme using input from the hospital health care professionals including obstetricians, nurses, nutritionists, health educators and health promoters. An active involvement of these personnel assisted to sustain the provision of the programme provided for pregnant women after the cessation of the study project. Another aim of the study was to evaluate the outcomes of the programme using a pre‐test–post‐test method among selected pregnant women who participated in the newly designed health education programme.
Advancing the science of symptom management
Authors: Dodd Marylin , Janson Susan , Facione Noreen , Faucett Julia , Froelicher Erika S. , Humphreys Janice , Lee Kathryn , Miaskowski Christine , Puntillo Kathleen , Rankin Sally , Taylor Diana
Published: March 2003

Advancing the science of symptom management

Abstract. Since the publication of the original Symptom Management Model (Larson et al. 1994), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars.

Aim. In this paper, we describe the evidence‐based revised conceptual model, the three dimensions of the model, and the areas where further research is needed.

Background/Rationale. The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home‐care settings because few models of symptom management have been tested empirically.

To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly‐based symptom management model allows the integration of science from other fields.
Continuous video recording: a new clinical research tool for studying the nursing care of cancer patients
Authors: Andersen Christina , Adamsen Lis
Published: March 2003

Continuous video recording: a new clinical research tool for studying the nursing care of cancer patients

Aim. The aim of this study was to clarify issues around the patient–nurse interaction during pulsed dose rate (PDR) brachytherapy.

Background. Cancer diagnosis, response and survival rates as well as the side‐effects of radiation therapy are well described in international literature. However, no scientific data apparently exist on the reactions and behaviour of cancer patients during stressful irradiation treatments nor on nursing performance in these situations. The study involved gynaecological and anal cancer patients. Treatment needles (10–20 cm) were implanted in the tumours of these patients during the PDR brachytherapy. This treatment was administered during a 15–30‐minute period each hour, for a duration of 30–60 hours. Patients were partially isolated and immobilized, and typically positioned on the back or side. In preparation for the therapy, patients had to fast and drink sparingly. Observation and nursing care could only be performed during pauses in the treatment.

Method. This paper is based on 142 hours of continuous video recording of patients undergoing PDR brachytherapy. Data were collected on five patients and 17 nurses.

Findings. The study shows that nurses were with patients for approximately 1/4 of the available time. The majority (75%) of any communication with patients centred around physical care. Although patients were in a stressful situation, they did not anticipate receiving any psychological support from nursing staff. Patients showed individual patterns of behaviour and coping.

Conclusions. Continuous video recording, as a research tool can document accurately interaction and behaviour between cancer patients and nursing staff. Video recording discloses examples of both eminent and negligent nursing care and as such can be a useful tool for instruction and for future research. The credibility, validity and limitations of using video recording are discussed.
The nurse – a resource in hypertension care
Authors: Aminoff Ulla Britt , Kjellgren Karin I.
Published: March 2003

The nurse – a resource in hypertension care

Aim of the study. To explore the content and structure of communication between patient and nurse at follow‐up appointments concerning hypertension.

Background. Hypertension is a chronic condition and calls for co‐operation between health care providers and patients over a long period of time. One important purpose of the follow‐up consultations is to transfer knowledge between patients and health care providers in order to empower patients. This is an important determinant of the quality of care.

Design/methods. The study was based on 20 audio‐recordings of actual follow‐up appointments and was approved by ethics committees. The consultations took place at four different health care units for hypertensive patients.

Findings. The average length of consultations was 18 minutes. In the consultations, patients initiated an average of eight new topics and nurses an average of 20. All nurses talked with patients about life style. Compared with previous studies of follow‐ups with physicians, consultations with nurses addressed lifestyle factors and adherence to treatment to a higher degree. It was also observed that patients were more actively involved in interaction with nurses compared with the follow‐ups with physicians.

