bluuebunny/crossref_metadata_2025 huggingface dataset:
‘We, not them and us?’ Views on the relationships and interactions between staff and relatives of older people permanently living in nursing homes
Authors: Hertzberg Annika , Ekman Sirkka‐Liisa
Published: March 2003

‘We, not them and us?’ Views on the relationships and interactions between staff and relatives of older people permanently living in nursing homes

This study describes relatives’ and staffs’ experiences of each other in their relationships and interactions in connection with the care of old people with dementia living in nursing homes. The aim was to identify obstacles and promoters concerning these interactions. A qualitative method was used. Data were collected from 27 hours of observations of group discussions about relatives’ and staffs’ communication, interactions and experiences. Three different groups, with eight participants, relatives, staff and a group leader in each, met six times during a period of 3 months. Findings indicate that the experiences that relatives and staff have of each other are related to issues about influence, participation, trust and measures to avoid conflicts. These conclusions build on concrete descriptions about care, activities, competence, communication and visits given by research participants. Experiences of situations were sometimes contradictory between relatives and staff. This implies that the potential for cooperation between relatives and staff in care of the elderly is not fully utilized. Suggestions for enhancing the relationships between relatives and staff are: pre‐planned informal, individual conversations between relatives and staff; development of ways to give regular two‐way feedback about matters concerning the resident and the relationship between staff and relatives; giving staff credit for measures taken to facilitate relatives’ involvement in the nursing home care; measures to improve documentation about families’ involvement; and working together with minor practical tasks.
Interprofessional relations between doctors and nurses: perspectives from South Wales
Authors: Snelgrove Sherrill , Hughes David
Published: March 2003

Interprofessional relations between doctors and nurses: perspectives from South Wales

This paper discusses findings from a study of interprofessional relationships between doctors and nurses in medical wards in three provincial general hospitals in south Wales. The aim of the research was to investigate the changing nature of doctor–nurse relations, and in particular, how far the notion of the doctor–nurse game, as developed by Leonard Stein ( Stein 1967,
1990), remains relevant to contemporary hospital work. The present paper concentrates on a subset of the findings concerned with doctors’ and nurses’ accounts of the hospital division of labour and the extent of any overlap in their work activities. Semi‐structured interviews were conducted with 20 doctors and 39 nurses in their places of work over a period of 4 months. Inductive analysis of the data indicated that, whilst doctors and nurses perceived their roles in largely traditional terms, there was some recognition of blurring of occupational boundaries, especially when considering work pressures, working at night and differences in practice in more specialized clinical areas. Although nurses were generally reluctant to challenge doctors’ authority, some used the notion of patient ‘advocacy’ to frame and justify their questioning of particular decisions. Whilst doctors valued ‘experience’ in nurses and saw experienced nurses as the group who might most legitimately move into doctors’ territory, nurses valued formal education and saw advanced nursing qualifications as the route to role expansion.
Exploring the risks associated with induction of labour: a retrospective study using the NIMATS database
Authors: Duff Carol , Sinclair Marlene
Published: March 2003

Exploring the risks associated with induction of labour: a retrospective study using the NIMATS database

Induction of labour is a valuable obstetric procedure, providing obstetricians with the means to intervene should the health of the fetus be in jeopardy. Currently the most common reason for induction of labour is prolonged pregnancy, as obstetricians and midwives are concerned about the risks of postmaturity such as stillbirth, intrapartum asphyxia and birth trauma which are often associated with prolonged pregnancy ( Lagrew & Freeman 1986). A retrospective comparative study was carried out in a large maternity unit to identify whether or not there was clinical evidence to support a policy of elective induction for post‐term pregnancy. Three years’ data were extracted from the Northern Ireland Maternity System (NIMATS) by writing new queries to the system. These data on 3262 women who delivered during 1994–96 were analysed to compare the outcomes for women who were induced with women who delivered spontaneously. Although the findings from the study in many instances failed to demonstrate statistical significance between the groups they did however, have important clinical significance. For example, those women who were induced had a 5% higher rate of caesarean section, 17% higher rate of epidural analgesia and on average a greater estimated blood loss. Statistical significance was evident when the apgar scores of the infants were compared; those induced had lower apgars at 1 minute (7·78 in the induced group compared to 7·9 in the spontaneous group [P < 0·01]) and at 5 min (8·99 in the induced group compared to 9·05 in the spontaneous group [P < 0·02]).
An evaluation of process and outcomes from learning through reflective practice groups on a post‐registration nursing course
Authors: Platzer Hazel , Blake David , Ashford Dorothy
Published: March 2003

