bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of first‐line nurse managers in New South Wales, Australia, in the 1990s
Authors: Duffield Christine , Moran Phyllis , Beutel Jenny , Bunt Sue , Thornton Anna , Wills Jo , Cahill Philippa , Franks Helen
Published: March 2003

Profile of first‐line nurse managers in New South Wales, Australia, in the 1990s

Aims. To determine a demographic profile, employment history and career plans of a sample of nursing unit managers (first‐line managers) in New South Wales (NSW), Australia in 1999. To compare the profile of first‐line nurse managers in 1999 with those in 1989.

Background. This study replicates another undertaken a decade earlier (see Duffield 1992). Tracking the changes to nurse manager positions is important, given changes to the educational preparation of nurses and restructuring within hospitals which have occurred in the past decade.

Method. The same questionnaire was used in both studies, with minor amendments and the addition of two items to reflect changes to organizational structures, whereby nurse managers are now responsible for non‐nursing staff. In 1999 all first‐line nurse managers in the largest health service in NSW were invited to participate in the study.

Results. A response rate of 77% was achieved. There were few differences of note in the demographic profile from 1989 to 1999. However educationally, first‐line nurse managers in 1999 were more highly qualified. A greater proportion had higher degrees and increasingly, in the management discipline.

Conclusion. Perhaps reflecting these qualifications, more managers in 1999 indicated their intention to move to more senior management positions in the next decade. The mode for experience in this role of 1 year in both 1989 and 1999 reflects a worrying trend of high turnover and inexperience amongst this group of managers. While maternity relief might account for this result, further research needs to determine more precise reasons. The ad hoc bases on which expert clinicians (clinical nurse specialists) act as the manager in his/her absence need to be critically examined. Alternative strategies such as introducing a formal second‐ in‐charge position may ensure more successful recruitment and retention of staff to these critical management positions.
Nurses and English primary care groups: their experiences and perceived influence on policy development
Authors: Dowswell Therese , Wilkin David , Banks‐Smith Jennifer
Published: March 2003

Nurses and English primary care groups: their experiences and perceived influence on policy development

Aims of the study. To investigate the experiences and perceived influence of nurses serving on English primary care group boards.

Background. The development of the nursing workforce and nursing services in primary care have been piecemeal and nurses have not always contributed to policy development. The recent establishment of primary care groups (PCGs) in the United Kingdom (UK) potentially offers nurses the opportunity to take a concerted and strategic role in developing professional roles and planning service developments.

Research methods. As part of a longitudinal study of a 15% random sample of English primary care groups, nurse board members were surveyed in the winter of 1999. One hundred and forty‐four nurses were invited to return self‐completion questionnaires.

Results. Completed questionnaires were returned by 106 of those invited to participate (73%). Respondents reported that combining their usual work with their role in the PCG was frequently difficult. Only 26% perceived that they had been well prepared for their new role. Compared with other board members [for example, general practitioners (GPs)], nurses perceived that their own influence was limited, with only a quarter rating the influence of nurses on decision‐making as great. Most of the sample were feeding back information to other primary care and community nurses working in the locality and 52% rated communication with this wider constituency as good or better. Nurse board members were enthusiastic about their role and optimistic about the positive future impact of PCGs on health.

Conclusions. PCGs are still at a relatively early stage in their development. It is still too early to assess their impact on nurses working in primary care and community settings. Board membership offers nurses a voice in local health policy development.
Phenomenology as a method to investigate the experience lived: a perspective from Husserl and Merleau Ponty's thought
Authors: Sadala Maria Lúcia Araújo , Adorno Rubens de Camargo Ferreira
Published: March 2003

Phenomenology as a method to investigate the experience lived: a perspective from Husserl and Merleau Ponty's thought

Aim. By taking nursing as a human relationships activity, in spite of its strong technical – scientific features, this article reflects on the phenomenological method as one of the ways to develop an investigation and acquire knowledge of the topic.

Rationale. Based on Husserl's phenomenology, which is opposed to the way of doing science based on the laws that regulate the physics and mathematics, the article introduces Merleau Ponty's existential phenomenology as the theoretical foundation for the method it proposes. My existential conceptions – people as historic beings inserted in a world over which they act but which, in its turn, determines them; the human perception as reference for our way of being in the world; the space‐time structure of perception – these are the key concepts that have led to the elaboration of an approach to phenomenological research.