Conclusions. Active patient participation in care is a critical factor in improving adherence to treatment. It would be of value to develop and assess a more patient‐centred organization of hypertension care and thereby more individualized hypertension treatment. Nurses may have a pivot role in such care.
Cohesion among nurses: a comparison of bedside vs. charge nurses’ perceptions in Australian hospitals
Authors: Chaboyer Wendy , Najman Jake , Dunn Sandra
Published: March 2003

Cohesion among nurses: a comparison of bedside vs. charge nurses’ perceptions in Australian hospitals

Aim. This study examines the extent to which hospital nurses view their working environment in a positive sense, working as a cohesive group.

Background. Despite the fact that nursing in Australia is now considered a profession, it has been claimed that nurses are an oppressed group who use horizontal violence, bullying and aggression in their interactions with one and other.

Methods. After ethical approval, a random sample of 666 nurses working directly with patients and all 333 critical care nurses employed in three large tertiary Australian hospitals were invited to participate in the study in the late 1990s. A mailed survey examined the perceptions of interaction nurses had with each other. The hypothesis, that level of employment (either Level I bedside nurses or Level II/III clinical leaders) and area of work (either critical care or noncritical care) would influence perceptions of cohesion, as measured by the cohesion amongst nurses scale (CANS) was tested.

Results. In total 555 (56%) surveys were returned. Of these, 413 were returned by Level I and 142 by Level II/III nurses. Of this sample, 189 were critical care and 355 noncritical care nurses. There was no difference between Level I and II/III nurses in mean CANS scores. It is interesting to note that the item rated most positively was ‘nurses on the units worked well together’, however, the item rated least positive was ‘staff can be really bitchy towards each other’ for both Level I and II/III nurses. There was no difference in CANS scores between critical care and noncritical care nurses.

Conclusions. Nurses working in Australian hospitals perceived themselves to be moderately cohesive but, as would be expected in other work settings, some negative perceptions existed.
Re‐thinking representations, re‐writing nursing texts: possibilities through feminist and Foucauldian thought
Authors: Huntington Annette D. , Gilmour Jean A.
Published: March 2003

Re‐thinking representations, re‐writing nursing texts: possibilities through feminist and Foucauldian thought

Focus. Critical approaches are increasingly being used to inform theory and research within the discipline of nursing. In this paper we discuss the work of feminist writers, particularly those located within the postmodern, and Michel Foucault. Their work, although having significant points of difference, can be viewed as complementary and our engagement with these ideas has led us to re‐think nursing knowledge.

Rationale. Using ideas from Foucault and postmodern feminism foregrounds critical questions such as whose knowledge is visible in nursing literature, whose is suppressed, and the power relationships reflected in representations of knowledge. Our exploration of representations of knowledge has led us to review fundamental nursing texts that we consider to be important political and ideological artefacts in the enculturation of student nurses. The dominant position of medical knowledge in the texts reviewed continues to position this ‘voice’ as primary in nursing literature.

Discussion. Drawing on our current research on endometriosis to illustrate the potential inherent in rewriting such texts, we argue for a repositioning of knowledge related to the illness experience. Privileging the voices of people who are the focus of our clinical care reflects the reality of nurses’ work; the embodied experience of the person is made visible rather than marginalized in the illness discourse.
Nursing research in Spain: bibliometrics of references of research papers in the decade 1985–1994
Authors: Pardo Carmen , Reolid María , Delicado María‐Victoria , Mallebrera Elena , García‐Meseguer María‐José
Published: March 2003

Nursing research in Spain: bibliometrics of references of research papers in the decade 1985–1994

Background. Spain is one of the few European countries to have recently totally incorporated the study of nursing into the university sector. Bibliometric studies may be of a great help for the consolidation of nursing research.

Aim of the study. The aim of this paper is to describe bibliographic references in Spanish nursing research papers and their evolution over a decade.

Method. The method consists of a retrospective bibliometric study of a sample (cluster sampling) of 622 research papers (original papers and review papers), which were contained in the Spanish nursing journals Enfermería Científica, Revista ROL de Enfermería, Enfermería Clínica and Enfermería Integral, and published from 1985 to 1994. The journal Nursing Research was selected for qualitative comparative purposes. A series of classic bibliometric indexes were used.