An evaluation of process and outcomes from learning through reflective practice groups on a post‐registration nursing course

Small groups were set up purposefully on a part‐time post‐registration Diploma in Professional Studies in Nursing programme to enable students to reflect on and learn from experience. The use of these groups was qualitatively evaluated by the use of in‐depth interviews. Although there were many barriers to such learning, some students made significant developments in their critical thinking ability and underwent perspective transformations that led to changes in attitudes and behaviour. These are identified as an increased professionalism, greater autonomy in decision making, more self‐confidence to challenge the status quo and make their own judgements, and a less rule‐bound approach to their practice. The processes by which these changes occurred are identified as support and challenge within the groups offered by both the facilitators and other group members.
Project 2000: a study of expected and experienced stressors and support reported by students and qualified nurses
Authors: Brown Hilary , Edelmann Robert
Published: March 2003

Project 2000: a study of expected and experienced stressors and support reported by students and qualified nurses

The present study was conducted in the light of major reforms to nurse education which have taken place in the United Kingdom since 1989. The study aimed to identify initially perceived stressors and coping resources and subsequently, to compare these with actually reported stressors and available resources, during a critical period in nurses’ careers. Three groups of nurses participated who were undertaking, or had recently completed, the first Project 2000 course at a university in the south of England. Participants were given an open‐ended questionnaire and asked to describe potential difficulties, and the coping resources they anticipated using, in a subsequent 6‐month period. Following analysis of the descriptors a structured questionnaire was developed to measure actually experienced difficulties and coping resources that were reported; this was completed by the three groups 6 months after the initial phase of the study. Both student and staff nurse groups reported fewer stressors and more resources than they had predicted. Students anticipated difficulties with competence but actually reported financial difficulties. They experienced support from mentors although this was not anticipated. Newly qualified staff nurses experienced fewer difficulties with meeting personal expectations of the role than they had anticipated. They reported more use of emotion‐focused coping and less professional support than the student groups. The results are discussed in relation to training needs.
New pharmacological treatments for Alzheimer’s disease: implications for dementia care nursing
Authors: Adams Trevor , Page Sean
Published: March 2003

New pharmacological treatments for Alzheimer’s disease: implications for dementia care nursing

This paper addresses developments regarding new pharmacological treatments for people with Alzheimer’s disease such as Donepezil and Rivastigmine. Following a brief discussion of the experience of people in the early stages of Alzheimer’s disease, the pharmacology associated with these new treatments is outlined. The implications of these treatments for nurses working with this client‐group are fully discussed within the context of assessment, treatment and cessation. It is argued that nurses have an important contribution in the management of these treatments and recommends that descriptive and evaluative research should be undertaken relating to this new specialist area of nursing care.
A review of health professional attitudes and patient perceptions on ‘inappropriate’ accident and emergency attendances. The implications for current minor injury service provision in England and Wales
Authors: Sanders Julie
Published: March 2003

A review of health professional attitudes and patient perceptions on ‘inappropriate’ accident and emergency attendances. The implications for current minor injury service provision in England and Wales

Increasing attendances in accident and emergency (A and E) departments in the United Kingdom have been attributed to a greater number of patients presenting with minor injuries. A and E staff believe this type of patient is suitable for primary care, and is ‘inappropriate’ for A and E management. Thus, A and E staff find ‘inappropriate’ attenders time‐consuming and unrewarding, and are less motivated to help them, whilst ‘inappropriate’ patients believe they have attended the appropriate service for their medical needs and expectations. This review examines research into health professional and patient attitudes towards ‘inappropriate’ attendances in accident and emergency. It identifies a discrepancy between health professional and patient perspectives regarding ‘inappropriate’ attendances. However, the change in accident and emergency services with the development of minor injury units and nurse practitioners within A and E to treat minor injury patients away from the mainstream A and E service, appears to be based on the professional attitude of what constitutes an appropriate A and E attendance, and not on the patients’ perspective. As negative attitude formation towards ‘inappropriate’ A and E attendances has occurred, there is concern that such attitudes could remain or develop again in the new units. Patients are generally not medically trained and may experience difficulty in ascertaining the severity of their own condition and attending the ‘appropriate’ service, as defined by trained professionals. This is exacerbated by the unclear boundaries and roles of minor injury units, nurse practitioners and general practitioners in minor injury care. Therefore research is required into current attendances in minor injury units, A and E departments and general practice, in order to develop clear roles and boundaries for these services. More importantly, research is warranted into the attitudes of all minor injury care providers towards attending patients, and into patient perceptions of the services offered.
An exploration of the epistemological intricacies of using qualitative data to develop a quantitative measure of user views of health care
Authors: Coyle Joanne , Williams Brian
Published: March 2003

