bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between menstrual attitudes and menstrual symptoms among Taiwanese women
Authors: Lu Zxy‐yann Jane
Published: March 2003

The relationship between menstrual attitudes and menstrual symptoms among Taiwanese women

Aim of the study. This study explored characteristics of the menstrual cycle including duration, prevalence and severity of symptoms and examined the relationship of these characteristics with attitudes toward menstruation.

Background. Conceptualization of menstrual phenomena and attitudes toward menstruation may vary among cultures. While data about menstrual health among American women are widely available, there are little data concerning menstrual health in Taiwanese women.

Design/Methods. A total of 30 healthy women with a mean age of 24·4 years participated in the study and made daily records of symptoms over a 90‐day period with the Woods Daily Health Diary (WDHD). They then retrospectively completed the Moos Menstrual Distress Questionnaire (MMDQ) and the Menstrual Attitudes Questionnaire (MAQ).

Results. The mean age of menarche of these women was 13 years, their mean cycle duration was 5·8 days and the cycle length was 31·1 days. The mean scores of five subscales for MAQ ranged from 2·19 to 3·28. Forty‐six percent of the surveyed Taiwanese women agreed that the onset of menstruation can be predicted and anticipated, and 78% of these women agreed that menstruation was a natural event.

Conclusions. Menstrual attitudes in Taiwanese women are multidimensional, and that significant cross‐cultural differences are present. Attitudes toward menstruation in Taiwanese women are related to their physical, cognitive, behavioural and psychological changes in the premenstrual and menstrual phases.
The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge
Authors: Twinn Sheila
Published: March 2003

The evaluation of the effectiveness of health education interventions in clinical practice: a continuing methodological challenge

Aim. This paper examines the methodological issues arising from an evaluation of the effectiveness of a health education project undertaken to increase Hong Kong Chinese women's knowledge of the prevention of cervical cancer and the uptake of screening.

Background. The significance of health promotion to the prevention of diseases currently affecting contemporary society has become increasingly recognized. Within the context of health promotion health education continues to provide an important preventive strategy. Indeed the leading causes of mortality such as coronary heart disease and cancer lend themselves well to health education interventions. However the evaluation of the effectiveness of health education remains complex and raises some important methodological issues.

Design. The project used a health education intervention as the major preventive strategy and employed multiple methods of evaluation to assess its effectiveness. Outcome evaluation consisted of a confidential questionnaire administered at two points in time to measure changes in health‐related behaviour and knowledge. It also included the collection of data from service providers to assess changes in the uptake of cervical cancer screening. Process evaluation involved the use of focus groups with randomly selected groups of women who had participated in the health education intervention and a diary kept by the project nurse.

Findings. Methodological issues identified in the evaluation of the project included the extent to which changes in health‐related knowledge and behaviour could be attributed to the intervention, the sensitivity of outcome measures and challenges in developing methods of process evaluation appropriate to the target population.

Conclusions. The findings highlight the complexity of designing effective evaluation strategies for health education and the need to consider these issues in the development of both process and outcome evaluation.
A measure of critical care nurses’ post‐code stress
Authors: Cole Frank L. , Slocumb Elaine M. , Mastey Jean Muldoon
Published: March 2003

A measure of critical care nurses’ post‐code stress

Aim.  The purpose of this research was to develop an instrument to measure critical care nurses’ post‐code stress and then to examine the psychometric properties.

Background.  Critical care nurses experience stress from multiple sources. One source of stress may arise from participation in resuscitation attempts and this has been labelled post‐code stress; however, no means exist for measuring this source of stress.

Design/Method.  In phase 1, 47 items were developed and submitted to a panel of experts for content validity. Based on content experts’ ratings, 20 items were retained for phase 2 instrument testing. To test the instrument, a convenience sample of critical care nurses was obtained from four institutions in north‐eastern United States. Each nurse received the Post‐Code Stress Scale and completed it anonymously. A subsample completed the Post‐Code Stress Scale a second time to assess stability reliability. The Nursing Stress Scale was also administered to assess construct validity.

Results/Findings.  An exploratory principal components factor analysis with varimax rotation suggested five dimensions to post‐code stress. These five dimensions accounted for 66% of the variance and indicated that stress arose from feeling discomposed, oppressed, uncertain, burdened and morally conflicted. The Pearson product moment correlation between the Post‐Code Stress Scale and the Nursing Stress Scale was 0·46, providing preliminary evidence of construct validity. Internal consistency reliability estimates for the five‐factor subscales ranged from 0·57 to 0·77 with only one factor being <0·70. The internal consistency reliability estimate for the final 14 items on the scale was 0·79.

