bluuebunny/crossref_metadata_2025 huggingface dataset:
A need to try everything: patient participation in phase I trials
Authors: Moore Sally
Published: March 2003

A need to try everything: patient participation in phase I trials

Rationale. The area of phase I trials is fraught with ethical dilemmas and controversy. Most existing research focuses on issues of human rights and the informed consent procedure. Little attention has been given to patients’ perceptions of participating in such trials.

Design. This paper describes a study using qualitative interviews and open‐stem questionnaires to begin to explore patients’ own perceptions of any benefits from participating in phase I trials.

Results. Findings suggest that for some patients, phase I trials fulfil a need to try everything in their fight against cancer. The study also suggests that being on treatment allows some patients to construct their lives meaningfully by providing a supportive structure and enabling hope. Implications for nursing practice and further research are discussed.
Living and coping with excessive infantile crying
Authors: Long Tony , Johnson Martin
Published: March 2003

Living and coping with excessive infantile crying

Aim. The aim of the study was to elicit from parents how they lived and coped with a baby who cries excessively. It sought to identify factors which made coping more difficult, as well as interventions perceived by parents to be effective in improving the situation.

Background. The excessive crying of a baby can be one of the most trying aspects of parenthood. Although there have been many studies into the cause and treatment of the problem, these have produced little convincing evidence and even less agreement among investigators. In the light of this an alternative approach is to provide effective support to enhance coping until the crying abates.

Design. This study was based in pragmatic ethnography and followed an adapted grounded theory approach. A total of 25 adults from 14 families participated, recounting their experiences with 20 babies who either were currently crying excessively or had done so previously while less than 1 year old. Data was collected by a factual questionnaire and tape‐recorded focused interviews conducted in the family home augmented by periods of participant observation.

Outcomes. Almost every aspect of family life was disrupted, resulting in strained relationships, feelings of guilt, and concerns about losing control. Repeated attempts had to be made to establish a diagnosis and to find a cure. Such attempts failed, leading to a repeated cycle of hope and disappointment. The greatest potential to effect a positive impact lay in the supportive role of health visitors. They needed to visit frequently; stay for a prolonged period; demonstrate engagement with the family and its difficulties; and impart specific messages with conviction and sincerity.

Conclusion. A specific, vital role was found for the health visitor in supporting parents through this problem, and aspects of the role were identified in which further study is indicated.
Emotions and illness
Authors: Bowman Gerald S.
Published: March 2003

Emotions and illness

Aim. This paper discusses issues central to emotional expression in illness. Its aim is to challenge the psychopathological paradigm currently utilized within healthcare and propose an alternative model based on healthy emotions.

Background. Emotions are important to human survival. It is argued that most patients will have an emotional response to their illness but anxiety and depression are unlikely to be representative of most patients experience. The paper focuses on two important negative emotions, fear and sadness, and their psychopathological associates, anxiety and depression. Problems of diagnosing anxiety and depression in practice are highlighted. It is contended that emotional reaction to illness is normal and that emotions expressed are likely to hold clues to individual adaptation. It is argued that in health care, emotions should be assessed as healthy reactions to a survival threat and merit study from this perspective if we wish to understand individual patient illness reaction and adaptation better. Literature from cardiology is used to illustrate clinical problems.

Rationale. Given the present knowledge of emotions, it should be possible to utilize emotion theory as a paradigm for studying human reaction to illness. This in turn could help shape studies on adherence and adaptation.

Conclusion. The reaction and experience of patient illness is unlikely to be understood through the psychopathology paradigm. A better understanding of patient reaction to their illness is more likely to emerge through the study of basic emotions during acute life‐threatening episodes.
Corporate working in health visiting: a concept analysis
Authors: Houston Anna M. , Clifton Jeanette
Published: March 2003

Corporate working in health visiting: a concept analysis

Aim of the paper.  The aim of this paper is to examine individualized health visiting care and compare it to corporate working within a consensual management style. Corporate working has been discussed and used in many different ways since the idea first came to light at the end of the 1980s. Resource management makes it an appealing model, however, analysing how corporate working functions in the practice setting reveals the complexity of this method of service provision.