Results. The mean of references per paper is 10·64 ± 10·42; this increased over time (P < 0·001). Review papers have more references (P < 0·001). Price index (percentage of references published during the last 5 years) is 44% and the Insularity (percentage of references published in same country as the article) is 55%. References to journals predominate (58·6%), with a growing tendency for references to Spanish nursing journals, although they are still scarce (18·1% of the references to journals). Spanish is the language of most of the references (60·3%), the second language being English (36·1%).

Conclusions. Bibliographic references in Spanish nursing research papers are scarce and not very specific: this happens both in regard to Nursing Research and to publications in other national and international science areas. However, there is an increasing tendency of references (including references to nursing journals) in the period analysed. The age of the references places Spanish nursing in an intermediate position between the ‘hard’ sciences and the humanities; and, according to the type of documentation used, we find it halfway between experimental and natural sciences, and technologies and social sciences. There has been a slight increase in references in English in recent years.
Traditional healing in Likorrahi in the early 20th century
Authors: Tsiou Chryssoula
Published: March 2003

Traditional healing in Likorrahi in the early 20th century

Aim. The aim of this study is to record empirical data and views regarding health, illness, healing, hygiene, prevention and birth in a rural society at the beginning of the 20th century.

Background. Likorrahi was a small Greek village in the region of Epirus that was abandoned during the 1970s. Epirus is a rural and mountainous area.

Design. The research was conducted 10 years ago among former inhabitants of the community of Likorrahi. The informants were 33 Likorrahites over the age of 60. The research method which was used was that of ethnographic interviews focusing on general health issues.

Findings. The findings show that in the early 20th century different doctors, nurses and midwives offered their health care services free to the Likorrahites. There were few doctors, there was no medicine and science knew little of disease.

Conclusions. This study has historical value for nurses and other health professionals. It will also be of interest to anthropologists, ethnographers and students of rural history.
The impact of assessing the prevalence of pressure ulcers on the willingness of health care institutions to plan and implement activities to reduce the prevalence
Authors: Halfens Ruud J.G. , Bours Gerrie J.J.W. , Bronner Claudia M.
Published: March 2003

The impact of assessing the prevalence of pressure ulcers on the willingness of health care institutions to plan and implement activities to reduce the prevalence

Background. In 1998, 89 health care institutions (hospitals, nursing homes, residential homes, and community care institutions) participated in the first Dutch National Pressure Ulcer Prevalence Study.

Aim. Based on the innovation–decision process for individuals (Rogers 1995), the effect of their participation was investigated at different levels in the institutions [prevalence assessment coordinator, director, ward management (enrolled) nurses, and the pressure ulcer committee].

Method. A mail questionnaire was developed and filled out by 54 coordinators of the participating health care institutions.

Results. Results showed that according to the coordinators most levels of the institutions were familiar with the results of the prevalence assessment, understood them, and were persuaded that their prevalence rate had to be changed. As a result, almost all of the coordinators of the institutions were planning activities to change pressure ulcer management, while half of the coordinators had already implemented some actions. The main activities planned or implemented were developing or updating the prevention and treatment protocol and educating the (enrolled) nurses. Some institutions were planning or had already implemented the appointment of a nurse specialist or a nurse paying special attention to pressure ulcers. Results showed that the different levels of the institutions took initiatives on different categories of activities.

Conclusion. It is concluded that participating in the first national prevalence study was a positive experience for the institutions, because agenda‐setting took place and most started to plan or implement activities to improve the prevention and treatment of pressure ulcers.
Infant feeding responsiveness: a conceptual analysis
Authors: Mentro Anne M. , Steward Deborah K. , Garvin Bonnie J.
Published: March 2003

Infant feeding responsiveness: a conceptual analysis

Background. The phenomenon of infant responsiveness to the caregiver during feeding interactions has been of interest to researchers for many years, because of its associated implications for child growth and development. Although many studies have examined feeding responsiveness in caregiver–infant dyads, it is infrequently and inconsistently defined in the literature.

Specific Aims. The purpose of this paper is to clarify the concept of infant feeding responsiveness through the provision of a working definition of the concept for further study and usage.

