bluuebunny/crossref_metadata_2025 huggingface dataset:
Grief and social support after the death of a spouse
Authors: Kaunonen Marja , Tarkka Marja‐Terttu , Paunonen Marita , Laippala Pekka
Published: March 2003

Grief and social support after the death of a spouse

The death of a spouse is one of the most stressful events in a person’s life. Social support has been shown to be widely beneficial in moderating the effects of both chronic and acute stress. The answers of Finnish widows and widowers (n=318) were analysed in order to investigate the sources of social support, what is the nature of support received, and whether social support is connected with coping with grief. The Hogan Grief Reactions Checklist was used to describe the grief as well as answers to open‐ended questions about what helped the widowed persons cope with their grief. Kahn’s theory of social support was used as a framework in the content analysis of the open‐ended answers. The results showed that Finnish widows and widowers receive social support most often from their own family and friends. They perceived the received support most helpful, but also the support that the grieving person can give to other family members is seen as important. Results suggest that those who had had social support were able to grieve by allowing themselves to disorganize and experience panic behaviour.
‘A heavy and blessed experience’: a psychoanalytic study of community Macmillan nurses and their roles in serious illness and palliative care
Authors: Jones Alun
Published: March 2003

‘A heavy and blessed experience’: a psychoanalytic study of community Macmillan nurses and their roles in serious illness and palliative care

This paper explores the psychoanalytic ideas of containment as described by Wilfred Bion and applies them to the work of community Macmillan nurses and to the ways in which they might understand and structure therapeutic conversations with people that are seriously ill. Case vignettes show the application of psychoanalytic thinking in context. The discussion offers the idea that the impact of physical illness is such that the emotional issues of patients, their families and fellow palliative care workers can saturate nurses. To protect themselves, nurses and other health workers might assimilate the emotional traumas of others into physical symptoms, and so they are ignored or overlooked in favour of drug therapies, pre‐occupations with breaking through silences and other concrete or demonstrable methods of treatment. An environment is needed in which a person with serious illness and his or her family member is helped to make sense of their experiences and so integrate them into a meaningful life continuum. Similar provisions are needed for nurses. Appropriate methods of clinical supervision might help these important provisions.
The power of women as nurses in South Africa
Authors: Van Der Merwe Anita S.
Published: March 2003

The power of women as nurses in South Africa

An epistemological analysis of the power of women as nurses in one of the larger and more deprived regions of South Africa, KwaZulu‐Natal, was carried out. The premises of the standpoint theory were used as a justificatory strategy for participant selection. A fourth premise of rurality was added to the existing three premises of race, class and gender. A phenomenological research approach incorporating two to three in‐depth interviews with each participant following a flexible guideline was utilized. Key concepts and realities such as powerlessness, powerfulness and empowerment were explored and a total of 44 audio‐taped interviews was transcribed. Data analysis was aided by a software programme for qualitative data analysis (NUD.IST) and focused on the exploration and development of themes, categories, relationships and condensed forms of outcomes. Detailed attention was given to ethical considerations such as anonymity, freedom of expression and rapport. The credibility of the study was enhanced through prolonged engagement, thick descriptions and the input of three experienced researchers. In reflecting on powerlessness, women as nurses belonging to the enrolled category were alienated as they were severed from the nursing profession and from the ruling gender of men. They were lost in routine activities, were misused, maternalized and domesticated at home and at work. These phenomena were voiced more strongly by the rural group of women. Registered nurses created their own freedom, often away from their men as in divorce, and sought solutions concerning powerlessness in more distant terms. They communicated a sense of empowerment in terms of education and personal qualities. Culture rather than race was emphasized as an essence of women’s oppression. Recommendations of the study focused on ways to limit categorial division, of aligning scope of practices with current health care practices in South Africa and further research regarding the value of the fourth premise of the standpoint theory is suggested.
Nursing science: the transformation of practice
Authors: Parse Rosemarie Rizzo
Published: March 2003

Nursing science: the transformation of practice

World‐wide transformations in nursing practice are evolving as more nurses are embracing extant nursing theories and frameworks in order to fortify their unique contributions to the healthcare system. This article specifies the importance of and the ethical considerations arising when using nursing knowledge from within the school of thought of the discipline to guide practice. The ideas set forth are in stark contrast to the general nursing process with its medical model‐driven diagnostic systems now proliferating in nursing practice in the global healthcare community. Both challenges and opportunities are present in the transformation of practice to a nursing knowledge base.
Managing urinary incontinence in the nursing home: residents’ perspectives
Authors: Robinson Joanne Patterson
Published: March 2003