Background.  This paper is based on a method of practice developed by health visitors in Haywards Heath, West Sussex, who implemented the process. The article examines individualized health visiting care and compares it to corporate working within a consensual management style. Important in this analysis are the elements of reflexivity, active listening, reflection and the application of ‘praxis’ within the corporate caseload approach.

Methods.  Rogers’ evolutionary concept model was used to illuminate and explain the different ways of delivering the health visiting service.

Findings.  There are benefits in working corporately: shared workload, increased professional support and improved accountability. Alongside the integrated supervision of this model is the opportunity offered to practitioners to innovate. This offsets any initial difficulty experienced in setting up this method and makes it a worthwhile change of style in health visiting practice. Improved service delivery, enhanced professional growth and increased opportunity for public health work can be demonstrated as outcomes of this model. For professionals this method may prevent ‘burn‐out’, enhance practice and increase innovation in health visiting practice. Using this method as a blueprint, practitioners can develop their own style of corporate working that offers a service that is equitable, proactive, efficient and accessible to clients.
Technology and humane nursing care: (ir)reconcilable or invented difference?
Authors: Barnard Alan , Sandelowski Margarete
Published: March 2003

Technology and humane nursing care: (ir)reconcilable or invented difference?

Aim(s) of the paper.  This paper questions the validity of a boundary presumed to exist between technology and humane care. It argues the need for reconciliation of presumed tension(s) between technology and person focused care and the need to reconsider our ways of understanding the relations between technology and nursing.

Background/rationale.
 Recent scholarship in the social sciences related to reproductive and imaging technologies and emergency resuscitation are examined and arguments are presented that question the appropriateness of a humanist view that emphasizes technology on the nonhuman and nonnatural side of a human/nonhuman, nature/artifice divide. It is argued that what determines experiences such as dehumanization is not technology per se but how individual technologies are used and operate in specific user contexts, the meanings that are attributed to them, how individuals or cultural groups define what is human, and the organizational, human, political and economic technological system (technique) that creates rationale and efficient order within nursing, health care and society.

Conclusion.  The paper concludes by asking whether the commonplace appeal to resolve tensions between humane care and technology has erroneously highlighted technology as the reason for impersonal care, and encourages re‐examination of the relationship(s) between technology, humane care and nursing practice.
Negotiating lay and professional roles in the care of children with complex health care needs
Authors: Kirk Susan
Published: March 2003

Negotiating lay and professional roles in the care of children with complex health care needs

Background. Children with complex health care needs are now being cared for at home as a result of medical advances and government policies emphasizing community‐based care. The parents of these children are involved in providing care of a highly technical and intensive nature that in the past would have been the domain of professionals (particularly nurses).

Aims of the paper. To assess how the transfer of responsibility from professionals to parents was negotiated, the tensions and contradictions that can ensue, and the implications for professional nursing roles and relationships with parents.

Design. Using a Grounded Theory methodology, in‐depth interviews were conducted with 23 mothers, 10 fathers and 44 professionals to gain insight into the experience of caring for children and supporting families in the community.

Findings. From the parents’ perspective, their initial assumption of responsibility for the care of their child was not subject to negotiation with professionals. Prior to discharge, parents’ feelings of obligations, their strong desire for their child to come home, and the absence of alternatives to parental care in the community, were the key motivating factors in their acceptance of responsibility for care‐giving from professionals. The professionals participating in the study had concerns over whether this group of parents was given a choice in accepting responsibility and the degree of choice they could exercise in the face of professional power. However, it was following the initial discharge, as parents gained experience in caring for their child and in interacting with professionals, that role negotiation appeared to occur.