Conclusions.  The instrument shows promise as a measure of post‐code stress based on the evidence obtained in this study; however, further psychometric testing is warranted.
Nurses’ attitudes to terminally ill patients
Authors: Román Eva M. , Sorribes Eva , Ezquerro Olga
Published: March 2003

Nurses’ attitudes to terminally ill patients

Background. The care of terminally ill patients is a challenge for nurses that has raised special interest in recent years. Several studies have shown a stereotyped negative attitude in nurses towards terminally ill patients. However, all have used methods with several limitations.

Aim. The aim of the study presented in this paper was to identify the nurses’ attitude to the terminally ill patient in Catalonia, Spain, and the relationship of this attitude to different socio‐demographic data (type of centre, shift, years of experience, age and sex) by means of a new quantitative method based on the free word‐association test.

Methods. One hundred and seventy‐five nurses working in 18 hospitals and hospices in Catalonia, Spain were included in the study. Data were analysed by the Associative Semantic Field Differential method by means of the computer programme CONTEXT and a quantitative evaluation of the degree of attitudes positivity was obtained.

Results. The study revealed a general slight negative trend in attitudes towards the terminally ill patient. A more positive attitude was observed in older caregivers and in women. The positivity in attitude decreased from morning to night shift. No differences were observed between nurses working in hospitals and those working in hospices.

Conclusions. We conclude that nursing attitudes can be analysed by methods such as that used in this study. Attempts can be made to modify this attitude in caregivers by means of training programmes and stimulating awareness of an adequate professional approach.
Changes in health visitors’ work
Authors: Ellefsen Bodil
Published: March 2003

Changes in health visitors’ work

Aims.  The Spurpose of this investigation is to describe Scottish health visitors (HVs) experience of changes in their work and compare these with their Norwegian counterparts.

Background.  The renewed emphasis on community health care, health promotion and illness prevention is a strong reason to focus on health visiting work. Knowledge about changes in practice are of special interest for nursing science as such knowledge could contribute to the development and advancement of the health visiting service.

Design.  The study used a comparative descriptive design. The data are based upon in‐depth interviews with nine HVs from Scotland and 12 HVs from Norway.

Results.  The results showed similarities as well as differences. HVs in Scotland and Norway experienced changes in work load with decreases in some areas and increases in others, changes in work practice, approaches and techniques with more emphasis on clients’ empowerment, and also fewer management positions held by nurses. The differences mainly related to the ways that the health visiting service had specialized and expanded. The aim of Scottish health visiting from ‘cradle to grave’ service was not adopted by the Norwegian HVs to the same extent. Scottish HVs specialized individually in some areas and used each other’s competence to a much greater degree than the Norwegian HVs.

Conclusions.  It appeared that the Scottish HVs had found a path where health visiting work aimed at illness prevention and health promotion for everyone was on the way to becoming a comprehensive service and a stronger and more integrated part of the health visiting service. This is a pathway that Norwegian HVs still have to pursue. The qualitative approach and the slightly different samples limited the possibility for generalizations. Further research should address the question of changes and patterns in health visiting work, of how the development came about, and what are the bases for the differences in specialization and expansion of the service. Secondly it should be asked to what degree the development influences the quality of health visiting and consequences for clients, community and health visiting service.
Chronic illness – a disruption in life: identity‐transformation among women with chronic fatigue syndrome and fibromyalgia
Authors: Asbring Pia
Published: March 2003

Chronic illness – a disruption in life: identity‐transformation among women with chronic fatigue syndrome and fibromyalgia

Background. People with chronic illnesses often suffer from identity‐loss. Empirical research concerning patients with chronic fatigue syndrome (CFS) or fibromyalgia has not, however, adequately addressed the consequences of these illnesses for identity.

Aim. The aim of this article is to describe how women with CFS and fibromyalgia create new concepts of identity after the onset of illness, and how they come to terms with their newly arisen identities. I aim to illuminate the biographical work done by these individuals, which includes a re‐evaluation of their former identity and life. This process is illustrated by the following themes: An earlier identity partly lost and Coming to terms with a new identity.

Method. The study is based on interviews with 25 women in Sweden, 12 with the diagnosis of CFS and 13 diagnosed with fibromyalgia. A grounded theory orientated approach was used when collecting and analysing the data.

Findings. The main findings are that: (1) the illnesses can involve a radical disruption in the women’s biography that has profound consequences for their identity, particularly in relation to work and social life, (2) biographical disruptions are partial rather than total, calling for different degrees of identity transformation, (3)␣many of the women also experience illness gains in relation to the new identity.