Managing urinary incontinence in the nursing home: residents’ perspectives

The purpose of this study was to develop a substantive theory describing and explaining cognitive, psychosocial, and behavioural aspects of living with urinary incontinence in a nursing home. Using grounded theory methodology, data were obtained from interviews, participant observation, and minutes from meetings of resident advisory councils, and analysed concurrently using the constant comparative method. Three nursing homes located in the metropolitan area of a major American city served as sites for the study. Ethical approval was obtained from the administrator of each facility and institutional review board of a major university. Ten residents served as primary participants, consenting to provide one audiotaped formal interview, subsequent opportunities to observe and discuss their methods of bladder control, and access to their health care records. Another 33 residents from these facilities served as secondary participants, providing opportunities for observation and informal interview when their bladder control needs, issues, or methods were visible to the investigator and seemed relevant to the evolving theory. Data were collected over a period of 17 months. Findings suggest that nursing home residents with actual or potential urinary incontinence engage in a process called managing urinary incontinence. Managing urinary incontinence occurs in the context of believing that it is an inevitable part of ageing and seeking to protect physical, psychological, and social integrity. Managing urinary incontinence is a dynamic process with consequences that are influenced by the degree to which six specific strategies are used with satisfaction by the resident and supported by staff and significant others. Implications for nursing practice and research are discussed.
Graduate nurses: critical thinkers or better decision makers?
Authors: Girot Elizabeth A.
Published: March 2003

Graduate nurses: critical thinkers or better decision makers?

This study evaluates the difference in development of critical thinking across four groups of nurses at different stages of the academic process and their perception of their decision‐making ability in practice. With the move of nurse education into institutes of higher education nationally, there are no empirical data in the UK to suggest that graduates practice any differently from their non‐graduate colleagues. An opportunistic sample of 82 nurses, was chosen from recent admission on a pre‐registration degree programme, to mature graduates, as well as a group of experienced, non‐graduate practitioners. A quasi‐experimental, between‐subjects design was used. A series of one‐way ANOVAs was used to analyse the difference in critical thinking across all four groups, employing the Watson–Glaser Critical Thinking Appraisal. Additionally, the Jenkins Clinical Decision‐Making in Nursing Scale was used to determine the differences in decision‐making ability in practice across three of the groups with clinical experience. Furthermore, a correlation was undertaken to determine what relationship, if any, existed between critical thinking and decision‐making in practice. It was found that there was no significant difference in the critical thinking skills across all groups studied, supporting the findings of other studies in the USA, which examined the cognitive skills of students undertaking graduate programmes. However, in their practice, it was found that those exposed to the academic process were significantly better at decision‐making than their non‐academic colleagues. Finally, no relationship could be found between the development of critical thinking and decision‐making in practice, suggesting that more work needs to be done to look carefully at both critical thinking skills and decision‐making in practice and the tools used to measure these.
The experiences of Taiwanese women caring for parents‐in‐law
Authors: Chao Shu‐Yuan , Roth Patricia
Published: March 2003

The experiences of Taiwanese women caring for parents‐in‐law

Using grounded theory, semistructured in‐depth interviews were conducted to explore the experiences of Taiwanese women who were caregivers for their parents‐in‐law. Thirty‐one Taiwanese women aged 23–58 participated in this study. ‘Just doing’ emerged as the core category and reflected the Taiwanese women caregivers’ process of striving to continue to fulfil the demands of their role during the period of commitment to their parents‐in‐law’s care. The related categories surrounding the core category in the paradigm for this study include: being called, caring for, holding up, keeping harmony, and maintaining filial piety. ‘Being called’ reflected the reasons that these women became caregivers to their parents‐in‐law under circumstances heavily influenced by cultural expectations. ‘Caring for’ provided the context for activities involved in providing daily comfort, keeping watch and seeking assistance when necessary. The category of ‘holding up’ reflected the caregiver’s interpretation of her duty, the extent of the difficulties she experienced and her responses to those difficulties. A philosophy of life, which strongly emphasizes ‘keeping harmony’ influenced how the caregiver interpreted her caregiving role and her ability to ask for assistance or more resources to overcome difficulties posed by the situation. Maintaining filial piety was identified as a primary duty, a lifelong commitment and a desired outcome. However, striving to achieve this outcome resulted in differing caregiver perceptions, ranging from serenity to personal self‐sacrifice. The findings clearly suggested that caregiving behaviours were influenced by cultural expectations when the parent‐in‐law was ill. This study of Taiwanese women caregivers’ experiences may be beneficial in facilitating the development of a comprehensive policy for long‐term care as well as suggesting possible intervention strategies for individual and family care. Recommendations for future research focus on cultural determinants of caregiving roles and coping strategies.
Levels of satisfaction of ‘low‐risk’ mothers with their current health visiting service
Authors: Bowns  , Crofts  , Williams  , Rigby  , Hall  , Haining
Published: March 2003