An exploration of the epistemological intricacies of using qualitative data to develop a quantitative measure of user views of health care

Nurse researchers are increasingly combining qualitative and quantitative methods in order to understand more fully the world of research subjects. Qualitative data are often used to explore the subjective meanings behind survey responses and to develop quantitative measures and scales. Insights from qualitative data help researchers to design instruments which are more sensitive to respondents’ meanings and interpretations. The aim of this paper is to highlight the epistemological and methodological complexities involved in this enterprise through drawing on our own experience of developing an instrument to examine person‐centredness in health care from a qualitative study of dissatisfaction. The intricacies of this project relate to: epistemological continuity and inconsistency; research roles; reflexivity; confirmation; and completeness. Through discussing the literature around integrating methods, we suggest that researchers could be assisted in their attempts to develop conceptually sound quantitative measures by extending the concept of reflexivity (used in qualitative research) to the quantitative components of mixed method studies. This would aid conceptual clarity by making explicit the social, cultural, and political construction of knowledge, and would also encourage researchers to reflect upon the ethical and political consequences of their research.
Reflection: nursing’s practice and education panacea?
Authors: Burton
Published: March 2003

Reflection: nursing’s practice and education panacea?

Nurses are now directed to ‘reflect effectively and practice reflectively’. When there is scant evidence to support the use of reflection, why does the United Kingdom Central Council, English National Board for Nursing Midwifery and Health Visiting and institutes of nurse education insist that nurses, at all levels of experience, reflect? Before developing the debate in relation to the robustness or otherwise of the concept of ‘reflection’ and its application to practice, a discussion as to what constitutes nursing knowledge, followed by an examination of the main theories related to adult learning, is presented. The paper develops to encompass a critical examination of both theoretical and applied perspectives on reflection. Conceptual issues and assumptions related to reflection are explored. Key areas considered are whether the practice of reflection facilitates the improvement of one’s knowledge, helps to generate theory and results in one becoming a more critical practitioner with resulting benefits for patients. It will be argued that reflective theory and practice has not yet been adequately tested and that there is a pressing need for evidence to demonstrate irrefutably the effectiveness of reflection on nursing practice, particularly with respect to patient outcomes.
Coping with type‐2 diabetes: the role of sense of coherence compared with active management
Authors: Sandén‐Eriksson Birgitta
Published: March 2003

Coping with type‐2 diabetes: the role of sense of coherence compared with active management

Changes in lifestyle, particularly in dietary and exercise habits, are necessary for the majority of patients with type‐2 diabetes but are difficult to carry out. However, Antonovsky describes a salutogenic health perspective grounded in patients’ developing what he terms ‘a sense of coherence’ (SOC). Can a strong SOC help diabetes patients to control the disease? The aim of this study was to analyse the relationship between SOC and treatment results measured as glucolysed haemoglobine (HbA1c) in patients with type‐2 diabetes. The aim was further to test the relationship between treatment results and an index of patients’ participation in active management and emotional state. Eighty‐eight patients answered a questionnaire containing 13 statements about sense of coherence (SOC‐13), questions about self‐assessed health, diabetes activity such as self‐management of diet, exercise and self‐control of blood sugar and emotional acceptance. There was no direct relationship between SOC‐13 and treatment results measured as HbA1c but there was a positive correlation between SOC‐13, self‐assessed health and HbA1c (P < 0·02). Self‐assessed health was seen as a mediating factor. The better patients’ estimation of their own health, the higher were SOC‐13 scores and the lower HbA1c. There was also a strong positive correlation between low levels of HbA1c and high levels of an index of active management and emotional acceptance of diabetes (P < 0·001).
Reactions of nurses and therapists in mainstream health services to contact with people who have learning disabilities
Authors: McConkey Roy , Truesdale Marie
Published: March 2003

Reactions of nurses and therapists in mainstream health services to contact with people who have learning disabilities