Conclusions. Thus, the biographical disruption and illness experience comprised both losses and illness gains that had consequences for identity.
Experiences of well spouses after lung transplantation
Authors: Kurz Jane McCausland
Published: March 2003

Experiences of well spouses after lung transplantation

Aim of the study. To explore what life is like for well spouses after their partners’ lung transplantation?

Background. The numbers of people having a lung transplant in the United States of America (USA), as well as surviving beyond 1 and 5 years, has increased steadily over the last decade. This trend is expected to continue. Few have examined the transplant experience from the view of well spouses who are the most typical patient‐support person. Researchers have shown that spousal adjustment is closely associated with patient adjustment and recovery.

Design/methods. Using written surveys and taped telephone interviews in 1998, a convenience sample of 12 well spouses shared details of their lives after their partners’ lung transplant. Spouses from eight states in the USA responded to an invitation to participate which was posted on an internet listserv. Ages ranged from 40 to 66 years and the posttransplant time ranged from 4 to 60 months. Spouses completed a demographic form, the Family Inventory of Life Events (FILE), and the Center for Epidemiologic Studies Depression Scale (CES‐D) prior to interview. Triangulation of methods augmented and corroborated data. Interviews stopped when saturation was reached. Data collection and analyses were carried out simultaneously using a constant comparative method.

Results. The core theme was the ‘roller coaster ride’ characterized by a series of ups and downs. Other major themes were coping, giving medications, knowing the donor, making comparisons, togetherness, and caring for the well spouse. Five identified stages were: the transplant event, cocooning, normalizing, branching‐out and settling down.

Conclusions. This study supports nurses using a family centred focus. Nurses in all practice areas can apply information gained from this study to help spouses anticipate chaos at each stage and develop effective coping strategies.
The effectiveness of parenting programmes facilitated by health visitors
Authors: Long Ann , McCarney Shane , Smyth Gladys , Magorrian Noreen , Dillon Audrey
Published: March 2003

The effectiveness of parenting programmes facilitated by health visitors

Aim of the study. This study was designed to evaluate the effectiveness of parenting programmes that are facilitated by health visitors and offer practical and emotional support to parents in the Down Lisburn Trust, Northern Ireland.

Methods. All parents (n=78) taking part were given a self‐administered questionnaire both before and after attending a ‘Positive Parenting’ programme. The questionnaire contained items gathering demographic information, standardized measures of clinical anxiety/depression, personality states and coping styles and participants’ experience of being a parent and what they wanted from the parenting group. Two items adapted from the Parent Stress Index looked at participants’ ratings of themselves as parents, and if they enjoyed this role.

Statistical analysis. All statistics were computed using the SPSS for Windows (version 7) statistical package. The parametric paired‐samples t‐test was used with the ratio data generated by the Hospital Anxiety and Depression Scale (HADS) questionnaire. It is used to test the difference between the means of the pre and postsets of scores for significance. The nonparametric Wilcoxon test was used to find if there was a significant difference between the pre and postprogramme related samples by ranking the means. The Wilcoxon was chosen firstly because the data were ordinal in nature, hence it cannot be assumed that the findings follow the normal curve of distribution and secondly because it cannot be assumed that the data have homogeneity of variance.

Findings. At the end of the 8‐week parenting programme, findings demonstrated significant statistically reduced levels of clinical anxiety and depression. Parents demonstrated an increase in more positive ratings of personality states such as not shouting at their children and being more calm and energetic at the end of the programme. Adaptive problem focused coping strategies were reported as being used more often subsequent to the programme, although some of the less adaptive emotion focused strategies had also increased in use. However, no change was evident in their ratings of how good a parent they were or if they enjoyed being a parent.

Conclusions. Health visitors have the skills and are in the position to be preventative agents of inadequate parenting, and advocates of positive parenting. Factors relevant to the realm of positive parenting are highlighted as possible avenues for future research.
Risk factors associated with noncompliance with methadone substitution therapy (MST) and relapse among chronic opiate users in an Outer London community
Authors: Mutasa H. C. F.
Published: March 2003

Risk factors associated with noncompliance with methadone substitution therapy (MST) and relapse among chronic opiate users in an Outer London community

Aims. The purpose of this study was to identify the risk factors associated with noncompliance with methadone substitution therapy (MST) and hence relapse in chronic opiate‐dependent users, as this has major clinical implications especially in community‐based detoxification programmes.