Methods. Medline, CINAHL, and PschInfo databases from the year 1970 to the present were searched for English articles containing the keywords ‘infant’, ‘feeding’, ‘responsiveness’, ‘synchrony’, and/or ‘interaction’. Articles were selected for inclusion according to whether or not the phenomenon of infant feeding responsiveness was defined or assessed. Walker and Avant’s (1995) method for concept analysis was employed for the development of defining attributes, case examples, antecedents, and consequences for further clarification of the concept of infant feeding responsiveness.

Findings. Infant feeding responsiveness was defined as the manifestation of physiologically influenced visual, expressive, vocal and motor reactive behaviours expressed by an infant in reaction to a caregiver’s feeding attempts, indicating a readiness to feed.

Conclusions. Implications for nursing are explored as well as the need for refinement of measures of this concept.
`Great fleas have little fleas': Irish student midwives' views of the hierarchy in midwifery
Authors: Begley Cecily M.
Published: March 2003

`Great fleas have little fleas': Irish student midwives' views of the hierarchy in midwifery

Background. Many studies have investigated the world of the student nurse, but there is little work into the lives and experiences of student midwives. Studies of Irish midwives' provision of care have demonstrated that they are not fulfilling their complete role, and research into their education was deemed to be necessary.

Aim. To explore the opinions, feelings and views of student midwives as they progressed through their 2‐year education programme in Ireland.

Methods. Both quantitative and qualitative methods were used and the qualitative sections of the study were guided by the phenomenological approach. Ethical approval was granted. All students in the first intake of 1995 in all seven midwifery schools in Southern Ireland agreed to take part (n=125). Individual and group interviews, diary‐keeping and questionnaires collected data.

Results. The findings presented in this paper describe the students' views of the hierarchical structures in midwifery, and the role and behaviours of the `Matron'. The data describes a subculture of nursing/midwifery subordination.

Discussion. One reason for the hierarchical nature of the midwifery profession may be because it is an almost totally female‐dominated profession, with the female hierarchy exercising control over other women within a male‐based power structure. Many hospitals preferred to employ their own students as staff, ensuring a continuation of the hierarchical regime.

Conclusion. The recurring nature of this problem may be because midwives now fear change more than they desire it. Further research is required to ascertain whether the reason for the strong hierarchy is because of the continuation of midwifery from the male‐dominated profession of nursing, to the existence of the industrial/economic model of maternity care or to the impact of the medicalization of childbirth.
Tracheal suctioning: an exploration of nurses' knowledge and competence in acute and high dependency ward areas
Authors: Day Tina , Farnell Sarah , Haynes Sheila , Wainwright Steven , Wilson‐Barnett Jenifer
Published: March 2003

Background and rationale.  With an increasing demand for intensive care beds more nurses in acute and high dependency wards will be expected to care competently for patients with tracheostomy tubes. Tracheal suctioning is an essential aspect of effective airway management. However, this has many associated risks and complications, ranging from trauma and hypoxaemia to, in extreme cases, cardiac arrest and death. It is imperative that nurses are aware of these risks and are able to practice according to current research recommendations.

Aims.  This study was designed to explore nurses' knowledge and competence in performing tracheal suctioning in acute and high dependency ward areas and to investigate discrepancies between knowledge and practice using method triangulation.

Methods.  Twenty‐eight nurses were observed using nonparticipant observation and a structured observation schedule. Each subject was interviewed and questioned about their tracheal suctioning practices, and subsequently completed a knowledge‐based questionnaire. Scores were allocated for knowledge and practice.

Findings.  The findings demonstrated a poor level of knowledge for many subjects. This was also reflected in practice, as suctioning was performed against many of the research recommendations. Many nurses were unaware of recommended practice and a number demonstrated potentially unsafe practice. In addition, there was no significant relationship between knowledge and practice. However, during the interviews, many nurses were able to provide a rationale for specific aspects of practice that were perhaps not based on current research recommendations.