Government policy in the United Kingdom is to make the National Health Service accessible to all citizens, including those who hitherto may have relied on specialist services. It is recognized that the attitudes of health professionals can be a major influence in making this happen. To date there has been a paucity of research studies involving nurses and therapists, two of the largest groupings of health care workers. The present study contrasted the reactions of nurses and therapists to their contact with people who have learning disabilities, with those of staff working in specialist services for this client group, and with students who are not involved in health services. Over 1000 respondents — mainly university students on undergraduate or post‐graduate courses — completed a written questionnaire. Although nurses and therapists had significantly less contact with people who had learning disabilities during their work than did staff in specialist services, there were no differences in terms of contact in personal life. In both instances their contacts were higher than those reported for non‐healthcare students. However both nurses and therapists were significantly less confident in working with a patient who had learning disabilities as opposed to one with physical disabilities. By contrast, willingness for social contacts did not vary across the four groups although respondents with previous personal contact were significantly more willing for this than those with no prior contact. The results confirm that the form of contact is a more salient variable on staff attitudes than contact per se. Hence, changed reactions are more likely to come about from successful contacts in a work rather than social environment. The implications are discussed for initial and post‐qualifying training courses, especially for suitable placement experiences. Suggestions are made for future research that focuses on increasing the expertise and confidence of nurses and therapists in working with patients who have learning disabilities.
Children’s community nursing services: models of care delivery. A review of the United Kingdom literature
Authors: Eaton Nicola
Published: March 2003

Children’s community nursing services: models of care delivery. A review of the United Kingdom literature

Children’s community nursing (CCN) services in the United Kingdom (UK) have slowly become recognized as an important component in the care of sick children. However, as yet not every child has access to a CCN scheme should the need arise. In the literature there are many descriptions of CCN schemes set up in various parts of the United Kingdom based on a variety of models. This article describes six models of CCN and discusses the main components considered important when implementing or evaluating those models. Components include qualifications of the members of the team, communication between members of the multidisciplinary team, clinical responsibility, resources, willingness and ability of parents to provide care, and accessibility of services. The benefits and limitations of the models are also considered.
One voice, different tunes: issues raised by dual analysis of a segment of qualitative data
Authors: Savage Jan
Published: March 2003

One voice, different tunes: issues raised by dual analysis of a segment of qualitative data

Qualitative data analysis is a complex and contested part of the research process that has received limited theoretical attention. This paper explores the relationship between the way in which data are analysed and the nature of findings that emerge. It does this in response to demands to recognize the multiple voices that inform representations of reality, and debates about whether the interpretation of data reveals or constructs meaning. A small segment of data provided by one informant is subjected to both thematic and narrative analysis and the different perspectives that emerge are discussed with reference to whether different kinds of analysis lead to different kinds of meaning being imputed to the same text. The paper suggests that, rather than provide a unified and ever‐more refined version of ‘reality’, the use of dual or multiple analysis helps to elucidate alternative interpretations of the data which might escape consideration with the use of a single approach.
Experiences of AIDS‐dedicated nurses in alleviating the stress of AIDS caregiving
Authors: Sherman Deborah Witt
Published: March 2003

Experiences of AIDS‐dedicated nurses in alleviating the stress of AIDS caregiving

From the beginning of the AIDS epidemic, there have been individuals dedicated to the care of patients with AIDS. However, there has been little research regarding their perceptions and experiences of AIDS caregiving and the strategies they use to alleviate the stress and promote their willingness to care. Based on the experiences of 12 nurses at one hospital, who had chosen to work on an AIDS‐dedicated unit, this exploratory study, conducted in 1998, explored the following: the physical, emotional or spiritual risks and stresses associated with AIDS caregiving; factors that provide resistance to the stresses of AIDS caregiving and promote a willingness to care; and strategies recommended by AIDS‐dedicated nurses in caring for patients with AIDS. The data reveal important themes related to the physical stress of AIDS caregiving, specifically being aware of risks, but not paralysed by fear, and bombardment of the senses. The coping strategies of nurses included taking the risk in their stride, reframing the risk, and protecting oneself. The emotional stress of AIDS caregiving included witnessing suffering, experiencing unresolved grief, accepting diversity, being emotionally connected, distress from the dismantling of the AIDS unit and work demands, and declining team spirit. Coping strategies included balancing personal and professional life, releasing pain, respecting yet controlling feelings, managing demands, and asking for help. Nurses maintained their spiritual perspective. They experienced through AIDS caregiving a greater sense of shared humanity and a new perspective of life. Findings indicate that AIDS‐dedicated nurses use many coping strategies. The experiences of these nurses can assist clinicians, educators and administrators in supporting nurses’ caregiving and promoting the quality of care offered to patients with AIDS.
End‐of‐life care preferences of Canadian senior citizens with caregiving experience
Authors: Wilson Donna M.
Published: March 2003

End‐of‐life care preferences of Canadian senior citizens with caregiving experience