Proposal of a methodology. Steps are proposed for such an approach, namely phenomenological description, reduction and analysis. These lead to the building up of ideographic and nomothetic analyses, thus unveiling and describing general truths about the phenomenon studied. Finally, the possibilities for applying the methodology to nursing research are discussed, illustrated by my research into student nurses' perspectives on working on an isolation ward.
Laddered questions and qualitative data research interviews
Authors: Price Bob
Published: March 2003

Laddered questions and qualitative data research interviews

Background. Nurse researchers frequently make use of open interviews in their studies, hoping to understand the private world of respondents, and in particular the ways in which thought and behaviour are connected to each other. Unfortunately, there is scant guidance on how to translate such goals into the specifics of interview technique, particularly the use of probing questions. The success of such interviews rests on working ethically and understanding the respondents needs during interview.

Aims. This paper explains a technique designed to direct the use of probing in interviews, and argues that its selective use might provide richer data than otherad hocapproaches employed by neophyte researchers.

Conclusion. It is argued that the technique increases the awareness of the researcher to ethical concerns and enables her or him to respond more sensitively. Laddered question technique is evaluated with reference to my own research into the negotiation of student support amongst nurse distance learners.
Does training in psychosocial interventions reduce burnout rates in forensic nurses?
Authors: Ewers Paula , Bradshaw Tim , McGovern John , Ewers Bob
Published: March 2003

Does training in psychosocial interventions reduce burnout rates in forensic nurses?

Background. Mental Health Nurses working in secure environments with patients suffering from serious mental illness have been shown to be at risk of clinical burnout syndrome, this can have adverse effects both on the nurses' health and the standards of care that they deliver.

Aim. To evaluate the effect of Psychosocial Intervention Training (PSI) on the knowledge, attitudes and levels of clinical burnout in a group of forensic mental health nurses.

Design. Baseline assessments of knowledge, attitude and burnout were completed by asking a group of 33 nurses working in a medium secure psychiatric unit to complete questionnaires. Twenty of the nurses volunteered to be included in a PSI training course and were randomly allocated either to receive the training or to a waiting list control group. The duration of the training was 6 months and on completion subjects in the experimental and control group completed the questionnaires again.

Results. Staff in the experimental group showed significant improvements in their knowledge and attitudes about serious mental illness and a significant decrease in burnout rates, whilst staff in the control group showed a small but nonsignificant improvement in knowledge and attitudes, and increase in burnout.

Conclusion. The findings suggest that providing forensic mental health nurses with a better understanding of serious mental illness and training them in a broader range of interventions, helps them to be more positive in their attitudes towards the clients that they work with and experience less negative effects of stress resulting from their caring role. The implications of this study for clinical practice and future research will be discussed.
The cooling‐suit: case studies of its influence on fatigue among eight individuals with multiple sclerosis
Authors: Flensner Gullvi , Lindencrona Catharina
Published: March 2003

The cooling‐suit: case studies of its influence on fatigue among eight individuals with multiple sclerosis

Aim of the study. To study if the use of a cooling‐suit by individuals with multiple sclerosis (MS) influenced their experience of fatigue and consequent restrictions in daily life.

Background. The majority of MS patients consider fatigue as one of their most disabling symptoms and as having a significant impact on their daily lives. Fatigue often increases in a warm environment. A cooling‐suit has been reported as a practical method of cooling, but the effect on fatigue has not yet been studied.

Research methods. Eight individuals used a cooling‐suit in their own homes during a test‐period. In a single case–control design, their experience of fatigue was studied before and after. Quantitative and qualitative methods were used: self‐assessments using the Fatigue Impact Scale (FIS), open‐ended interviews and semi‐structured diaries.

Results. All study participants reported a reduction in fatigue during the test period. On the FIS, they scored reductions in the physical, cognitive and psycho‐social dimensions of daily life. They experienced fatigue less often and for shorter periods. In their diaries and interviews they described decreased muscular strain, less sense of fatigue in relation to intake of food and positive effects on cognitive, social or affective problems related to fatigue.

Discussion. The cooling‐suit is a practical method for cooling. It gives freedom and flexibility and can be used regardless of setting. Nurses who meet heat‐sensitive individuals with MS have the opportunity to give information on cooling methods, including how to use a cooling‐suit. In this pilot study we found that individuals with MS who suffered from fatigue reported a number of improvements in quality of daily life.

Conclusions. The result indicates that use of a cooling‐suit by individuals with MS may decrease their sense of fatigue. In this sample positive outcomes on daily life situations were reported. Further studies are needed to support these results.
Balancing involvement: employees' experiences of merging hospitals in Sweden
Authors: Engström Agneta Kullén , Rosengren Kristina , Hallberg Lillemor R.‐M.
Published: March 2003

Balancing involvement: employees' experiences of merging hospitals in Sweden

Background. The health care of today stands in front of demands on financial and structural changes. New technology and global economy are forces driving on the change process.