Conclusions.  The study raised concern about all aspects of tracheal suctioning and has highlighted the need for changes in practice, clinical guidelines and focused practice‐based education.
Patient‐controlled analgesia: what information does the patient want?
Authors: Chumbley Gillian M. , Hall George M. , Salmon Peter
Published: March 2003

Aims of the study.  To formulate and evaluate an information leaflet for patients using patient‐controlled analgesia (PCA), incorporating information thought to be important by patients.

Rationale.  The benefit of current information leaflets, written by professionals, has not been studied and their value to patients is unknown.

Background.  Previous studies have shown that information leaflets were poorly designed and written in language too difficult for patients to understand.

Research methods.  Seven focus groups were conducted to establish what information patients wanted to know about PCA. This information was incorporated into a new information leaflet. One hundred patients were randomized to receive either the new leaflet or the old leaflet in current use. A questionnaire was used to establish whether the new leaflet was more clear and informative than the old one.

Results.  Patients wanted to know that the drug used in PCA was morphine. They wanted more information about side‐effects, needed to be reassured that it was safe, and that they could not overdose or become addicted. They wanted detailed instructions and diagrams about the technique. The questionnaire study established that the new leaflet was clearer and more informative.

Conclusion.  Patients' contribution led to major change, producing a leaflet which was clearer, more attractive, more informative and which proved more satisfactory to patients.
Partnership: an analysis of the concept within the nurse–client relationship
Authors: Gallant Mae H. , Beaulieu Marcia C. , Carnevale Franco A.
Published: March 2003

Background/Rationale. Current nursing literature that describes the nurse–client relationship as a partnership provides little clarity about the elements and processes of this partnership. This is hardly surprising as conceptual definitions of partnership differ in scope and vary according to the context of the partnership and types of partners.

Aims of the paper. This paper examines the concept of partnership using Rodgers's (2000) evolutionary approach to concept analysis. The paper describes the antecedents, attributes and consequences of partnership as well as changing socio‐political and economic contexts that illuminate how and why nurse–client partnership emerged. Temporal changes in the concept of partnership are also examined.

Findings. The nurse–client relationship as partnership evolved from a growth in democratic thinking and progress in clarifying how to honour basic human rights in health care relationships. The attributes of partnership include structural and process phenomena. The structure of partnership includes the phases of the relationship, focus and aims of each phase, and roles and responsibilities of the partners. The process of partnership embodies power sharing and negotiation. The main consequence of partnership is client empowerment, which is understood to be the improved ability of the client to act on his/her own behalf.

Conclusions. The paper concludes with suggestions for further development of the concept of partnership through empirical research.
Patients' experiences of illness, operation and outcome with reference to gastro‐oesophageal reflux disease
Authors: Nilsson Gunilla , Larsson Sylvia , Johnsson Folke , Saveman Britt‐Inger
Published: March 2003

Background.  Describing the illness‐story from a patient perspective could increase understanding of living with a chronic disease for health professionals and others, facilitate decision‐making about treatment and enhance information about the outcome from a patient perspective.

Aim.  To illuminate patients' illness experiences of having a gastro‐oesophageal reflux disease (GORD), going through surgery and the outcome.

Methods.  Twelve patients were interviewed 5 years after having had the operation; six patients had had fundoplication via laparoscopy and six via open surgery. Each patient was asked to talk openly about their experiences, thoughts, feelings and consequences of living with the illness, going through surgery and the period from surgery to the day of interview. A qualitative content analysis was performed concerning the context of the data and its meaning.

Findings.
 Three central categories were identified and nine subcategories: living with GORD– symptoms of the disease affecting daily living, taking medicines, work, family and social life; concerns related to surgery– decision‐making about the operation, influence by physicians; life after the operation– outcomes and consequences, side‐effects and complications of the operation, sick leave, information and sharing experiences with future patients. All patients were free from symptoms of the illness after surgery independent of type of surgery, but side‐effects from surgical treatment varied individually. Interviewees would have liked information concerning side‐effects after surgery from previous patients.