Conclusion. This study supports other research that has found that professionals’ expectations of parental involvement in the care of sick children role can act as a barrier to negotiation of roles. In this study, parental choice was also constrained initially by parents’ feelings of obligation and by the lack of community services. Nurses are ideally placed to play the central role not only in ensuring that role negotiation and discussion actually occurs in practice, but also by asserting the need for appropriate community support services for families. Being on home territory, and in possession of expertise in care‐giving and in managing encounters with professionals, provided parents with a sense of control with which to enter negotiations with professionals. It is important that changes in the balance of power does not lead to the development of parent–professional relationships that are characterized by conflict rather than partnership.
From tall poppies to squashed weeds*: why don’t nurses pull together more?
Authors: Farrell Gerald A.
Published: March 2003

From tall poppies to squashed weeds: why don’t nurses pull together more?

Aims. To develop a conceptual framework to account for interpersonal conflict in nursing. To extend the boundaries of debate on the causes of interpersonal conflict in nursing.

Background/Rationale. In nursing, attempts to offer an explanation for staff conflict or, as it is traditionally referred to, horizontal violence, have, nearly always, been influenced by oppression and feminist theories. Such macrolevel analyses avoid discussing the details of individual acts of aggression in favour of considering nurses’ alleged disempowerment in relation to other perceived dominant groups, especially male doctors, and the violence these groups inflict in terms of the denial of power, control, and access to rewards – material or otherwise.

Methodology. A critical analysis of an extended literature review adapted from a doctoral dissertation.

Discussion. While the oppression and feminist perspectives can be insightful they are also limiting in that they omit the finer grained‐analysis necessary for a fuller understanding of staff conflict. At least three levels of explanation can be offered to account for poor staff relationships – a macrolevel, which focuses on nurses’ relationships vis‐à‐vis dominant groups, a mesolevel analysis, which concentrates on organizational structures, including workplace practices – many of which are controlled by nurses themselves, and a microlevel analysis, which emphasizes the interactional nature of interpersonal conflict.

Conclusions. It is contented that it is not only the alleged misogyny intrinsic to oppression theory that shackles and impedes nurses, but nurses themselves, who in their everyday work and interpersonal interactions, act as insidious gatekeepers to an iniquitous status quo.
An examination of the role and function of psychiatric nurses in clinical practice in Ireland
Authors: Cowman Seamus , Farrelly Mary , Gilheany Patricia
Published: March 2003

An examination of the role and function of psychiatric nurses in clinical practice in Ireland

Aim of the study.  The aim of the study was to describe the role and function of all grades of psychiatric nurse in clinical practice so as to clarify the nature and scope of psychiatric nursing services.

Background and rationale.  The psychiatric nursing role in Ireland and the United Kingdom (UK) in recent years has undergone a period of great change. There is a new emphasis on health promotion, early intervention, community development, with nursing being provided closer to where people live and work as well as making access to services easier for vulnerable groups of the population. Role ambiguity and the difficulty with defining psychiatric nursing work is a constant theme in the psychiatric nursing literature and this leaves the profession of psychiatric nursing rather vulnerable during this period of intense change.

Design and methods.  A descriptive qualitative research design with a multimethods approach to data collection was utilized involving three disparate but complimentary methods.

Results and findings.  Following data analysis, nine categories of nursing role were identified; these included both independent and interdependent roles. Clearly psychiatric nursing occupied a pivotal role in all mental health care settings. A major proportion of psychiatric nursing related to caring interactions and this appears to be a central nursing element. The assessment and maintenance of patient’s safety was also important as mental health problems may place the patient or others in a position where their physical safety is threatened.

Conclusion.  It is concluded that Irish psychiatric nurses have been innovative and initiated many new services in response to emerging needs. Our understanding of psychiatric nursing is far from complete and the immediate challenge is to determine the knowledge and skills base required for independent therapeutic roles in response to changing mental health care needs.
Evaluating the self‐assessed support needs of women with breast cancer
Authors: Lindop Edward , Cannon Sue
Published: March 2003

Evaluating the self‐assessed support needs of women with breast cancer

Aims of the study.  The first aim of the study was to identify the self‐assessed support needs of women with breast cancer at various points of illness and, secondly, to establish if these needs formed clusters which could provide the basis for developing a standardized scale of needs for use by breast care teams in the evaluation of care.