Aims. The aim of this study is to describe and broaden the understanding of the employees' experience of being involved in a merger between two health care districts in Sweden.

Methods. This study was carried out from a qualitative approach according to the grounded theory tradition. From a theme guide with specific questions, 31 interviews were carried out with employees working in the health care.

Findings. Five categories emerged from the body of interviews: balancing involvement, trust respect, challenge and commitment. Balancing involvement was defined as an overall core category related to the other categories. The categories trust, respect, challenge and commitment were related to subcategories and affected the core category balancing involvement.

Conclusions. The overall findings point to the importance of balancing the employees' involvement in order to reach goal fulfilment change in a merger process.
Unravelling the unknowns of reflection in classroom teaching
Authors: Scanlan Judith M. , Care W. Dean , Udod Sonia
Published: March 2003

Unravelling the unknowns of reflection in classroom teaching

Background. The use of reflection in education has emerged as an effective means of connecting theory with practice. However, the literature reveals limited empirical work on the conceptualization of reflection.

Aim of the study. The purpose of this qualitative research study was to understand more fully the meaning and use of reflection in teaching, and how reflection contributes to the development of teaching expertise in the classroom.

Ethical approval. The study received ethical approval from the Faculty of Nursing Ethical Review Committee, University of Manitoba. Issues related to confidentiality of information, and power relationships between the investigators were addressed. Students were reassured that no data were collected about them during participant observations in the classrooms.

Methods. The investigators were the sources of data. Data were collected using five different methods over the course of two academic years, including written autobiographies, critical incident journals, classroom observations, debriefing following classroom observations and research team meetings.

Findings. The data were analysed using content analysis, and four themes were identified (i) making connections, (ii) developmental aspects, (iii) influence of context on reflection, and (iv) influence of emotions on reflection.

Study limitations. The interpretation of the findings of this study should be used with caution given the qualitative design and small number of participants.

Conclusion. Participation in the study increased the awareness of the investigators' personal use of reflection. The process of studying our own use of reflection allowed us to step outside the performance treadmill to better understand, accept and reshape what we do over and over in the classroom. This study supports an examination of one's experiences as a means of understanding reflection and its use in the classroom.
The role of the district nurse in bereavement support
Authors: Birtwistle Jon , Payne Sheila , Smith Peter , Kendrick Tony
Published: March 2003

The role of the district nurse in bereavement support

Background. District nurses are frequently involved in the care of patients immediately prior to death and could therefore provide support to bereaved relatives. However, little is known about nurses' views on bereavement support or their actual involvement.

Aims of the study. To survey a representative sample of district nurses to ascertain their current practice and perceived role in supporting bereaved people and to identify factors that influence their practice.

Design and method. A self‐completed postal questionnaire was distributed anonymously to 522 district nurses in the central southern coastal area of Britain. It comprised five sections: interest in and education about bereavement; a Likert scale to measure nurses' views about bereavement care; information about the practice with which the nurse had links; bereavement care provided by the practice; and demographics.

Results. A 62% response rate was achieved following two reminders. Sixty‐nine per cent reported having an interest in bereavement support. Logistic regression modelling identified older age of the nurse and district of employment as the best predictors of interest in bereavement, and older age of the nurse, district of employment and higher level of academic qualification (having a diploma or degree) as the best predictors of active follow‐up bereavement visiting. Ninety five percent of district nurses believed their role should involve visiting bereaved relatives/carers of patients they have nursed, but only 19% believed they should visit bereaved people when the deceased was not their patient.

Conclusions. Older age, higher qualifications and district of employment among district nurses were associated with greater interest in bereavement and more proactive care of bereaved people. The findings of this survey have important implications for the training, continued education and the extended role of the nurse in bereavement support.
The impact of part‐time post‐registration degrees on practice
Authors: Hardwick Sharon , Jordan Sue
Published: March 2003

The impact of part‐time, post‐registration degrees on practice

Aim. This study aimed to identify how graduates from part‐time, post‐registration degree courses in nursing and midwifery perceived that their practice had changed as a result of the knowledge and skills acquired on their courses.

Background. Despite increasing investment in continuing professional education and expansion of nursing roles, little work has been undertaken to assess the impact of graduates' skills on nursing care and clinical outcomes.