Levels of satisfaction of ‘low‐risk’ mothers with their current health visiting service

Aims and objectives To assess the expressed levels of satisfaction of ‘low‐risk’ mothers with the current health visiting service. Setting Sheffield, England, Autumn 1997. Methodology Self‐completion, postal questionnaire (initial postcard reminder followed by a second letter and questionnaire) to a sample of 403 mothers assessed as ‘low priority’ by their health visitor. Questions largely related to maternal opinion of the adequacy of the health visiting service delivered during the first 9–12 months. The local research ethics committee approved the study. Results A corrected response rate of 75% with little evidence of significant bias. A high proportion (86%) of women stated that they were either ‘fairly’ or ‘very’ satisfied with the service they had received from their health visitor with regard to their baby. A lower proportion (72%) was equally satisfied with the service they had received in respect of their own health. Despite an average number of approximately 10 contacts in relation to infant health with the health visitor during the first year of life, some 6% of women wanted more frequent contacts, particularly in the first few weeks. Study limitations The questionnaire was designed specifically for the study and validation was limited. The study population comprised a selected, ‘low‐risk’ group. Conclusions The number of reported contacts with the health visitor seemed to greatly exceed those indicated by a basic child health surveillance programme. The overall level of maternal satisfaction is high, though a minority of women would like more support. Dissatisfaction was expressed with the lack of an appointment system for clinics, poor punctuality in home visits, and inappropriate or inadequate advice.
A case for case studies: exploring the use of case study design in community nursing research
Authors: Bergen Ann , While Alison
Published: March 2003

A case for case studies: exploring the use of case study design in community nursing research

The case study has become an accepted vehicle for conducting research in a variety of disciplines. However, the meaning behind the term is not always made explicit by researchers and this has given rise to a number of assumptions which are open to challenge, and to questions about the robustness of the method. This paper explores some of the issues arising from one particular definition of case study research, used in a study by Yin which examined the practice of case management in community nursing. Four main areas are discussed. First, defining ‘case’ is seen to pose questions about the relationship of the phenomenon to its context, the degree of researcher control over case definition, the limits to what may constitute a ‘case’ and what is meant by the term ‘unit of analysis’. Second, the relevance of external validity to case study research is supported through the use of a number of tactics, in particular Yin’s concept of replication logic, which involves generalizing to theory, rather than to empirical data. Third, the use of method triangulation (multiple methods of data collection) is advanced as a means of enhancing construct validity in research where data converge around a particular theory. Finally, the relationship of the case study to theory construction, through the prior development of ‘propositions’ is discussed. Each of these issues is applied to the design and conduct of a research study based closely on Yin’s multiple case study framework. Thirteen ‘cases’ were selected of case management practice and data were collected through interviews and examination of literature and documentation, to explore the suitability of community nurses for the role. It is concluded that, given the appropriate subject matter, context and research aims, the case study method may be seen as a credible option in nursing research.
Pen pals: correspondence as a method for data generation in qualitative research
Authors: Kralik Debbie , Koch Tina , Brady Beverley M.
Published: March 2003

Pen pals: correspondence as a method for data generation in qualitative research

The study aimed to understand the impact of chronic illness on the lives of midlife women and explore and share the ways in which women adapt to and/or tolerate chronic illness in their lives. In 1998, 80 women participated in a study in which data were generated by corresponding with the researcher. Guided by feminist principles of collaboration, reciprocity and disclosure, we created rich stories about what it is like to live with a chronic illness. In this paper we will discuss the first phase of this inquiry which utilized correspondence between the researcher and the women. The issues posed by the use of correspondence as an innovative data generation process will be analysed. Correspondence, at first glance, may appear to be a rather impersonal communication medium. However, we are committed to this method of data generation and believe we have unlocked the doors to a viable qualitative research process. The literature to guide this process is scarce so we are keen to share work in progress. We will describe the preparation phase in setting up the study; discuss some practical issues, share some of the researcher’s experiences in generating narratives from dialogues and hear from the women themselves what they consider to be significant about this research process.
The importance of ‘knowing the patient’: community nurses’ constructions of quality in providing palliative care
Authors: Luker Karen A. , Austin Lynn , Caress Ann , Hallett Christine E.
Published: March 2003