A grounded theory study of senior citizens’ preferences for end‐of‐life care was conducted in 1998 in Canada. Seniors who had experienced the deaths of others and who had considered their own death and dying were the target population. The sample was 49 seniors who met the study criteria. Participants provided end‐of‐life care in a variety of settings for 1–8 family members or friends. Two concepts identified were expected dependency while dying and appropriate end‐of‐life care. Almost all participants preferred to be cared for at home, yet family caregivers who could provide appropriate end‐of‐life care when dependent were needed for this to occur. The appropriateness of end‐of‐life care was contingent upon the place where end‐of‐life care occurred, as well as the type of care provided. Life prolongation was not desired, 53% even endorsed euthanasia as a way of bringing about the inevitable end to life.
Development and testing of the Family Caregiving Factors Inventory (FCFI) for home health assessment in Taiwan
Authors: Shyu Yea‐Ing Lotus
Published: March 2003

Development and testing of the Family Caregiving Factors Inventory (FCFI) for home health assessment in Taiwan

This paper describes the development and psychometric testing of the Family Caregiving Factors Inventory (FCFI). Data were collected from 97 caregivers of frail elders in Taiwan to examine the validity and reliability of the four FCFI scales: caregiving resources, caregiver self‐expectations, caregiving task difficulty, and knowledge of the care receiver. Acceptable test–retest and internal consistency reliabilities were found, though inter‐rater reliability was unsatisfactory for caregiving task difficulty and knowledge of the care receiver scales. Testing of hypothesized relationships between the FCFI and related variables supported the construct validity of the FCFI. Confirmatory factor analysis with good overall model fits also supported the construct validity of the FCFI scales. In its present form, the FCFI can facilitate home health assessment and problem identification for families with frail elders. Studies with larger samples are needed to further verify the measurement models.
Should service providers be paid for providing pre‐registration clinical placements?
Authors: Jones Myfanwy Lloyd , Akehurst Ron
Published: March 2003

Should service providers be paid for providing pre‐registration clinical placements?

The authors have argued elsewhere that second‐ and third‐year student nurses and midwives on ward‐based clinical placements make a service contribution which is of significant value to the service provider. The value of the service contribution made by students in community‐based clinical placements is lower, not least because such placements cannot free staff time in the same way as on the wards, and thus the presence of students appears to form a cost to the service provider. It is clear that there is no case for introducing a system of payments for ward‐based placements, but in community‐based placements the position is less obvious. The argument hinges upon the perceived value to the service provider of the qualitative benefits associated with the presence of students on placement. Other studies have suggested that these benefits are such as to outweigh the associated costs. Because the presence of students on clinical placement is associated with both costs and benefits, efforts should be made to ensure that both ward‐based and community‐based placements are distributed as fairly as possible between locations so that no one location is unduly advantaged or disadvantaged by the number of students which it receives.
Family and staff perceptions of the role of families in nursing homes
Authors: Ryan Assumpta Ann , Scullion Hugh F.
Published: March 2003

Family and staff perceptions of the role of families in nursing homes

Admission to a nursing home is generally regarded as the termination of family care and the commencement of institutional care. Research suggests that following placement families are often expected to relinquish their dependent older relative to the bureaucracy of the institution. The aim of this study was to investigate family and nursing home staff perceptions of the role of families caring for residents in nursing homes. A convenience sample of 44 family carers and 78 nursing home staff completed questionnaires, and interviews were conducted with 10 family carers and 10 nursing home staff. The results suggest that family carers perceived themselves to have a greater role in caring for relatives than that perceived by the nursing home staff. Either families overestimated their involvement, or staff underestimated family involvement in caring for residents in nursing homes. Families were mostly satisfied with their role and with the care provided in nursing homes. They perceived nurses as providers of technical care and they perceived themselves as having an important role in providing social and emotional care. Families trusted the clinical judgement of the staff but the staff were reluctant to trust family carers, especially in situations where care involved an element of risk. Family roles were limited by members’ own ability to care and the dependency of the resident, while professional responsibility and accountability discouraged nurses from sharing some caring roles. The results indicate that families in this study were more willing to help in nursing home care and were perhaps under‐valued as a resource within the nursing home setting.
Correlates of safer sex communication among college students
Authors: DiIorio Colleen , Dudley William N. , Lehr Sally , Soet Johanna E.
Published: March 2003