Background. Community mental health nurses (CMHNs) and other health/social care professionals need to be aware of the main risk factors associated with MST noncompliance among long‐term opiate users living within their catchment areas. The sex‐matched patterns of biopsychosocial risk factors can be useful predictors of the ability of clients to comply with MST and their likelihood to complete the detoxification programme. A knowledge of the patterns of these high‐risk factors also allows the care professionals to: (1) draw‐up or re‐draw care contracts that reflect their patients’ biopsychosocial circumstances; (2) initiate much broader, client‐centred, relapse prevention strategies; (3) select suitable patients for specialized detoxification contracts; and (4) modify the care approach from detoxification to maintenance contracting particularly for clients with low predicted scores for the former contract‐type.

Methods. As successfully demonstrated in this semi‐quantitative descriptive investigation, identification of these sex‐typed biopsychosocial high‐risk factors can easily be undertaken during assessment and when the clients attend regular review. In this study, numerical information was gathered during personal face‐to‐face interviews, and was supplemented with that contained in past multidisciplinary case notes.

Results. Overall, the medication noncompliant female clients were associated with personality trait, decreased educational expectations, everyday life stresses, ambivalent thoughts, social company availability, comorbidity, boredom, and family‐related conflicts; whereas the noncompliant male clients were associated with poor motivation, fashion and reputation, peer association, uncontrollable drug‐cravings, drug availability, major life events, too stringent prescribing/poor client‐centred care package, heavy intravenous users, young polydrug users, and triple users.

Conclusions. These findings have important nursing practice connotations. This study is advocating the routine identification of biopsychosocial high‐risk factors associated with MST noncompliance by all CMHNs working with chronic opiate‐dependent users.
Homeless children: the lives of a group of Brazilian street children
Authors: Ribeiro Moneda Oliveira , Trench Ciampone Maria Helena
Published: March 2003

Homeless children: the lives of a group of Brazilian street children

Aim. To evaluate the life trajectories of a group of school‐age street children frequenting two São Paulo city public shelters.

Background. A large proportion of the Brazilian child population suffers extreme disadvantage, although the Brazilian government gave the issue ‘absolute priority’ in 1990. Maternal and Under 5 mortality rates remain unacceptably high. In the metropolitan region of São Paulo an estimated 200 000 minors do not live with their mothers. Brazilian street children live lives of extreme personal and social risk.

Study method. The data were collected through individual, semi‐structured interviews, with 14 school age (7–12 years) participants frequenting two city public refuges, with their legal guardians’ consent. Data analysis was based on Social Representation Theory and used content analysis.

Findings. The children’s most meaningful experiences were grouped into the thematic categories of family, the street, friends, drugs, the police, the shelters and the future. Synthesis of these categories showed the lives of these children to be permeated by violence, resulting in experiences restricting their full development.

Conclusion. The solution to their problems depends on pressure being put on the State by the civilian community in order to establish social and health policies that conform to the Child and Adolescent Statute (ECA). We consider that assisting street children involves attitudes that go beyond professional performance and demands acts of citizenship.

Recommendations. The development of an ethical‐political attitude by professionals to the problems of homeless street children is essential, and educational curricula should be appropriately constituted. Political projects to develop health and welfare policies and education should be directed to these children and their relatives, and include participation by health professionals to provide the necessary preventive and curative services.
Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong
Authors: Holroyd Eleanor , Twinn Sheila , Shiu Anne
Published: March 2003

Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong

Aim of the study. The purpose of this exploratory study was to describe the type and nature of psychosocial nursing interventions provided for cardiac clients in Hong Kong’s Community Rehabilitation Centres (CRNs).

Design/methods. Using a two‐phase case study design data were collected from nurses, cardiac clients and their caregivers. The initial phase focused on identifying the types of psychosocial interventions provided. These data were obtained by observing nursing activities and the keeping of daily journals by the nurses. The second phase acquired data from structured telephone interviews, that reviewed clients’ perceptions of the psychosocial interventions provided by the nurses and face‐to‐face interviews with clients and their caregivers.

Findings. These findings revealed that the nurses’ interpersonal skills of information giving, social support and counselling were highly valued by cardiac clients and their caregivers. Both clients and caregivers outlined a concern about the lack of individual care and this was reflected in the focus of the CRN on group processes.

Conclusion. Recommendations for psychosocial cardiac care are made for public health nurses and nurses working in community settings.
A synthesis technique for grounded theory data analysis
Authors: Eaves Yvonne D.
Published: March 2003

A synthesis technique for grounded theory data analysis

Aims. The purposes of this paper are to examine the issues surrounding current changes in grounded theory (GT) research methods and to explicate an innovative synthesis technique to GT data analysis.