Conclusions.  This study contributes to knowledge about patients' long‐term suffering, their control of symptoms and how they have tried to cure themselves, but also about their concerns about surgery and the importance of surgical treatment to their quality of life. They wanted information about treatment, outcome and consequences, not only from a health care perspective but also from previous patients having had the same treatment.
The meaning of models of nursing to practising nurses
Authors: Wimpenny Peter
Published: March 2003

Background.It is contended that models of nursing have lost the momentum and challenge that they promised the profession. Their use, value and purpose have been seriously questioned and new perspectives on their use and implementation in practice, education and research are required. In addition, limited evidence exists on the implementation of models into clinical areas.

Aim.To explore the meaning of models of nursing to practising nurses.

Methods.Serial interviews with qualified nurses who were undertaking an educational programme or module that explored and examined models of nursing.

Findings.The outcome reveals that the use of the terms, models of nursing or nursing model, are limited and confusing as the terms can encompass a range of meanings. It is suggested that a three‐model typology exists that clarifies more fully the present position of nursing models. The three models are Theoretical Model, Mental Model and Surrogate Model.

Limitations.The focus on data collection through serial interviews with qualified practitioners could have been broadened to include a range of data sources such as teachers and clinical areas, which could have enriched the phenomenon of models of nursing.

Conclusions.There is a greater need to understand nursing models within the framework of the three‐model typology and to reconsider their introduction and use in this context.
Governing the conduct of conduct: are restraints inevitable?
Authors: Irving Kate
Published: March 2003

Background.  The purpose of this article is to provide an interpretation of how restraint use is maintained and legitimized despite negative reports on its efficacy and questions about its ethicality. My research examined the use of restraint on a patient requiring care in an acute teaching hospital in Australia. This article examines one case study that was part of a PhD research project. The literature reveals evidence of the harm that restraints cause, as well as their ineffectiveness as a safety measure. In addition, it indicates that the prevalence of restraint use is high.

Methods.  The study is framed by a Foucauldian approach to discourse analysis. This report is an in‐depth case study including observations of the patient, interviews with members of the multidisciplinary team and analysis of medical, physiotherapy and nursing notation.

Findings.  Discourses from the health care team are identified by which restraint use is justified, and legitimized by staff. An important discursive practice is ‘constituting the patient's inability to self govern' and their resulting marginalization from the services provided by the team.

Limitations.  There are certain philosophical limitations including classical arguments about the position of postmodernism and specifically the ideas of Michel Foucault as opposed to other philosophy's ability to make sense of a phenomenon. The study was carried out in Australia and thus the discursive practices may be dissimilar in other countries.

Conclusions.  Through these discursive practices we can understand how staff maintain a monopoly over the truth and perpetuate claims about the inevitability of restraint use.
Systematic review of patient handling activities starting in lying, sitting and standing positions
Authors: Hignett Sue
Published: March 2003

Background. Over the last 20 years a number of methods have been recommended in professional guidelines for moving patients. This review was undertaken as it was recognized that there was a need for clinical work involving handling patients (systems of work and equipment) to be based on scientific evidence.

Aims. The aim of this paper is to report the methodology, search strategy and results relating to work involving the care, treatment and transfer of patients starting in lying, sitting and standing positions.

Methods. An unusual philosophical stance has been taken by appraising studies within a study type rather than comparatively. This facilitated the inclusion of a wide range of study designs (quantitative and qualitative). A string search was run on eight databases and supplemented by other search strategies. A published checklist was selected and inter‐rater reliability established before the main review commenced. A systematic process for inclusion, exclusion, appraisal, extraction and synthesis was undertaken.

Results. Thirty‐two studies were included: nine for activities with the patient starting in a lying position and 23 for the sitting position. No studies were found with respect to patient handling activities starting in a standing position. These data were synthesized into evidence statements.

Conclusions. The evidence statements support the use of hoists (for nonweight bearing patients), standaids, sliding sheets (double thickness rollers), lateral transfer boards, walking belts and adjustable height beds and baths. It is suggested that these items should constitute a minimum equipment list for any clinical environment where patient handling takes place on a regular basis. The lack of research relating to patient handling in standing is of particular concern and it is recommended that this area should be a high research priority to address concerns about patient handling in rehabilitation activities.
Long‐term consequences of changes in territory quality on feeding and reproductive strategies of vervet monkeys
Authors: LEE  , HAUSER
Published: March 2003

1.  Food availability and quality are important determinants of mammalian reproductive success, and long‐term changes in food availability were assessed for their impact on diets and reproduction of three adjacent groups of vervet monkeys in Amboseli, Kenya in two periods spanning an interval of 9 years.