Correlates of safer sex communication among college students

The purpose of this study was to examine factors that are thought to promote communication about safer sex and HIV among college students in the United States of America and to determine the extent to which communication about safer sex is important in the use of condoms. A better understanding of factors associated with safer sex communication can be helpful in developing HIV and STD prevention programmes for college students. Following approval from the institutional review boards of the six participating colleges and universities, researchers collected data from a random sample of students. The study included participant responses if participants were 18–25 years of age, single and sexually active. For the sample of 1349 participants, the mean age was 20·6 years. Sixty‐three per cent of the sample was female, 50·5% white, 42·3% African‐American, and the remainder of other ethnic groups. Over 50% of respondents reported frequent condom use, with 28% noting that they used a condom every time and 30·6% reporting condom use almost every time they had sex. Only 9·6% indicated that they never used a condom. The results of hierarchical multiple regression analysis revealed that the perception of quality of general communication with parents, the perception of a partner's attitude towards communication, communication self‐efficacy, and communication outcome expectancies, were associated with safer sex communication. However, the association between safer sex communication and condom use was weak, suggesting that other factors excluded from this study are important in determining condom use for this sample of respondents. The findings provide some implications for HIV interventions. Interventions that enhance self‐efficacy and positive outcome expectancies related to communication about safer sex are likely to foster discussion with a sexual partner. However, they might not lead to actual condom use.
Intolerable human suffering and the role of the ancestor: literary criticism as a means of analysis
Authors: Harrison Elizabeth
Published: March 2003

Intolerable human suffering and the role of the ancestor: literary criticism as a means of analysis

This essay explores the experience of intolerable human suffering in Toni Cade Bambara's novel, The Salt Eaters. The method of analysis is literary criticism, a technique that shares many of the same goals as other types of inquiry. It employs close reading to illuminate the novel's meaning(s), thereby revealing information about the nature of intolerable human suffering. Morrison's characteristics of black art is the literary and cultural framework that guides the analysis of Bambara's novel. The paradigm has broad application for nursing. The purpose of this analysis was to describe the role of the ancestral system as a predictor of the trajectory of suffering. The results extend Morrison's paradigm and her notion of ancestor to include traditions and other non‐corporeal factors that are essential for well‐being and survival. The protagonist in Bambara's novel, Velma Henry, is the patient and exemplar who does not succumb to intolerable suffering because of its cumulative weight, but because she has lost touch with the traditions of her people, an essential component of her ancestral system. The ancestral system is a rich and complex network of individuals, groups, customs and beliefs that are instructive, protective and benevolent. Ancestors are also timeless and provide wisdom, but when the ancestral system is weak or absent, the trajectory of suffering is not favourable. Nurses must learn to recognize intolerable human suffering, to identify the patient's ancestral system, and to work within that system to keep suffering patients from harm.
Pattern recognition as a caring partnership in families with cancer
Authors: Endo Emiko , Nitta Natsuko , Inayoshi Mitsuko , Saito Ryoko , Takemura Kaori , Minegishi Hideko , Kubo Satsuki , Kondo Mayumi
Published: March 2003

Pattern recognition as a caring partnership in families with cancer

The purpose of this study was to address the process of a caring partnership by elaborating pattern recognition as nursing intervention with families with cancer. It is based on Newman's theory of health as expanding consciousness within the unitary‐transformative paradigm and is an extension of a previous study of Japanese women with ovarian cancer. A hermeneutic, dialectic method was used to engage 10 Japanese families in which the wife‐mothers were hospitalized because of cancer diagnosis. The family included at least the woman with cancer and her primary caregiver. Each of four nurse‐researchers entered into partnership with a different family and conducted three interviews with each family. The participants were asked to describe the meaningful persons and events in their family history. The family's story was transmuted into a diagram of sequential patterns of interactional configurations and shared with the family at the second meeting. Evidence of pattern recognition and insight into the meaning of the family pattern were identified further in the remaining meetings. The data revealed five dimensions of a transformative process. Most families found meaning in their patterns and made a shift from separated individuals within the family to trustful caring relationships. One‐third of them went through this process within two interviews. The families showed increasing openness, connectedness and trustfulness in caring relationships. In partnership with the family, each nurse‐researcher grasped the pattern of the family as a whole and experienced the meaning of caring. Pattern recognition as nursing intervention was a meaning‐making transforming process in the family–nurse partnership.
Health promotion and the role of the school nurse: a systematic review
Authors: Wainwright Paul , Thomas Jane , Jones Melanie
Published: March 2003

Health promotion and the role of the school nurse: a systematic review

This paper describes findings from a systematic review of the literature on the effectiveness of school nurses in promoting the health of school children. The paper gives a brief account of the background to the study and the search strategy adopted. Some key findings are presented and discussed. The brief for the review was to seek evidence of effectiveness in the practice of school nurses. The results of the review were disappointing, in that little research of acceptable quality was found and little could be said about effectiveness. The result is therefore a more diffuse review that gives a summary of descriptive research and current views and opinions, although it does also present some pointers for future research. The study was funded by Health Promotion Wales.
Clinical supervision as an emancipatory process: avoiding inappropriate intent
Authors: Heath Helen , Freshwater Dawn
Published: March 2003