Method. Postal questionnaires were used to survey all graduates of post‐registration Bachelor's and Master's courses in nursing and midwifery from one institution in the United Kingdom (UK) (n=60). Respondents were asked to describe how they felt their graduate skills were used in practice and if this was influenced by any factors in the workplace. Data were analysed descriptively, and by content analysis.

Findings. Forty‐three of 58 graduates contacted responded (74%). The majority (33/43, 77%) of respondents felt that their graduate skills were used in practice. Although most felt that their clinical practice had changed as a result of their degree studies, no practical examples of this were given, despite specific questioning. Many examples of academic and research skills acquired on the course were cited, which raises the question of whether the degree courses provided graduates with academic rather than clinical knowledge. There was ambivalence as to their perceptions of barriers in the workplace, which may have impeded the application of knowledge acquired on the courses.

Implications. The clinical effectiveness of education initiatives depends on the learners, the course and the workplace. To maximize the benefits accruing to patients from continuing professional education and role expansion, further exploration of the contribution of higher education programmes to clinical practice is required.
Food‐related health perceptions and food habits among older women
Authors: Gustafsson Kerstin , Sidenvall Birgitta
Published: March 2003

Aim.  The aim of the present study was to explore food‐related health perceptions and food habits among older women.

Background.  Food‐related health promotion has its main focus on disease prevention. With a holistic perspective on health, social and psychological aspects also need to be considered for total wellbeing.

Methods.  Qualitative interviews, representing an ethnographic approach, were carried out with 18 women, aged 65–88, living alone or cohabiting, who independently managed shopping and cooking. Interviews were conducted at the women's homes, and analysed for coherent themes. The women also gave data on three days' eating and drinking in a food diary.

Findings.  Two themes were found: ‘A healthy slimming meal or the usual’ and ‘Meals – a pleasure or an obligation’. The first theme summarized the women's health perceptions related to food, where the dominating view was fear of fat. Some also had a bad conscience about not eating according to recommendations. Use of low‐fat products was not a predominant habit among these women. In the second theme, meals in fellowship were perceived as a pleasure, while women living alone tended to simplify cooking and eating. This was also reflected in their food habits, with fewer cooked meals, as well as events with coffee with cakes, compared with cohabiting women.

Conclusions.  Food‐related health promotion must pay more attention to women living alone. Women who have lost their partners, may be at risk for poor nutritional intake as they often simplified the entire meal situation, while cohabiting women perceived food and cooking as a central task in their lives. One responsibility for nurses working in the community is to recognize and assess older women's deficient eating habits, assess them and plan eating together with the woman to prevent poor nutritional intake. Relatives and community staff could also be involved in this work.
Compliance in a randomized controlled trial: the implementation of emotion‐orientated care in psycho‐geriatric facilities
Authors: Schrijnemaekers Veron J.J. , Van Rossum Erik , Van Heusden Michèle J.T. , Widdershoven Guy A.M.
Published: March 2003

Aim.  The aim of this study was to gain insight into compliance with the introduction of a new care model [emotion‐orientated care (EOC)] as part of an intervention study (RCT) in psycho‐geriatric care. The success of the implementation (compliance), as well as the expectations and experiences concerning the training were studied.

Methods.  Observations were conducted in four intervention homes and four control homes, and care‐plans of residents were also analysed to see whether the implementation had succeeded. Semi‐structured interviews were conducted with four persons in each of the four intervention sites (a total of 16 interviews) to study the experiences with the training and implementation.

Findings.  The observations showed no clear differences between intervention and control homes with regard to the interactions between residents and professional caregivers. Analysis of the reporting systems revealed differences within, as well as between, the intervention and control homes. The content of the reports showed no differences between the intervention and control homes. The interviewees had different expectations of the EOC training, depending on their disciplinary background. The caregivers regarded the training as a confirmation of their current practice. They experienced some changes at the individual level and some of them reported that the co‐operation between units had become better. At the home‐level no changes were reported. Every interviewee indicated that the implementation of EOC was difficult and laborious and that there were (mainly organizational) obstacles that could hinder the implementation of the EOC training.