Background. In recent years there has been a steady rise in the number of published research reports that use the GT method. However, this growing body of GT literature has been criticized for its lack of adherence to the method as explicated by its originators, Glaser and Strauss.

Methods. Recent and past literature that explicates, describes, and discusses GT methods is reviewed. A synthesis technique for grounded theory data analysis was developed to analyse qualitative data collected for a grounded theory study on caregiving. This synthesis technique was derived from the works of four grounded theorists (Kathy Charmaz, Mark Chesler, Juliet Corbin and Anselm Strauss).

Results. The lack of clarity and the inconsistencies surrounding GT analysis, as reported in the literature, resulted in the development of a synthesis technique based on the works of the aforementioned‐grounded theorists. The product was a synthesis approach that included analytical steps from each of these authors.

Conclusions. This synthesis approach increased understanding and enhanced clarity of GT data analysis techniques. This paper illustrates how integration of works by noted qualitative scholars is an appropriate and effective means to advance the discourse on data analysis for GT research studies.
Timing of quality of life (QoL) assessments as a source of error in oncological trials
Authors: Hakamies‐Blomqvist L. , Luoma M.‐L. , Sjöström J. , Pluzanska A. , Sjödin M. , Mouridsen H. , Østenstad B. , Mjaaland I. , Ottosson S. , Bergh J. , Malmström P.‐O. , Blomqvist C.
Published: March 2003

Timing of quality of life (QoL) assessments as a source of error in oncological trials Aim of the study. To produce an empirical estimate of the nature and magnitude of the error produced by incorrect timing quality of life (QoL) measurements in patients receiving chemotherapy.

Design. In a multicentre trial, 283 patients were randomized to receive either docetaxel (T) or sequential methotrexate and 5‐fluorouracil (MF). The QoL was assessed at baseline and before each treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ‐C30). The study design was retrospective. Data were analysed using t‐tests.

Results. Erroneous timing affected the QoL findings in both treatment arms. At baseline, there were statistically significant differences in the MF group on the nausea/vomiting scale, with ill‐timed assessment showing more symptoms, and in the T group on the physical functioning scale with ill‐timed assessments indicating better QoL. The mean scores of correct vs. incorrect timings over the first 14 cycles showed statistically significant differences on several scales. In the MF group, ill‐timed assessments indicated significantly worse physical functioning and global QoL, and significantly more of the following symptoms: fatigue, nausea/vomiting, insomnia, appetite loss, and constipation. In the T group, ill‐timed assessment showed better physical functioning, less dyspnoea and more insomnia than correctly timed assessments. The reasons for erroneous timing were not always detectable retrospectively. However, in some cases the MF group, being in standard treatment, seemed to have followed a clinical routine not involving the active participation of the study nurse responsible, whereas patients in the experimental T group were more consistently taken care of by the study nurses.

Conclusions. Incorrect timing of QoL assessments in oncological trials jeopardises both the reliability of the QoL findings within treatment and the validity of QoL outcome comparisons between treatments. This issue should be emphasized in the planning of both the study design and clinical routines.
The relationship of a mother’s working model of feeding to her feeding behaviour
Authors: Pridham Karen F. , Schroeder Michele , Brown Roger , Clark Roseanne
Published: March 2003

The relationship of a mother’s working model of feeding to her feeding behaviour

Aims of the study. This study aimed to examine the difference the attunement of a mother’s working model of feeding to her infant makes for her positive feeding affect and behaviour, accounting for infant and mother conditions.

Background/rationale. The concept of a mother’s working model of feeding is derived from attachment theory. Caregiving, including feeding, is a component of this theory. The conditions that may influence the attunement of a mother’s working model of feeding to her infant include infant birth maturity status (premature, full‐term), age at assessment, and robustness, indexed by weight‐for‐age z score (WAZ). Mother conditions include symptoms of depression and feeding practice (breast feeding or exclusive bottle feeding).

Design/methods. Participants in this longitudinal study were 99 mothers and their infants (47 full‐term, 52 premature, very low birth weight). After written informed consent was given, home assessments were made when infants were approximately 1, 4, 8 and 12 months old (adjusted age for premature infants). Working model attunement was assessed with a video‐assisted interview. A mother’s positive affect and behaviour, including sensitivity and responsiveness, were rated from videotaped feeding interaction.

Results/findings. Repeated measures analysis with a general linear mixed model showed a significant positive relationship with positive affect and behaviour for both working model attunement and the WAZ score and a significant negative relationship for symptoms of depression. Neither birth maturity status, infant age, nor feeding practice had a significant effect on mother’s positive affect and behaviour during feeding.