2.  Diets were largely restricted to the products of two species of acacia trees (Acacia xanthophloea and Acacia tortilis), with food selection primarily determined by availability (tree density, size and seasonal production of foods).

3.  Over this period the overall abundance of major foods, measured through absolute species density, declined while territory size increased.

4.  Despite significant changes in food plant densities, diets remained relatively stable, suggesting a component of consistency in diet choice. Limited options or high costs for incorporation of novel foods are suggested as factors maintaining this stability, with deleterious consequences in the face of very long‐term habitat changes.

5.  This study suggests that the habitat deterioration, assessed by reduction in food densities, initiated local group extinction. An increased energy expenditure in foraging, high mortality and low reproductive rates ultimately led to a population crash under conditions of reduced food availability.
Population size dependence, competitive coexistence and habitat destruction
Authors: HUXEL GARY R. , HASTINGS ALAN
Published: March 2003

1.  Spatial dynamics can lead to coexistence of competing species even with strong asymmetric competition under the assumption that the inferior competitor is a better colonizer given equal rates of extinction. Patterns of habitat fragmentation may alter competitive coexistence under this assumption.

2.  Numerical models were developed to test for the previously ignored effect of population size on competitive exclusion and on extinction rates for coexistence of competing species. These models neglect spatial arrangement.

3.  Cellular automata were developed to test the effect of population size on competitive coexistence of two species, given that the inferior competitor is a better colonizer. The cellular automata in the present study were stochastic in that they were based upon colonization and extinction probabilities rather than deterministic rules.

4.  The effect of population size on competitive exclusion at the local scale was found to have little consequence for the coexistence of competitors at the metapopulation (or landscape) scale. In contrast, population size effects on extinction at the local scale led to much reduced landscape scale coexistence compared to simulations not including localized population size effects on extinction, especially in the cellular automata models. Spatially explicit dynamics of the cellular automata vs. deterministic rates of the numerical model resulted in decreased survival of both species. One important finding is that superior competitors that are widespread can become extinct before less common inferior competitors because of limited colonization.

5.  These results suggest that population size–extinction relationships may play a large role in competitive coexistence. These results and differences are used in a model structure to help reconcile previous spatially explicit studies which provided apparently different results concerning coexistence of competing species.
Biases in the estimation of the demographic parameters of a snowshoe hare population
Authors: Haydon Daniel. T. , Gillis Elizabeth. A. , Stefan Carol. I. , Krebs Charles. J.
Published: March 2003

1. Survival rates and natalities for a population of snowshoe hares in the Yukon were estimated independently of and simultaneously with estimates of population change during the increase phase of a hare cycle.

2. Simple demographic models are used to show that even though the estimated survival rates and natalities were high relative to previously published estimates, the observed demographic parameters are unable to explain the extent of population increase, and we conclude that some of these parameters must be underestimates.

3. A sensitivity analysis is used to examine the potential influence of changes in these demographic parameters on the population growth rate. During most years of the hare cycle the population growth rate is potentially most sensitive to changes in juvenile postweaning survival. Only during crash years is adult survivorship likely to be a more important determinant of the rate of population change.

4. Examination of previously published data sets on two full population cycles suggests that while survival rates are positively correlated with population growth rates, their incorporation into demographic models results in frequent underestimation of the rate of population increase.
Predation, group size and mortality in a cooperative mongoose, Suricata suricatta
Authors: Clutton‐Brock T. H. , Gaynor D. , McIlrath G. M. , Maccoll A. D. C. , Kansky R. , Chadwick P. , Manser M. , Skinner J. D. , Brotherton P. N. M.
Published: March 2003

1. In social mammals where group members cooperate to detect predators and raise young, members of small groups commonly show higher mortality or lower breeding success than members of large ones. It is generally assumed that this is because large group size allows individuals to detect or repel predators more effectively but other benefits of group size may also be involved, including reduced costs of raising young and more effective competition for resources with neighbouring groups.