Conclusions.  Observations and the analysis of the reporting systems indicated that there was no clear difference between intervention homes and control homes as to the actual implementation of the intervention, indicating that the compliance with the new care model was not optimal. The interviews gave some insight into factors that caused lack of compliance.
Cultural aspects of adjustment to coronary heart disease in Chinese‐Australians: a review of the literature
Authors: Daly John , Davidson Patricia , Chang Esther , Hancock Karen , Rees David , Thompson David R.
Published: March 2003

Background.  The burden of illness associated with Coronary Heart Disease (CHD) has determined this as a key focus for research at a basic science, individual and population level. Although considerable research has been conducted on specific aspects of the experience of CHD, such as anxiety or depression, there is a lack of research investigating the global aspects of the illness experience from the individual's perspective. Furthermore, there is a paucity of research examining the cross‐cultural experiences of patients from Non‐English Speaking Backgrounds (NESB). Given the multicultural nature of Australian society, and that health and illness are culturally constructed experiences (Manderson 1990), it is important to include the perspectives of people from minority cultures in health related research in order to provide culturally sensitive and appropriate health care and information during an illness. Further, the potential to prevent and modulate the course of CHD, by strategies such as smoking cessation and lipid management, mandate a health promotion agenda based on equity and access for all members of society.

Aims.  This article discusses cultural aspects of CHD in relation to nursing and allied health care during the recovery phase of an acute cardiac event. It reviews the research that has been conducted in this area, focusing on the Chinese‐Australian population.

Literature search.  The CINAHL, MEDLINE, FAMILY (Australian Family and Society Abstracts Database), PsychINFO, and Multicultural Australian and immigration Studies (MAIS) databases were searched, identifying literature published from 1982. Keywords used were Chin* (Chinese, China), Asia* (Asia, Asian), experience, adjustment, psychological, heart, coronary, cardiac, health and services. Reports not written in English were excluded. Australian Government reports were also searched, as well as hand searching of nursing and medical textbooks. These searches resulted in over 1000 articles. However, only around 50 were relevant for this review.

Implications.  Chinese‐Australians are one of the fastest growing populations in Australia, and are at increased risk of CHD upon settling to Australia. Recommendations for future research and for the practice of nursing are provided.
Health promotion and lifestyle advice in a general practice: what do patients think?
Authors: Duaso Maria Jose , Cheung Philip
Published: March 2003

Background/rationale.  Since 1990 health promotion and lifestyle advice has been integrated in general practice and has been mainly undertaken by practice nurses. However little is known about patients' views of the service provided.

Aims of the study.  To examine patients' recall and perceptions of lifestyle counselling received from practice nurses in a general practice in the North‐east of England. To investigate the extent to which patients' needs are met. To assess the main sources of health information sought by patients.

Design/methods.  Cross‐sectional descriptive survey. A total of 512 patients were sent a postal questionnaire about current lifestyle, recall of lifestyle advice received and perceptions of the advice provided.

Findings.

 A response rate of 64% was achieved. Questionnaire analysis revealed unhealthy lifestyles among the population studied that could be addressed through health promotion, e.g. 25% were smokers; 44% exercised occasionally; 40% had a body mass index >25 kg/m
2 . Advice received on diet was reported by 6% of patients; on exercise by 4%; on smoking by 4% and on alcohol consumption by 2%. Patients were willing to receive more health promotion in areas such as stress, exercise and weight reduction. Magazines (67%) and TV (47%) were selected as the main sources for health promotion information.

Conclusions.  Health needs to be promoted. The low rate of lifestyle advice reported by the patients implies that more preventive advice should be provided in primary care settings. More effective health promotion should be planned according to the needs of the practice population.
Towards clarification of the meaning of spirituality
Authors: Tanyi Ruth A.
Published: March 2003

Background.  Rhetoric about spirituality and nursing has greatly increased, as scientific‐based approaches are not fully able to address many human problems, such as persistent pain. Despite the renewed interest and growing literature on spirituality, there is no consensus on a definition of this concept. There is also ambiguity on how this concept is incorporated into nursing practice, research, and education.

Aim.  This paper aims to contribute toward clarification of the meaning of spirituality in relevance to health and nursing today through a conceptual analysis process.

Methods.  Information was obtained through dictionary definitions and electronic database searches of literature on spirituality spanning the past 30 years. The criteria for selection included scholarly articles and books with a definition of spirituality, and research studies that investigated the meaning of spirituality to individuals' health. A total of 76 articles and 19 books were retrieved for this analysis.

Findings.  Spirituality is an inherent component of being human, and is subjective, intangible, and multidimensional. Spirituality and religion are often used interchangeably, but the two concepts are different. Spirituality involves humans' search for meaning in life, while religion involves an organized entity with rituals and practices about a higher power or God. Spirituality may be related to religion for certain individuals, but for others, such as an atheist, it may not be.