Conclusions. Nurses’ efforts to enhance the attunement of a mother’s working model of feeding may help mothers feed with greater positive affect and behaviour. Further study of how the attunement of a mother’s feeding expectations and intentions are related to her symptoms of depression and with what she makes of the infant’s growth and well‐being is needed. The theoretical model needs testing with infants from the entire premature population.
Healing through self‐reflection
Authors: Thorpe Karran , Barsky Jeannette
Published: March 2003

Healing through self‐reflection

Background. Today, women have an enlightened view towards their life cycles, which is evidence of their healing potential. Women need to share their insights about their healing potential gained through self‐reflective processes. Their voices must be heard so that we can benefit from their collective wisdom. The process of healing through self‐reflection has begun as a group of nurses share their insights. Documenting the perspectives of these nurses provides the opportunity for other women to learn from and apply this knowledge to their lives.

Method. Through purposive sampling, eight registered nurses, all women, were selected to participate in in‐depth, personal, semi‐structured interviews. The purposes in this paper are to describe a three‐stage (i.e. awareness, critical analysis, and new perspective) reflective‐thinking model and discuss the application of this model to women’s expressed inner knowledge and wisdom across personal and professional life cycles.

Results. Three themes, signifying their ability to heal themselves, were labelled: Spirituality, Be‐ing Versus Do‐ing, and Eustress Versus Distress.

Conclusions. Essentially, self‐reflection results from both personal and professional stimuli and signifies the need for change so that healing can begin. Recommendations are offered for nurse educators and researchers.
HIV, stigma and health: integration of theoretical concepts and the lived experiences of individuals
Authors: Taylor Bridget
Published: March 2003

HIV, stigma and health: integration of theoretical concepts and the lived experiences of individuals

Aim. To explore individual concepts of health and the role of stigma in human immunodeficiency virus (HIV) and HIV disease. The balance of power and knowledge are examined from both macro and micro perspectives, including both concepts of health and health and illness behaviour.

Method. A literature review which supports the integration of theoretical concepts and research findings demonstrating the lived experiences of individuals.

Conclusion. Stigma is a social construct which has significant impact on the life experiences of individuals both infected with and affected by HIV. The stigma experienced is unique to each individual and changes dynamically throughout the course of the HIV illness trajectory. Each of the four identified phases poses unique stigmatic qualities.
Sociological perspectives on self‐help groups: reflections on conceptualization and social processes
Authors: Adamsen Lis , Rasmussen Julie Midtgaard
Published: March 2003

Sociological perspectives on self‐help groups: reflections on conceptualization and social processes

Aim. The paper discusses two themes: first, professional involvement in self‐help groups and secondly, sociological evidence on self‐help groups in postmodern society.

Background. Self‐help groups are a growing phenomenon across national borders and social/political systems. They affect the individual participants’ activity level, strengthening of their self‐perception and sense of belonging.

Methods. The methodological approach chosen is cross‐sectional analysis of empirical findings, which is used for concept evaluation. Selected sociological theory is brought into the discussion of the role and significance of self‐help groups.

Findings. New empirical sociological evidence shows that health care professionals – nurses, psychologists, social workers – have become an integrated part and thus essential actors in self‐help groups within as well as outside the framework of the formal health care system. Involvement in self‐help groups is a relatively new area of nursing practice and nursing research and serves an important function in that it sheds light on a rather unique form of social practice that is partly organized and managed by the participants themselves. By implementing modern sociological theory, which does in fact discuss social processes and relations as well as network formation, it is possible to investigate group processes unique to self‐help groups and whether self‐help groups potentially suppress or liberate at the individual as well as at the institutional level.

Conclusions. The pronounced professional involvement leads us to question if it would not be time to re‐conceptualize the self‐help phenomenon, which on the one hand presupposes professional interaction and on the other hand introduces consultative services in connection with group processes. This indicates that it is necessary to introduce new aspects and themes for discussion in the health care debate and the work that goes beyond the predominantly individual orientated treatment and care function.
A model for the delivery of culturally competent community care
Authors: Kim‐Godwin Yeoun Soo , Clarke Pamela N. , Barton Leslie
Published: March 2003

A model for the delivery of culturally competent community care

Aim. To describe the proposed Culturally Competent Community Care (CCCC) model, and the process of development and testing of the model.