The importance of ‘knowing the patient’: community nurses’ constructions of quality in providing palliative care

This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B–H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in ‘new nursing’ which identifies the uniqueness of patient needs, and where the nurse–patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with ‘new nursing’ emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal.
Blurring boundaries: professional perspectives of the emergency nurse practitioner role in a major accident and emergency department
Authors: Tye Christopher C. , Ross Fiona M.
Published: March 2003

Blurring boundaries: professional perspectives of the emergency nurse practitioner role in a major accident and emergency department

The role of the emergency nurse practitioner (ENP) has increasingly become part of mainstream healthcare delivery in major accident and emergency departments in the United Kingdom. Although some research data are available in this field, there has been little attempt to evaluate the impact of the implementation of the ENP role from the perspective of those healthcare professionals most closely involved at local level. This paper describes one part of a case study evaluation of the role in an accident and emergency department in the South Thames English region. Nine face‐to‐face semi‐structured interviews were carried out with the key multidisciplinary stakeholders in the organization. Five major themes emerged from the data analysis: blurring role boundaries; managing uncertainty; individual variation; quality vs. quantity; and the organizational context. Whilst some professional consensus was evident regarding the benefits of the role, such as improved waiting times and patient satisfaction, there appeared also to be a degree of ambivalence, particularly regarding current role configuration, value for money, and the extent to which the role should be expanded in the future. These issues are discussed in terms of professional identity, changing role boundaries, and professional personhood. It is argued that the benefits and pitfalls of the ENP role need to be considered within the context of local service provision. The growing emphasis on clinical governance reinforces the need for ongoing audit of role effectiveness in order to meet the challenges and uncertainties of increasingly blurred professional boundaries.
The use of simulation and post‐simulation interview to examine the knowledge involved in community nursing assessment practice
Authors: Bryans Alison , McIntosh Jean
Published: March 2003

The use of simulation and post‐simulation interview to examine the knowledge involved in community nursing assessment practice

This paper describes the development of an innovative research approach which used the complementary methods of simulation and post‐simulation interview to examine the knowledge‐base involved in community nursing assessment practice in the United Kingdom. The study commenced in 1994 and the main phase of data‐gathering took place over a 3‐week period in 1995. Having outlined the study’s aim, context and theoretical background, this paper focuses on the two main methods of data‐gathering used. Detailed description of the simulation method and the post‐simulation interview and the rationales for their use are followed by critical discussion which identifies their particular strengths and weaknesses. Threats to validity are also considered. It is argued that the combined use of a simulated assessment and a post‐simulation structured interview has great potential as a means of exploring the knowledge involved in community nursing assessment practice.
Is the complexity of care a paradox?
Authors: Stockdale Merren , Warelow Philip J.
Published: March 2003

Is the complexity of care a paradox?

This paper looks at the phenomenon known as care and the medium through which it is expressed — caring. It explores some of the meanings of these terms but focuses particularly on nursing care. Superficially, nurses and society have a broad understanding of what ‘care’ means but common usage of the word belies its complexity. When examined alongside the writings of scholars the inconsistent nature of care and caring emerges. We reflect on the difficulties this presents for both the nurse and the cared for when, on the one hand care is promoted as the essence of nursing, while on the other there is no acceptable definition of care on which to base this claim. Encompassed within our discussion is the underlying theme that although care is an appropriate ideal for nursing it does not capture all of the day‐to‐day realities and hence it is not an overriding ideal. Care in nursing in this sense is contradictory and we describe it as paradoxical.
Methodological issues in grounded theory
Authors: Cutcliffe John R.
Published: March 2003