Conclusion.  In order to provide clarity and enhance understanding of this concept, this analysis delineates antecedents, attributes, constructed case examples, empirical referents, and consequences of spirituality. A proposed definition of spirituality emerged from this process, which may be applied broadly. Implications for nursing practice, education, and research are discussed.
‘It's the first scientific evidence': men's experience of pregnancy confirmation
Authors: Draper Jan
Published: March 2003

Background and aims.  In contrast to women's experiences of motherhood, there has been comparatively little research investigating men's experience of the transition to fatherhood and how changing cultural perspectives contribute to the contemporary experience of fathering. This paper draws on the findings of a larger ethnographic study of men's transition to fatherhood in the United Kingdom (UK) and discusses men's experiences of pregnancy confirmation.

Methods.

 A longitudinal ethnographic approach was chosen to investigate men's ‘real life’ accounts of their transition to fatherhood. A mixture of ‘novice’ and experienced fathers (
n  = 18) were recruited from antenatal classes in the north of the UK during 1998. Semi‐structured interviews were conducted on three occasions, twice during their partner's pregnancy and once afterwards.

Findings.  Framed by the context of the contemporary construction of involved fatherhood, the men frequently spoke of their desire to be ‘involved’ with their partner's pregnancy and yet reported difficulty in engaging with its reality. They nevertheless participated in a range of activities – body‐mediated‐moments – which brought them closer to their partner's pregnant body and therefore their unborn baby. These activities centred on pregnancy confirmation, announcement, foetal movements, the ultrasound scan, and culminated in their presence during labour and delivery. This paper discusses their involvement in the process of pregnancy confirmation.

Conclusion.  The men's experiences of early pregnancy were marked forcefully by their involvement in the confirmation process. This activity gave men entry into a physical dimension, helping them forge an involvement in the pregnancy and shape their early transition to fatherhood.

Implications for practice.  The study has provided insight into expectant men's experiences of pregnancy and contributed to the understanding of the changing nature of contemporary fatherhood in the UK. Recognition of men's changing roles in pregnancy, and greater insight into their experiences should be of relevance to all those supporting the transition to parenthood, including midwives, obstetricians, ultrasonographers and childbirth educators. Such increased awareness should inform the antenatal support given to men and reinforce the importance of relevant antenatal preparation that effectively meets the needs of not only expectant women, but also expectant men.
Storytelling of co‐operative team meetings in acute psychiatric care
Authors: Vuokila‐Oikkonen Päivi , Janhonen Sirpa , Saarento Outi , Harri Marja
Published: March 2003

Background.  One of the goals of co‐operative psychiatric nursing and co‐operative team meetings is to improve patients' and significant others' participation and thus, to enhance patients' resources outside the hospital. The objective of this paper is to describe the different expert interventions that either enabled or prevented patient and his/her significant others participation in co‐operative team meetings in acute psychiatric wards.

Methods.  The data consisted of 11 videotaped team meetings. The participants were voluntary patients, significant others and experts in health and social care. A narrative approach focused on the storytelling of all members in the meetings. The method of modified dialogue analysis was used to identify the ideas of the stories.

Findings.  The same topic of discussion was shared in active participation. The experts asked open‐ended questions, the patient and his/her significant others' were free to express their viewpoints and the experts' interpretation was based on their stories. The experts presented the reasons for their questions, and the contents of the questions were verbalized. In passive participation, the experts questions were based on their own point of view, and the patient and his significant others merely answered these questions. If the expert opinion appeared too dominating at the co‐operative team meeting, the patient's and his/her significant others' participation was in jeopardy.

Conclusions.  The physician either dominates the storytelling or gives space for free expressions of various viewpoints during the co‐operative team meetings.
Applying phenomenography in nursing research
Authors: Sjöström Björn , Dahlgren Lars Owe
Published: March 2003

Aims. This paper examines phenomenography, a research approach designed to answer certain questions about how people make sense of their experience. The research approach, developed within educational research, is a content‐related approach investigating the different qualitative ways in which people make sense of the world around them. The outcomes of phenomenographic research are different content‐related categories describing the differences in other people's ways of experiencing and conceiving their world.

Methods. The research approach is presented by describing the underlying ontological and epistemological assumptions, describing the research method in detail and providing some examples of phenomengraphic studies in health care and nursing research. The possibilities for applying the methodology to nursing research are discussed, illustrated by research examples. Finally, the future role of the approach within nursing research is discussed.

Conclusion. The emphasis on differences in the phenomenographical research approach makes it distinct from other research approaches, and accordingly, it seems to be reasonable to incorporate knowledge of this kind in the professional education of health care personnel.
Screening for depression in a hepatitis C population: the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES‐D)
Authors: Clark Cinda H. , Mahoney Jane S. , Clark David J. , Eriksen Lillian R.
Published: March 2003

Rationale.  Depression is reported as a serious adverse event of antiviral therapy used to treat patients with hepatitis C (HCV); therefore, there is a need to identify a reliable and valid measure of depressive symptoms for this population.