Clinical supervision as an emancipatory process: avoiding inappropriate intent

As clinical supervision becomes more widely implemented in the United Kingdom with concerns and resistances being eroded as practitioners discover its benefits, it is important that potential limitations and perhaps failures are avoided. This paper utilizes Johns’ (1996) intent‐emphasis axis to explore how a technical interest, misunderstanding of expert practice, and confusion of self awareness with counselling, can detract from the supervisory process. Several of the criticisms of reflective practice will be examined to demonstrate where concerns are valid and where they may be based on misunderstandings and the need to control clinical supervision. Greater awareness of inappropriate emphasis and intent should enable even relatively inexperienced supervisors to help their supervisees move towards independence, emancipation and evolving expertise.
The use of reflection in a palliative care programme: a quantitative study of the development of reflective skills over an academic year
Authors: Duke Sue , Appleton Jane
Published: March 2003

The use of reflection in a palliative care programme: a quantitative study of the development of reflective skills over an academic year

Reflection has gained a reputation for encouraging the integration between theory and practice within professional education. However, this reputation is based on an evidence base that mostly consists of theoretical debate. The aim of this study was to test our experience that the ability to reflect is developmental and that some reflective skills are harder to achieve than others. The research was undertaken by assessing the degree to which registered nurses achieved reflective criteria within assignments submitted for a variety of palliative care undergraduate modules. A total of 160 assignments were analysed using a marking grid constructed from a literature review and the results were compared between students and across academic terms. The results suggest that students are able to describe their practice but find it harder to analyse knowledge, the context of care and to action plan. Nevertheless, reflective abilities developed over time with significant developments made between each term. However, the development of skills indicative of critical reflection was less evident and confined to the ability to raise implications for future learning. The lack of multivariate analysis limits the study. However, the findings build on previous research and prompt questions for future work, particularly with respect to the process of reflection and how this can be supported in order to encourage the development of critical reflective skills.
Enhancing hope in people with a first recurrence of cancer
Authors: Herth Kaye
Published: March 2003

Enhancing hope in people with a first recurrence of cancer

Researchers and clinicians have identified the need for well‐defined intervention studies to test the efficacy of interventions designed to strengthen hope. This quasi‐experimental study sought to determine if a specific nursing intervention program designed to enhance hope would positively influence levels of hope and quality‐of‐life (QOL) in a convenience sample of 115 people with a first recurrence of cancer who were randomly assigned to one of three groups: treatment group (hope), attention control group (informational), or control group (usual treatment). The Herth Hope Index (HHI) and the Cancer Rehabilitation and Evaluation Systems, Short Form (CARES‐SF) were administered prior to intervention, immediately after intervention and at 3, 6, and 9‐month intervals. Treatment and control groups differed significantly with regard to level of hope (P=0·02) and QOL (P=0·03). Both the level of hope and QOL were significantly increased (P=0·03) immediately after intervention and across time (3, 6 and 9 months). This study was a preliminary attempt to design, implement, and evaluate a theory‐driven hope intervention program. Knowledge about the effectiveness of specific interventions designed to enhance hope is vital if nurses are to significantly influence hope in those whom are in their care.
A qualitative study of stress factors in the early stage of acute traumatic hand injury
Authors: Gustafsson Margareta , Persson Lars‐Olof , Amilon Anders
Published: March 2003

A qualitative study of stress factors in the early stage of acute traumatic hand injury

The aim of the study reported in this paper was to identify stress factors in the early stage of acute traumatic hand injury. Stress factors were defined as circumstances which the hand‐injured patients experienced as problems in the actual situation. A total of 20 patients, treated as inpatients at the Department of Hand Surgery in Örebro Medical Centre Hospital, Sweden, were interviewed 8–20 days after the day of the accident. The analyses of the interviews followed the first step in the analytical process described in a modified model of grounded theory. The trauma experience was one of the stress factors in the early stage. Single acute traumatic stress symptoms, mostly involuntary recollection and re‐experience of the trauma, were found in a fourth of the hand‐injured patients. All patients reported impaired functioning caused by their hand, irrespective of injury. Practical problems with daily activities and being dependent on help from others for solving practical problems were stress factors caused by functional impairment. Before the accident most of the hand‐injured had been very active, also working a lot with their hands in their leisure‐time. Involuntary inactivity was a big problem for some of them. Other stress factors in the early stage were uncertainty about function in the future and pain. The appearance of the hand was a minor problem before the first follow‐up visit. Probably because the hand was hidden in a bandage. However, some hand‐injured felt discomfort in seeing the hand when the dressing was changed at the first follow‐up visit.
Nurse education in Mbarara, Uganda
Authors: Kemp Joan , Tindiweegi Jocelyn
Published: March 2003

Nurse education in Mbarara, Uganda

Aim. To describe the establishment of a professional development programme for qualified nurses at Mbarara University Teaching Hospital, Uganda.