2. To investigate the extent to which predation rate affects survival, we compared mortality rates in two populations of suricates (Suricata suricatta), one living in an area of high predator density (Kalahari Gemsbok Park) and one living in an area of relatively low predator density (neighbouring ranchland). Most aspects of feeding ecology and growth (including time spent feeding, daily weight gain, growth, adult body weight, breeding frequency and neonatal mortality) were similar in the two populations. In contrast, mortality of animals over 3 months old was 1·7 times higher in the Park than on ranchland.

3. Mortality of juveniles between emergence from the natal burrow and 6 months of age was higher in small groups than large ones in the Park but significantly lower in small groups than large ones on ranchland. Adult mortality declined in larger groups in both areas.

4. The tendency for survival to be low in small groups had far‐reaching consequences for the risk of group extinction. During a year of low rainfall in the Park, all groups of less than nine animals became extinct and population density declined to around a third of its initial level. We argue that high group extinction rates are to be expected in species where survival declines in small groups and mortality rates are high.
The structure of a leafminer–parasitoid community
Authors: Rott A.S. , Godfray H.C.J.
Published: March 2003

1. Quantitative food webs were constructed describing the community of leafmining moths in the genus Phyllonorycter (Gracillariidae) and their parasitoids at a site in southern England.

2. Twelve species of Phyllonorycter were reared from four species of tree. The moths were attacked by 27 species of hymenopterous parasitoids.

3. Four webs were constructed for successive moth generations over 2 years. A summary web was built and a comparison made between webs expressed in terms of number of mines and number of females recruiting to the next generation.

4. All hosts and most parasitoids were recorded in the first year, but new host–parasitoid associations were discovered throughout the sampling period. The diversity of mines and parasitoids was similar across generations.

5. The structure of the parasitoid community was strongly influenced by the host plant.

6. The extent of potential indirect interactions between hosts was assessed by constructing quantitative parasitoid overlap diagrams. The measure of influence used was the importance of one species as a source of parasitoids attacking the other. The greatest potential for apparent competition was between species of host attacking the same species of plant.
The spatio‐temporal distribution of Mycobacterium bovis (bovine tuberculosis) infection in a high‐density badger population
Authors: Delahay R. J. , Langton S. , Smith G. C. , Clifton‐Hadley R. S. , Cheeseman C. L.
Published: March 2003

1. The European badger (Meles meles) is implicated as a reservoir of Mycobacterium bovis (bovine TB) infection for cattle in Britain and Ireland. In the present study the spatio‐temporal distribution of M. bovis infection was investigated. Analyses were carried out on data from a long‐term epidemiological and ecological study of the dynamics of bovine TB in a wild population of badgers at Woodchester Park in south‐west England.

2. During the 15 years of the capture–mark–recapture study (1982–96), 3316 trapping and post‐mortem records were obtained from 1270 individual badgers. Annual prevalence of infection based on positive serological and bacterial tests varies between 10·3% and 17·7% of the population.

3. Infection was aggregated in social groups in the west of the study area, confirming the findings of previous studies. However, temporal trends in disease were not synchronized amongst neighbouring groups, suggesting low rates of disease transfer between them.

4. There was significant serial correlation in the disease status within groups over time, suggesting that infection persists for many years in some social groups. The presence of infectious adult female badgers in groups was associated with new infections, and provides further evidence for their importance in the maintenance of infection within groups. However, no statistically significant correlations were detected between the demographic characteristics of social groups and group infection status.

5. The distribution of disease reflects stable persistent foci of infection in the badger population, with limited evidence of transfer between social groups. The accurate identification of stable foci of infection would allow a range of management strategies for the control of bovine TB to be efficiently targeted in such populations. However, the extent to which this pattern of infection is representative of low‐density and disturbed badger populations is unknown.