Aims.  To determine reliability, construct validity and predictive validity of the Center for Epidemiological Studies Depression Scale (CES‐D) in a hepatitis C (HCV) population.

Ethical issues.  Study reviewed/approved by the University Institutional Review Board and informed consent obtained.

Methods.
 Longitudinal design testing psychometric properties of the CES‐D prior to treatment and 4 and 24 weeks postinitiation of treatment. Reliability was tested using Cronbach's coefficient α. Construct validity was tested, prior to therapy, using principal components factoring with varimax rotation. Predictive validity was tested using repeated measures analysis of variance (anova) of CES‐D scores at 4 and 24 weeks postinitiation of treatment.

Results.
 Non‐probability sample, 116 adult HCV patients [62 (53%) males and 54 (47%) females]. Reliability (Cronbach's α) = 0·88 pretreatment, 0·89 week 4 and 0·90 week 24. Construct validity testing revealed four factors: negative affect; positive affect; somatic; and depressed affect/somatic. Exception for two items, ‘felt sad’ and ‘couldn’t get going', all items loaded distinctly with correlation coefficients in the range of 0·51–0·84. Predictive validity testing revealed a statistically significant effect over time (P < 0·001) in the direction predicted (pretreatment x = 13·97; post 4 weeks x = 19·54 and 24 weeks x = 19·97).

Conclusions.  The CES‐D is a reliable and valid instrument to screen for depressive symptoms in HCV patients. The instrument detected the predicted increase in depression associated with HCV. Examination of the sensitivity and specificity is needed to determine the most accurate cut‐off score.
Transforming loss: Taiwanese women's adaptation to stillbirth
Authors: Hsu Min‐Tao , Tseng Ying‐Fen , Kuo Ling‐Lih
Published: March 2003

Aim.  To explore the experiences of Taiwanese mothers of stillborn babies, their coping strategies, and the ways in which their subsequent human interactions are shaped by Taiwanese culture.

Background.  Giving birth to a male family heir is still considered an important responsibility for Taiwanese women. The ideology of continuity is still at the centre of Chinese family life in which women are expected to deliver babies that will continue their husbands' family lines. Research on the connection between this responsibility and women's reaction to stillbirth in a cultural context is limited. Understanding Taiwanese women's experiences with stillbirth will add to the body of nursing knowledge, especially in terms of giving culturally competent nursing care.

Methods.  Interpretive ethnographic procedures were used to locate coping strategies. Twenty mothers who had stillbirth experiences were interviewed periodically during the 2 years following their losses. Following Agar's example, data were analysed to identify themes representing coping strategies.

Findings.  The four major themes identified were (a) transforming the meaning of death, (b) doing something for the deceased, (c) anticipating another pregnancy, and (d) rebuilding a social fabric.

Conclusion.  The processes that the mothers of stillborn babies experience represent transformations that involve engagement with cultural expectations for woman. The authors suggest that these cultural impacts should be incorporated into nursing assessment and treatment practices.
‘I’m still waiting...': barriers to accessing cardiac rehabilitation services
Authors: Tod A.M. , Lacey E.A. , McNeill F.
Published: March 2003

Background.  The United Kingdom (UK) National Service Framework for coronary heart disease challenges health services to address existing problems regarding the quality and content of cardiac rehabilitation services. Concern also exists regarding inequalities in access to services. The South Yorkshire Coalfields Health Action Zone (SYCHAZ) funded this study to harness the views and experiences of staff and patients regarding existing services. The intention is to use the information gained to develop acceptable and accessible services for the future.

Aims.  To explore what barriers exist for patients in accessing cardiac rehabilitation services within the South Yorkshire Coalfield locality.

Ethical issues and approval.  Patients were identified and recruited with the assistance of staff responsible for their care. Informed consent was obtained prior to participation. Approval was obtained from the relevant Ethics Committees.

Methods.  Qualitative methods were used, including semi‐structured interviews and Framework Analysis techniques. Purposive sampling was used to select participants.

Instruments.  Semi‐structured individual interviews of 15 staff and 20 postmyocardial infarction patients. One group interview with seven health visitors and two with lay members of heart support groups.

Outcomes.  Barriers to accessing cardiac rehabilitation.