Methodological issues in grounded theory

Examination of the qualitative methodological literature shows that there appear to be conflicting opinions and unresolved issues regarding the nature and process of grounded theory. Researchers proposing to utilize this method would therefore be wise to consider these conflicting opinions. This paper therefore identifies and attempts to address four key issues, namely, sampling, creativity and reflexivity, the use of literature, and precision within grounded theory. The following recommendations are made. When utilizing a grounded method researchers need to consider their research question, clarify what level of theory is likely to be induced from their study, and then decide when they intend to access and introduce the second body of literature. They should acknowledge that in the early stages of data collection, some purposeful sampling appears to occur. In their search for conceptually dense theory, grounded theory researchers may wish to free themselves from the constraints that limit their use of creativity and tacit knowledge. Furthermore, the interests of researchers might be served by attention to issues of precision including, avoiding method slurring, ensuring theoretical coding occurs, and using predominantly one method of grounded theory while explaining and describing any deviation away from this chosen method. Such mindfulness and the resulting methodological rigour is likely to increase the overall quality of the inquiry and enhance the credibility of the findings.
Perceptions of the role of the school in providing information and support to adolescent children of women with breast cancer
Authors: Chalmers Karen I. , Kristjanson Linda J. , Woodgate Roberta , Taylor‐Brown Jill , Nelson Fred , Ramserran Sagietta , Dudgeon Deborah
Published: March 2003

Perceptions of the role of the school in providing information and support to adolescent children of women with breast cancer

Little is known about the needs of adolescents of women with breast cancer. The purpose of this study was to describe the perceptions of adolescents (ages 12–20) about the role of the school in assisting them in dealing with the cancer experience. An exploratory, qualitative study was done to elicit detailed descriptions of adolescent’s needs for information and support in response to their mother’s breast cancer. A convenience sample of 31 adolescents of women in five illness phases participated in semi‐structured interviews. In addition, two focus group interviews were conducted. Interviews were tape‐recorded, transcribed and analysed using content analysis techniques. Findings specific to the adolescents’ perceptions of the role of the school were discussed according to content, type, amount, timing, provider and quality of information. Support needs were discussed as type of support, source of support, amount, timing and focus. Although school personnel attempted to be supportive and adolescents received generic information about cancer, overall the needs of the adolescents were not adequately addressed. Recommendations for schools and health services in assisting adolescents to cope with this major life experience are made.
Prevention as intervention
Authors: August‐Brady Michele
Published: March 2003

Prevention as intervention

Prevention as intervention is identified as a middle‐range theory consistent with the Neuman systems model. Through an examination of anxiety research using Neuman’s theory, prevention as intervention is examined for clarity, simplicity, generality, accessibility and importance. Conceptual clarity is in need of improvement to proceed with theory testing research. Until such concepts as the flexible and normal lines of defence, created environment, and the inter‐relatedness of core system variables are further understood, the theory of prevention as intervention remains unclear.
Patients’ and carers’ perceptions of factors influencing recovery after cardiac surgery
Authors: Davies Nigel
Published: March 2003

Patients’ and carers’ perceptions of factors influencing recovery after cardiac surgery

Stress and anxiety experienced by patients following myocardial infarction are well documented. Moreover, partners feel distress when they realize that they must assume responsibility for day‐to‐day care once the period of hospitalization is over. However, despite the trend towards early hospital discharge and the role which carers appear to be expected to undertake during the recovery of patients who have had cardiac surgery, few studies have been undertaken with this group outside the United States of America. This omission was filled by a descriptive survey with 60 patients and carers following cardiac surgery. Data were obtained during early recovery (1 week after hospital discharge) and 6 weeks later. The results indicated that carers assumed a heavy burden once the patient had left hospital and were less satisfied with the timing of discharge than the patients. Information provided by nurses was consistently rated more highly than information provided by doctors or physiotherapists but there was scope for increasing input with both groups. High levels of satisfaction with the information provided by health professionals were associated with lower scores on the Hospital Anxiety and Depression Scale. More qualitative, in‐depth studies to explore the precise needs of patients and their carers are needed to ensure that in future both groups are better prepared.
The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample
Authors: Shyu Yea‐Ing Lotus
Published: March 2003

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample

This study explored the needs of family caregivers during the transition from hospital to home. Data from 37 face‐to‐face interviews with 16 caregivers before discharge and at 2 weeks and 1 month after discharge were subjected to constant comparative analysis. Findings revealed changes in family caregivers’ needs during the discharge transition. While preparing to take caregiving responsibility, caregivers reported a need for various types of information. After the discharge, but before home caregiving settled into a pattern, they needed help with caregiving practices. After reaching a pattern for providing family care, caregivers frequently reported needs for continuous emotional support. These findings provide a basis for transitional care services such as discharge planning and home health care services.
The interplay between social and cultural context and perceptions of cardiovascular disease
Authors: Murray Sarah A. , Manktelow Ken , Clifford Collette
Published: March 2003