Background. Community health nurses are challenged to provide culturally competent care in all types of communities. However, existing models have not provided community nurses with specific guidelines, and none attempt to explain the effects of culturally competent care on populations in community settings. Therefore, it is necessary to develop a model that is comprehensive in its description of the dimensions of culturally competent care in community‐based settings and that also requires a focus on ethnic populations. The model is essential for reducing racial and ethnic health disparities.

Methods. Based on literature review and concept analysis, three constructs of the Culturally Competent Community Care Model were developed. Two of the constructs, the health care system and health outcomes, were developed based on a literature review. The main construct of the model, cultural competence, was developed after a concept analysis, following the development and testing of the Cultural Competence Scale (CCS). Interviews with eight community health nurses and a survey by five community nurse experts were conducted in order to refine and confirm the dimensions of cultural competence and its impact on health outcomes.

Conclusions. The proposed dimensions of culturally competent care are caring, cultural sensitivity, cultural knowledge, and cultural skills. This model focuses on the relationship between cultural competence and health outcomes for culturally diverse populations. The framework provides specific guidelines for community nurses in developing and assessing cultural competence and meeting the health needs of diverse communities.
Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine
Authors: DeKeyser Freda G. , Cohen Bella Bar , Wagner Nurit
Published: March 2003

Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine

Aims. The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables.

Background. Over recent years there has been increased interest among the lay public and health care professionals in complementary and alternative medicine (CAM). Previous studies have shown that several variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. Conflicting reports were found with respect to the relationship between health locus of control and the use of CAM. Israel is a small country comprised mostly of immigrants from vastly differing cultures with differing beliefs about health and health care. Nurses whose origins are similar to the general population are also caregivers who are used to integrating diverse therapies into the plan of care devised with the client. No study was found which investigated these issues among Israeli nurses.

Design/methods. A systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem, Israel were invited to participate in the study. Informed consent was obtained. Four self‐administered, pencil and paper, questionnaires were distributed to the study participants: a questionnaire designed by the authors to determine the level of knowledge and attitudes towards complementary and alternative medicine; a questionnaire which measured satisfaction with the patient–physician relationship; a questionnaire which measured health locus of control; and a demographic questionnaire. Participants received a packet containing the questionnaire and a note explaining the study. The anonymous questionnaires were collected by the ward secretaries and sent in bulk to the researchers.

Results. Results demonstrated that nurses in this sample perceived that they had little knowledge of complementary and alternative medicine but were very interested in learning more. Few used complementary and alternative medicine in their nursing practice but levels of personal use were similar to that of the general population. Nurses who used complementary and alternative medicine were satisfied with their care.

Conclusions. In general, nurses tended to be wary of the use of complementary and alternative medicine. Nurses were also not satisfied with their relationships with their physicians. Those of middle age were more likely to use complementary and alternative medicine but no other demographic characteristics were associated with knowledge or attitudes towards complementary and alternative medicine. Nurses had higher levels of internal health locus of control which was associated with more positive attitudes and knowledge levels of complementary and alternative medicine.
Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers
Authors: De Jonge Ank
Published: March 2003

Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers

Aim of the study. To gain insight into the support teenage mothers received during pregnancy, birth and their child’s pre‐school years and young women’s perceptions of the usefulness of a support group for teenage mothers.

Background. Most qualitative studies have focused on teenage mothers around the time of the birth of their first child. For this study, women were recruited several years after the birth (median 8·5 years), so that they would have had time to reflect on the support they had received.

Design. The qualitative method of semi‐structured interviews was chosen to obtain in‐depth information and to allow teenage mothers’ own views to be heard. Ten individual interviews and one paired interview were undertaken.

Findings. Recruitment was difficult because taking part in research was not a priority for many of the women. The study confirmed the strong link between deprivation and teenage pregnancy found in other studies, and suggested that mental health problems in teenage mothers may be more difficult to detect. Teenage women need more information on mental health and on services available to them. The fear, expressed by some of the women in this study, of becoming different from other women in their social network should be considered by health workers when establishing intervention programmes.

Conclusions. Professional bodies of health workers should lobby government to provide a minimum standard of living and sufficient child‐care to combat deprivation. Former teenage mothers should be involved in the recruitment, planning and implementation stages of research and interventions. Health professionals should be aware that mental health problems in teenage mothers may be particularly difficult to detect. Key community health workers or a support group may provide information on services, mental health and education facilities available that would benefit teenage mothers. A support group may also give emotional support.
Mothers’ grief following the death of a child
Authors: Laakso Hilkka , Paunonen‐Ilmonen Marita
Published: March 2003

Mothers’ grief following the death of a child

Aim of the study. Research has shown that caring for a dying child is among the hardest and more demanding tasks in nursing, because the staff are forced to manage their heavy work with inadequate skills and experience. This article deals with the findings of a recent study, the purpose of which was to analyse the mother’s grief and coping with grief following the death of a child under the age of 7 years.