Results.  This study revealed a limited service capacity. Big gaps exist between patches of service activity that most patients appear to slip through. Problems in accessing the service were categorized into five themes: absence, waiting, communication, understanding, and appropriateness. Some groups fared worse in terms of access to services, for example women, the elderly and those in traditional working class coalfields communities. Professional and more affluent participants appeared better able to negotiate their way around the system by seeking out advice or ‘going private’.

Limitations.  The omission of medical staff and ethnic minority patients.

Conclusions.  Cardiac rehabilitation in the policy targets in UK will only be met with substantial investment to address the barriers identified here.
The essence of cancer care: the impact of training on nurses' ability to communicate effectively
Authors: Wilkinson Susie M. , Gambles Maureen , Roberts Anita
Published: March 2003

Background.  The importance of effective communication between health professionals and patients with cancer is widely recognized. Training programmes aimed at improving key communication skills are becoming increasingly available.

Purpose.  To evaluate a communication skills programme delivered to 308 cancer nurses as part of degree/diploma courses. Based on previous work, it was hypothesized that a statistically significant improvement between pre‐ and postintervention scores would be observed.

Methods.  Audiotaped nursing assessments with patients were undertaken before and after the course. These were evaluated according to coverage of nine previously identified key areas of communication.

Results.
 Mean postcourse scores rose by 5·9 points (
P
 < 0·001) to 16·3 (out of a possible 27). All nine individual areas of the assessment showed statistically significant improvements postintervention (
P  < 0·001). The areas showing most improvement were those with a high emotional content.

Conclusions.  This study has demonstrated that an integrated approach to communication skills training has the potential to improve nurses' skills, particularly in emotionally laden areas across the spectrum of roles in cancer care.
Competition refuges and coexistence: an example from Serengeti carnivores
Authors: DURANT SARAH M.
Published: March 2003

1.  In the last two decades predator–prey models have shown that ‘refuges’, in which prey can seek respite from predation, are crucial for the persistence of prey and predator. This concept is equally applicable to interspecific competition and, in a heterogeneous environment, species with low competitive ability should seek out ‘competition refuges’ where competition is reduced.

2.  Cheetahs have low competitive ability compared with their principal competitors, hyenas and lions, which are directly responsible for their low density. This study uses distribution data collected in the Serengeti National Park in Tanzania over a 4‐year period to show that cheetahs are more strongly associated with each other than with their competitors and utilize areas with low‐density prey.

3.  Cheetahs exhibit local avoidance behaviour in both space and time with respect to lions and hyenas. This behaviour is facultative and is strongest when cheetahs are engaged in activities that might expose them to food loss or increase the risk of close interactions, such as when they are hunting or eating.

4.  Lactating cheetahs, whose range is restricted, are more likely to have difficulties finding prey and come into more frequent contact with lions than free‐ranging animals.

5.  It is argued that although cheetahs always lose in direct competition, they persist in the ecosystem by seeking out ‘competition refuges’ with low densities of lions and hyenas and that their mobility is the key to their continued coexistence with these predators. This pattern of distribution may be generally applicable to other species which, although widely distributed, always occur at low densities.
Aerial distribution, flight behaviour and eggload: their inter‐relationship during dispersal by the sweetpotato whitefly
Authors: Isaacs Rufus , Byrne David N.
Published: March 2003

1. The aerial distribution ofBemisia tabaciGennadius (the sweetpotato whitefly) was studied during the early ascent phase of flight, to test the degree to which dispersal patterns reflect the flight behaviour of individuals.

2.Marked whiteflies were trapped at four heights between 0 and 7·2 m above fallow ground, and at six distances between 0 and 100 m from the insect source. Insects were trapped during a 2–3 h period after the initiation of flight activity during the summers of 1995 and 1996.

3.Analysis of trap catch data revealed a clear negative exponential relationship between height and aerial distribution, and a slightly weaker negative power relationship between distance and aerial distribution. Marked insects were caught in the uppermost traps adjacent to the source, indicating that a portion of the population had a strong capacity for ascent out of the flight boundary layer.

4.Eggload decreased with the height, but not the distance, at which whiteflies were trapped. Mean eggload close to the ground was significantly greater than that for those trapped at 4·8 and 7·2 m, supporting the hypothesis that there is a trade‐off between flight and oogenesis in weak‐flying insects.

5.Air temperatures during the trapping periods were positively correlated with the proportion of male and femaleB. tabacicaught in the highest traps, but not in the most distant traps.

6.The significance of these results for accurate prediction of whitefly dispersal is discussed, and the importance of individual's behaviour in determining dispersal patterns of small insects is emphasized.