The interplay between social and cultural context and perceptions of cardiovascular disease

This paper seeks to explore the impact of social and cultural factors upon perceptions of the patients’ cardiovascular risk and intended lifestyle changes. Qualitative and quantitative research approaches were used. The sample was purposeful; matched groups of 10 first time post myocardial infarction (MI) patients, 10 informal (spouse, blood relative or partner) and 10 formal carers (nursing staff) were selected on a convenience basis. Personal interviews were conducted with participants, during which a semistructured questionnaire was completed. A combination of descriptive statistics and qualitative analysis of these data revealed that social and cultural factors formed the basis of patients’ and informal carers’perceptions of cardiovascular risks and social information networks provided the main source of information about cardiovascular risk. For the staff, known risk factors based on epidemiological evidence (lack of exercise and diet) formed the basis of their perceptions of the patients’ cardiovascular risk factors. However, for all the participant groups (i.e. patients, informal carers and staff) the risk factors – diet and exercise were indicated as being the patients’ intended lifestyle changes., The results illustrate potential interplay between ‘social’ and ‘cultural’ context and perceptions of cardiovascular risk and incongruency between perceptions of risk and perceptions of the patients’ intended lifestyle change. These results may assist nurses in giving effective advice to patients and relatives about lifestyle change following myocardial infarction and inform future policy for cardiac rehabilitation.
An exploration of the relationships between uncertainty, psychological distress and type of coping strategy among Chinese men after cardiac catheterization
Authors: Taylor‐Piliae Ruth E. , Molassiotis Alexander
Published: March 2003

An exploration of the relationships between uncertainty, psychological distress and type of coping strategy among Chinese men after cardiac catheterization

The experience of cardiac catheterization (CC) has included feelings of uncertainty, stress, fear and anxiety in many patients. However, conflicting findings from previous research have been reported. Chinese patients who undergo CC may experience psychological distress in a different way to other cultures as a result of traditional beliefs. Moreover, little research examining the impact of CC among Hong Kong Chinese has been carried out. Therefore, the aim of the study was to explore relationships between uncertainty, psychological distress and coping strategy in Chinese men after CC, using Mishel’s model of uncertainty in illness as a framework. A convenience sample of 27 men hospitalized for cardiac catheterization participated in this study using a descriptive, correlational research design. Ethical approval was obtained from the Ethics Committee of the Medical Faculty at the Chinese University of Hong Kong and from the Executive Committee of the hospital. Participation was on a voluntary basis with patient confidentiality assured. Self‐report questionnaires included Chinese versions of Mishel’s Uncertainty in Illness Scale (MUIS), the Profile of Mood States (POMS), the State‐Trait Anxiety Inventory (STAI) and the Chinese Coping Scale (CCS) for data collection. Data were analysed using the Statistical Package for Social Sciences. High mean scores for uncertainty (mean=101·4, SD=11·49) and variables measuring psychological distress (mood disturbance mean=36·6, SD=33·6, state‐anxiety mean=39·1, SD=8·95, trait‐anxiety mean=43·7, SD=8·1) among these participants suggest that Hong Kong Chinese men experience uncertainty and psychological distress when undergoing cardiac catheterization. Strong relationships between uncertainty and mood disturbance (r=0·57, P=0·01), trait‐anxiety and mood disturbance (r=0·65, P=0·01) and state‐anxiety and external coping strategies (r=0·50, P=0·05) were found. These findings suggest that relationships between uncertainty, psychological distress and external coping strategies exist in Chinese men hospitalized for cardiac catheterization. Moreover, these findings may help nurses’ design culturally specific interventions for their patients.
Validation of a questionnaire to evaluate the quality of life of nonprofessional caregivers of dependent persons
Authors: Gallego Carmen Fuentelsaz , Roger Montserrat Roca , Bonet Inmaculada Úbeda , Viñets Lourdes García , Ribas Assumpta Pont , Pisa Rosa López , Oriol Rosalía Pedreny
Published: March 2003

Validation of a questionnaire to evaluate the quality of life of nonprofessional caregivers of dependent persons

Aim of the study. To determine the acceptance, validity and reliability of the questionnaire for assessing the type of informal care that caregivers of dependent people give and the effects this care might have on the health of the carer.