Background.  It has been found that support given to women with breast cancer has a positive effect upon their reactions to the illness and may even prolong their survival. Given that breast cancer affects a large number of women it is obviously important that those affected receive, in addition to the best available medical treatment, the type of support that best meets their needs. This study aimed to provide information on the impact of breast cancer and the need for various types of support by examining women’s own assessment of their needs at different stages of their illness.

Design and methods.
 A purposive sample of 12 women with a diagnosis of breast cancer was selected in one health authority in England, United Kingdom (UK). Women selected represented a wide age range (between 26 and 58), were married or in long‐term cohabiting relationships and were at different points on the illness trajectory. Women were invited to take part in a semi‐structured interview about their experiences of breast cancer. The data from these interviews were analysed using the software package Qualitative Solutions and Research, Nonnumerical Data Indexing, Searching and Theorizing (QSR*NUDIST). Following this content analysis, a questionnaire was formulated which divided statements into seven categories: diagnosis, treatment, support, femininity and body image, family and friends, information and after care, to be rated on a Likert scale ranging from ‘of no importance’ to ‘extremely important’. Questionnaire data were analysed by means of a one‐way analysis of variance (for three independent variables) or t‐test for two independent variables.

Results.  The questionnaire was sent to 971 women and achieved a response rate of 50·4%. The mean score for statements of need reached the level of point 4 on the Likert scale (important) with three exceptions: having professional help with family problems and domestic upheaval, coping with feelings of anger and dealing with the question ‘why me?’

Conclusion.  With the above three exceptions, women experienced a high level of need associated with a diagnosis of breast cancer. Studies of this kind should enable resources to be targeted to areas of highest need.
Feeling at home in nursing homes
Authors: De Veer Anke J.E. , Kerkstra Ada
Published: March 2003

Feeling at home in nursing homes

Aim. The purpose of this study was to examine determinants of feeling at home and in particular the privacy in nursing homes in The Netherlands. The first question was to what extent nursing homes differed in the degree residents feel at home and experience privacy. The second question was whether feeling at home is related to privacy in the nursing homes.

Background. Feeling at home is of particular importance to residents of nursing homes because the average length of stay in The Netherlands is about 16 months. A growing number of people are of the opinion that the privacy of the residents has to be improved. Privacy in nursing homes, therefore, has been high on the political agenda over the last few years. Four aspects of privacy were distinguished: privacy related to the characteristics of the building, privacy as a consequence of the attitude of nurses towards residents, privacy in terms of choice and control over time schedules and activities, and privacy related to the amount of disturbance caused by other residents.

Design. The data were collected from individual interviews with 686 residents and family‐members in 36 nursing homes in The Netherlands.

Results. Following quantitative data analysis, it was found that nursing homes differed in the proportion of residents feeling at home as well as in three aspects of privacy. Differences in feeling at home were found to be related to privacy, especially to the perceived attitudes of nurses and perceived disturbance caused by other residents. A weak relationship was found between residents and their perceived privacy of the building.

Conclusions. A significant amount of variation in privacy was found at the nursing home level. This implies that feeling at home is not only individually determined but can be influenced by the nursing home’s management policy.
Triage nurses’ clinical decision making. An observational study of urgency assessment
Authors: Gerdtz Marie F. , Bucknall Tracey K.
Published: March 2003

Triage nurses’ clinical decision making. An observational study of urgency assessment

Background. Researchers have described both the various decision tasks performed by triage nurses using self‐report methods and identified time as a factor influencing the quality of triage decisions. However, little is known about the decision tasks performed by triage nurses when making acuity assessments, or the factors influencing triage duration in the real world.

Aims. The aims of this study were to: describe the data triage nurses collect from patients in order to allocate a triage priority using the Australasian Triage Scale (ATS); describe the duration of nurses’ decision making for ATS categories 2–5; and to explore the impact of patient and nurse variables on the duration of the triage nurses’ decision making in the clinical setting.