Design. Data were collected from mothers using a survey (n=91) and an interview (n=50). As the topic was very sensitive ethically and emotionally, survey data were collected first and the mothers were asked to give their consent to taking part in an interview. The study employed both quantitative and qualitative methods. The data were analysed using statistical methods and content analysis. However, only the qualitative part of the study is presented in this article.

Findings. The findings show that nursing staff had skills to support grieving mothers, but that there were many feelings and experiences of grief that remained unidentified by staff. The staff’s ability to meet the mothers’ individual needs while the child was in hospital and after the child’s death was inadequate. The information received from staff was perceived to be insufficient or offensive to mothers.

Conclusions. The development of basic and further education and of various support measures would enable the staff to better cope with their work. Focusing on interactive skills and meeting the patient’s individual needs using reflective practice would improve the quality of care. Communication and collaboration between different occupational groups should be promoted, because mothers were dissatisfied with dissemination of information, and ambiguous responsibilities between different occupational groups hampered the acquisition of information.
Reflective practice and clinical supervision: meticulous rituals of the confessional
Authors: Gilbert Tony
Published: March 2003

Reflective practice and clinical supervision: meticulous rituals of the confessional

Background. Reflective practice and clinical supervision are progressively asserting hegemony upon nursing practice with claims of emancipation and empowerment. However, this is being achieved in an environment where there is little critical debate about the assumptions on which these practices are based.

Aim. This paper sets out to challenge the basis upon which reflective practice and clinical supervision are promoted within nursing discourse by employing Michel Foucault’s (1982) concept of governmentality.

Theme. A broad Foucauldian perspective is used to demonstrate how the technologies of reflective practice and clinical supervision have been accommodated within modern forms of government. These technologies are consistent with the flattened hierarchies and increasing dispersal of practitioners in contemporary health care. In this context reflective practice and clinical supervision can be shown to function in two independent but interrelated ways. First as modes of surveillance disciplining the activity of professionals. Second, as ‘confessional’ practices that work to produce particular identities – autonomous and self‐regulating.
Private thoughts in public spheres: issues in reflection and reflective practices in nursing
Authors: Cotton Antoinette H.
Published: March 2003

Private thoughts in public spheres: issues in reflection and reflective practices in nursing

Aim. This paper aims to problematize the notions of reflection and reflective practice, particularly as they relate to private thoughts in public spheres and the constitution of personal and professional subjectivities.

Background/rationale. Reflection and reflective practice, through the technologies of power and technologies of the self, permit the previously private thoughts of nurses to enter the public sphere where they are subject to surveillance, assessment, classification and control. Instead of raising serious concerns and debate about such practices, the plethora of literature, whilst using a bewildering array of ambiguous, diverse interpretations of reflection and reflective practice, has been united in claiming them as good for nurses and nursing.

Approach. The paper draws on Foucauldian concepts of power‐knowledge and discourse to interrogate radically the conceptualizations of reflection and reflective practice in contemporary nursing literature.

Conclusions. The paper challenges the hegemonic discourse of reflection in nursing. It argues that new conceptualizations of reflection that acknowledge and value a diversity of perspectives, contexts and dimensions are needed.
Mental health nurses’ perceptions of nurse prescribing
Authors: Nolan Peter , Haque M. Sayeed , Badger Frances , Dyke Robert , Khan Imran
Published: March 2003

Mental health nurses’ perceptions of nurse prescribing

Aims. This study aimed to ascertain mental health nurses’ perceptions of the advantages and disadvantages of nurse prescribing and to identify the educational needs of mental health nurse prescribers.

Design. A questionnaire was designed and administered to a convenience sample in the UK of 73 mental health nurses in clinical practice, 14 working in in‐patient settings and 59 in the community. Questions included both closed and open‐ended items. Descriptive statistics were used for numerical data, and category analysis of the open‐ended questions was undertaken by two of the researchers independently and then conjointly.

Findings. The majority of respondents felt that mental health nurse prescribing would significantly improve clients’ access to medication, improve compliance, prevent relapse and prove cost effective. However, many were anxious that they did not have sufficient knowledge and skills to assume responsibility for prescribing.

Conclusions. Although there would be benefits to clients and patients, further training, rigorous supervision and the co‐operation of doctors will be required if mental health nurse prescribing is to yield the anticipated benefits.