Background. In Spain, the formal health care system provides 12% of the total time dedicated to health care, the remaining 88% is carried out by the informal system within the home environment. The act of caring has effects on various areas of the life of the carer and on family functioning. This makes clear the existing risk when the principal carer becomes a secondary nurse.

Methods. This research was a cross‐sectional design, carried out in municipalities in the province of Barcelona (Spain) from January to December 1997. The subjects of the study were 240 caregivers of dependent people. The questionnaire (ICUB97©) is based on the Virginia Henderson’s 14 Needs nursing model. The validity of the content was assessed through the consensus of a group of experts, validity of design by means of comparison with the hypotheses.

Results. Test–retest reliability was completed for the three parts of the questionnaire and the κ index values was 0·89, 0·80 and 0·75 for each part. The higher the level of dependency of the person cared for, the more care tasks the carer had to perform. A correlation coefficient of 0·58 was obtained for the Barthel Index (P < 0·001) and 0·53 on the Philadelphia Index (P < 0·001). The care tasks performed by the carer showing greatest correlation with dependency level were; help with elimination (r=0·73, P < 0·001), help with feeding (r=0·55, P < 0·001) and help in personal development (r=0·55, P=0·001).

Conclusions. This questionnaire provides a reliable and valid instrument for measuring the care given by caregivers to dependent people, to meet their basic needs as well as for assessing the needs of the carers who experience problems by the act of caring. It is therefore important for nursing practice, to have a validated instrument available for identifying the tasks performed by family carers and the effects on their health.
Further testing of the Mental Health Problems Perception Questionnaire
Authors: Angus Neil J. , Lauder William , Reynolds William
Published: March 2003

Further testing of the Mental Health Problems Perception Questionnaire

Aim of study. This paper reports a two‐part study relating to the further psychometric development of the Mental Health Problems Perceptions Questionnaire.

Background. The instrument was developed and used originally in a study to investigate the role of district nurses in caring for people with mental health problems, who live in rural settings. It is underpinned by an explicit theoretical framework in which therapeutic commitment, role support and role competency are core concepts.

Design. A two‐part study is described. Part One used a test–retest method to examine the stability of the instrument on repeated administration. Part Two examined the instrument’s internal reliability and construct validity by calculation of Cronbach’s alpha co‐efficients and exploratory factor analysis.

Results. Satisfactory internal reliability for a new instrument was demonstrated. Exploratory factor analysis supported the previously proposed theoretical framework. Significant correlations were demonstrated between the scales which constitute the instrument, thereby providing further evidence of construct validity.

Conclusions. The Mental Health Problems Perceptions Questionnaire provides a potentially useful instrument in relation to future educational, clinical and managerial research.
The feasibility of a nurse practitioner‐led primary health care clinic in a school setting: a community needs analysis
Authors: Clendon Jill , White Gillian
Published: March 2003

The feasibility of a nurse practitioner‐led primary health care clinic in a school setting: a community needs analysis

Aim. The aim of this New Zealand study was to determine the feasibility of establishing a nurse practitioner‐led, family focused, primary health care clinic within a primary school environment as a means of addressing the health needs of children and families. A secondary aim was to ascertain whether public health nurses (PHNs) were the most appropriate nurses to lead such a clinic.

Method. Utilizing a community needs analysis method, data were collected from three sources – known demographic data, 17 key informant interviews and two focus group interviews. Questions were asked regarding the health needs of the community, the perceptions of participants regarding the role of the PHN, and the practicalities of establishing a clinic including the services participants would expect a clinic to provide. Analysis was exploratory and descriptive.

Results. Findings included the identification of a wide range of health issues. These included asthma management and control issues, the need to address poor parenting, and specific problems of the refugee and migrant population. Findings also demonstrated that participant understanding of the role of the PHN was less than anticipated and that community expectations were such that for a PHN to lead a primary health care clinic it would be likely that further skills would be required. Outcomes from investigating the practicalities of establishing a nurse practitioner‐led clinic resulted in the preparation of a community‐developed plan that would serve to address the health needs of children and families in the area the study was undertaken. Services that participants identified as being appropriate included health information, health education, health assessment and referral.

Conclusion. Overall findings indicated that the establishment of a nurse practitioner‐led, family focused, primary health care clinic in a primary school environment was feasible. While a PHN may fulfil the role of the nurse practitioner, it was established that preparation to an advanced level of practice would be required.
How do we facilitate carers’ involvement in decision making?
Authors: Walker Esther , Jane Dewar Belinda
Published: March 2003

How do we facilitate carers’ involvement in decision making?