Design. A structured observational study was employed to address the research aims. Observational data was collected in one adult emergency department located in metropolitan Melbourne, Australia. A total of 26 triage nurses consented and were observed performing 404 occasions of triage. Data was collected by a single observer using a 20‐item instrument that recorded the performance frequencies of a range of decision tasks and a number of observable patient, nurse and environmental variables. Additionally, the nurse–patient interaction was recorded as time in minutes.

Results. It was found that there was limited use of objective physiological data collected by the nurses’ in order to decide patient acuity, and large variability in the duration of triage decisions observed. In addition, analysis of variance indicated strong evidence of a true difference between triage duration and a range of nurse, patient and environmental variables.

Conclusion. These findings have implications for the development of practice standards and triage education. In particular, it is argued that practice standards should include routine measurement of physiological parameters in all but the collapsed or obviously unwell patient, where further delay may impede the delivery oftime‐critical intervention. Furthermore, the inclusion of arbitrary time frames for triage assessment in practice standards are not an appropriate method of evaluating triage decision making in the real world.
Exploring Spanish emergency nurses’ lived experience of the care provided for suddenly bereaved families
Authors: Socorro Lourdes López , Tolson Debbie , Fleming Valerie
Published: March 2003

Exploring Spanish emergency nurses’ lived experience of the care provided for suddenly bereaved families

Aim of the study. To investigate the experience of emergency nurses caring for suddenly bereaved family members in the clinical setting, particularly after they are informed about the loss of a loved one.

Design/methods. Data was obtained from semi‐structured interviews with seven emergency nurses drawn from emergency nursing staff working in a Spanish Hospital. Interviews were tape recorded, and hermeneutic‐phenomenological analysis was applied to gain understanding from the emergency nurses’ experiences.

Setting. The Accident and Emergency department in the Hospital Universitario Insular de Gran Canaria (Spain). Study undertaken in partial fulfillment of the main author’s MSc (Department of Nursing and Community Health) at Glasgow Caledonian University.

Results. Several themes emerged from those interviews, which appeared to form the basis of the emergency nurses’ reality: knowing, relationships, culture and reality. They showed the need to reflect on personal and professional experiences to facilitate personal growth, discover meaning for emergency nurses and examine the possible implications for clinical care.

Conclusions. This study enabled both participants and the researcher to evaluate critically what was troublesome from their perspective and to identify sources of innovation and liberation within everyday practices.
Intuition: an important tool in the practice of nursing
Authors: McCutcheon Helen H.I. , Pincombe Jan
Published: March 2003

Intuition: an important tool in the practice of nursing

Aim. The aim of the study reported here was to evaluate the role of intuition, to examine nurses’ understanding of intuition and their perceptions of their use of intuition, and to assess the impact of intuition on nursing practice.

Background. When we read the dictionary definition of intuition, we have a sense of the meaning but there is also a sense of something still not quite defined. Yet we instinctively know what intuition is. That is, of course, an example of intuition in itself: an understanding of the concept based on our feelings, knowledge and experience. Intuition is a concept neither clearly articulated nor adequately theorized in nursing. There is evidence to suggest that practising nurses use intuition and that its use can change outcomes for patients. Because of its influence on patient well being, it needs to be recognized as an important tool in the practice of nursing. The very nature of intuition determines that there will be little agreement on a precise definition and little empirical evidence to support its existence or worth. Neither of these issues detracts from the fact that intuition is an important part of nursing.

Methods. Grounded theory was used as the overarching theoretical and methodological framework for this study. Using focus group interviews and the Delphi survey technique, data were collected from 262 Registered Nurses who volunteered to take part in the study.

Findings. The theory that emerged from this study provides nurses with a way of articulating their understanding of intuition and their perceptions of its use in nursing practice.

Conclusions. Intuition is not some mystical power that appears from nowhere, with no rational explanation or basis. The findings from this study show that it is a product of the synergy that occurs as a result of the interaction of a number of factors.
The needs of parents with chronically sick children: a literature review
Authors: Fisher Helen R.
Published: March 2003

The needs of parents with chronically sick children: a literature review

Aims. This paper aims to provide health care professionals with an enhanced knowledge of the needs of parents with chronically sick children.