Background. Between 1997 and 1999, a group of hospital‐based nurses and university lecturers in Hull, United Kingdom, planned and delivered a series of modules to set the Ugandan nurses on course for continuing professional development.

Approach. A descriptive account of the delivery of the programme.

Findings. Evaluation of the programme indicates that the nurses’ morale was raised by satisfactory completion of the modules and that there were visible improvements in the organization of patient care in the hospital.

Conclusions. This professional development programme was a learning experience for all the parties involved. Support from Hull for the education of nurses in Mbarara will continue.
Vulnerability to health problems in female informal caregivers of persons with HIV/AIDS and age‐related dementias
Authors: Flaskerud Jacquelyn H. , Lee Patricia
Published: March 2003

Vulnerability to health problems in female informal caregivers of persons with HIV/AIDS and age‐related dementias

The health of informal caregivers is often studied from the perspective of caregivers’ and care receivers’ personal and interpersonal characteristics. This study offers an alternative explanation based on a vulnerable populations framework and considers the role of resource availability to the health status of informal caregivers (n=76). Caregivers in a convenience sample were females of diverse ethnicity and socioeconomic status, and care recipients were diagnosed with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) or age‐related dementias (ARD). Personal interviews using structured instruments were conducted with caregivers who were attending outpatient clinics at a public hospital and a VA hospital. Instruments included the Center for Epidemiologic Studies Depression‐Scale (CES‐D), the Global Health Assessment (GHA), the Activities of Daily Living Scale (ADL), the Memory and Behavior Problems Checklist (MBPC) and items from the Symptom Checklist‐90 (SCL‐90) measuring anger, anxiety and loneliness. Caregivers were experiencing both physical and mental health problems. Regression analyses were used to examine the relationships among resources available to caregivers, conditions that put caregivers at risk for poorer health, and health status itself. Analyses were conducted for each group of caregivers separately (HIV and ARD) and for the total group, using depressive symptoms and perception of physical health as dependent variables. In caregivers of people with HIV/AIDS (PWHIV), caregiver distress over care recipient symptoms, anxiety and education were related to depressive symptoms. Depressive symptoms, anger and functional status of the PWHIV were related to caregivers’ perception of poorer physical health. In caregivers of people with ARD, there were no significant predictors for depressive symptoms or perception of physical health. In the total group of caregivers, lower income and more anger were related to depressive symptom score. When perception of physical health was the dependent variable, minority ethnicity and depressive mood were related to worse perception of physical health. These findings support the relationship of a lack of resources to health status. A community‐based programme of resources and health care services for the caregiver–care receiver dyad is recommended.
Male appropriation and medicalization of childbirth: an historical analysis
Authors: Cahill Heather A.
Published: March 2003

Male appropriation and medicalization of childbirth: an historical analysis

Aims of the paper.  This paper aims to explore through historical analysis some of the means by which medicine successfully appropriated and medicalized pregnancy and childbirth and to consider the impact that this has had on women’s experiences within maternity care.

Background and rationale.
 The appropriation and medicalization of pregnancy and childbirth by men are rooted in a patriarchal model that has been centuries in the making. A model that perceives women as essentially abnormal, as victims of their reproductive systems and hormones, it is also one that defines pregnancy as inherently pathological – a clinical crisis worthy of active intervention. In both law and medicine men have used their power to define reproduction as a biological defect (LeMoncheck L. 1996Journal of Clinical Ethics7, 160–176), requiring both legal regulation and medical intervention, whilst feminist writers have long argued that women’s experiences within the health care system at least to some extent reflects their social position.

Conclusions.
 Male justifications of female inferiority have been developed and nurtured through professional discourses and socialization processes inherent within medical education and practice (Cahill H. 1999 MA Thesis, University of Keele). These assumptions are internalized and reproduced to shape quite profoundly, the nature of doctors’ interactions with women in their care. Perhaps more fundamentally, such discursive explanations of women’s bodies as inherently defective continue to shape women’s position in society. Maternity care is a key area in which women’s ability to exercise real choice and make informed decisions is limited and where doctor–patient interactions are themselves constructions of existing gender orders; women’s autonomy continues to be violated through both quite subtle and overt discourse and practice.