Background. Government health care policy urges service providers to involve service users in the decision‐making process. Research studies have recommended changes to current health care practice to facilitate this involvement. However, carers’ organizations continue to highlight a gap between policy and practice in relation to involvement.

Aim. The aim of the study reported on in this paper was to investigate involvement in a specific health care context with a view to identifying both opportunities for change and practical, realistic ways of bringing about that change. This was a qualitative case study using a case study design. The field site selected was a respite and assessment (23 bedded) ward within the Psychiatric Unit of a hospital specializing in the care of older people. Informal carers (n=20) and members of the multidisciplinary team (n=29) were interviewed about their views and experiences. The interviews were audiorecorded and transcribed. Family meetings, multidisciplinary team meetings and ward routines were the focus of non‐participant observation. Field notes from these observations, together with the interview data were analysed using constant comparative method.

Results and Conclusions. The reported experiences of carers in this study highlighted four markers of satisfactory involvement: feeling that information is shared; feeling included in decision making; feeling that there is someone you can contact when you need to; and feeling that the service is responsive to your needs. The majority of carers felt dissatisfied with the level of involvement. The situation we found echoed that found in other studies, i.e. the majority of informal carers (henceforth ‘carers’) interviewed were dissatisfied with the level of their involvement. However, our investigation, in which the views of health care professionals as well as those of carers were sought, provided invaluable insight into why this might be the case. Two main sources of difficulty were found: hospital systems and processes, and the relationship between nursing staff and carers. The argument made is that practitioners themselves must notice and challenge these barriers if carer involvement is to be facilitated.
Subject positions theory – its application to understanding collaboration (and confrontation) in critical care
Authors: Sundin‐Huard Deborah
Published: March 2003

Subject positions theory – its application to understanding collaboration (and confrontation) in critical care

Background.  Doctors and nurses do not usually take a collaborative approach to the ethical challenges of the critical care environment. This leads to the stresses that produce moral anguish and burnout – both for nursing and medical staff. A more collegial relationship between nurses and physicians should improve patient care. If we are to promote this collegiality, one way to proceed is to investigate the interactions between health care professionals in order to develop an understanding of the barriers to, and supports for collaboration.

Aim.  Subject positions theory offers a method of explaining and elucidating the interactions between nurse and physician in terms of power dynamics, mutual expectations and the discourse available to each individual. This paper aims to demonstrate how subject positions theory can facilitate the interpretation of the interactions between health professionals in terms of the power dynamics influencing those interactions.

Discussion.  This paper will use the example of a case study from my own research to demonstrate the application of this theory and its usefulness in the analysis of the interactions between health care professionals.

Conclusions.  Application of this theory is used to demonstrate the author’s argument that the current political and cultural structure of the health care system does not support the subject position – nurse advocate.
The relationship between support and stress in forensic community mental health nursing
Authors: Coffey Michael , Coleman Mick
Published: March 2003

The relationship between support and stress in forensic community mental health nursing

Aims of the study/paper.  This paper reports the results of a survey of forensic community mental health nurses (FCMHNs) in England and Wales which aimed to ascertain the level of stress and burnout experienced by this group.

Background/Rationale.  Several studies have identified that mental health nursing is a stressful activity and the relationship between factors such as age, experience, support, caseload size and perceived stress have been explored. However, until recently, no studies have examined the situation of FCMHNs and this paper extends the analysis of studies completed by the main author, considering issues related to coping abilities and support systems.

Design/Methods.
 The survey involved respondents completing a demographic questionnaire and a range of standardized validated measures (Maslach Burnout Inventory, General Health Questionnaire and Community Psychiatric Nurse Stress Questionnaire). The population for the study was all identified FCMHNs attached to the 26 National Health Service (NHS) Medium Secure Units in England and Wales (n=104).

Results/Findings.
 A high response rate of 77% (n=80) was achieved. The results identified that a number of respondents were experiencing burnout. Statistically significant associations were found between caseload size and level of stress. The results also suggest that support from managers and colleagues were an important factor in ameliorating the experience of stress and show that individuals in this study experiencing high levels of stress adopted palliative behaviours such as use of alcohol.

Conclusions.  The paper concludes by suggesting that such findings should be considered when delivering stress management programmes and reinforce the potential benefit of effective clinical supervision as a means of staff support.