Design. The article takes the form of a critical literature review and examines eight research studies that were carried out from 1987 to 1997, written in the English language and analysing solely the needs or experiences of both parents with at least one chronically sick child.

Findings. Appropriately all eight studies were carried out from the naturalistic paradigm and yielded rich data. The synthesis of the results of the papers found three main themes emerging: the need for normality and certainty, the need for information, and the need for partnership.

Conclusion. The results of the review serve to emphasize and reiterate the burden of the demands made on these parents, and act as a reminder of the need for empathetic care delivery.
Different effort constructs and effort–reward imbalance: effects on employee well‐being in ancillary health care workers
Authors: Van Vegchel Natasja , De Jonge Jan , Meijer Titia , Hamers Jan P. H.
Published: March 2003

Different effort constructs and effort–reward imbalance: effects on employee well‐being in ancillary health care workers

Aims of the study. The present study investigates the relationship between Effort–Reward Imbalance (ERI) and employee well‐being, using three different concepts of efforts (i.e. psychological demands, physical demands and emotional demands).

Background. The ERI model had been used as a theoretical framework, indicating that work stress is related to high efforts (i.e. job demands) and low occupational rewards (e.g. money, esteem and security/career opportunities). The ERI model also predicts that, in overcommitted workers, effects of ERI on employee well‐being are stronger compared with their less committed counterparts.

Methods. A cross‐sectional survey among 167 ancillary health care workers of two nursing homes was conducted. Multiple univariate logistic regression analyses were used to test the relationship between ERI and employee well‐being.

Results. Results of the logistic regression analyses showed that employees with both high (psychological, physical and emotional) efforts and low rewards had higher risks of psychosomatic health complaints, physical health symptoms and job dissatisfaction (odds ratios (ORs) ranged from 5·09 to 18·55). Moreover, employees who reported both high efforts and high rewards had elevated risks of physical symptoms and exhaustion (ORs ranged from 6·17 to 9·39). No support was found for the hypothesis on the moderating effect of overcommitment.

Conclusion. Results show some support for the ERI model; ancillary health care workers with high effort/low reward imbalance had elevated risks of poor employee well‐being. In addition, results show that the combination of high efforts and high rewards is important for employee well‐being. Finally, some practical implications are discussed to combat work stress in health care work.
Facilitating and obstructing factors for development of learning in clinical practice: a student perspective
Authors: Löfmark Anna , Wikblad Karin
Published: March 2003

Facilitating and obstructing factors for development of learning in clinical practice: a student perspective

Aim of the study. The aim of this study was to provide information on what the student nurses found facilitating and obstructing for their learning during clinical practice.

Background. Earlier studies of experiences of learning in clinical practice have shown that factors as the possibilities of variations of experiences, the culture of the workplace, and communication between the educational institution and health care facilities are of importance. Less is known about the opportunities which students are given in order to practise the skills that they will be expected to perform as new graduate nurses.

Methods. The experiences of 47 degree student nurses from two colleges in Sweden were gathered in weekly diaries during their final period of clinical practice. A content analysis technique was used to analyse their diaries.

Results. The students emphasized responsibility and independence, opportunities to practise different tasks, and receiving feedback as facilitating factors. Other perceived promoting factors included perceptions of control of the situation and understanding of the ‘total picture’. Examples of obstructing factors were the nurses as supervisors not relying on the students, supervision that lacked continuity and lack of opportunities to practise. Perception of their own insufficiency and low self‐reliance were drawbacks for some students.

Conclusions. Recommended proposals are presented to lecturers and supervising staff concerning organizational and educational changes, and changes of attitudes for elucidating the students’ experiences of different facilitating and obstructing factors. Changes may contribute to making easier the students’ transition into the nursing profession.
The role of the nurse within the multi‐professional rehabilitation team
Authors: Long Andrew F. , Kneafsey Rosie , Ryan Julia , Berry Judith
Published: March 2003

The role of the nurse within the multi‐professional rehabilitation team

Aim of the study/paper. To identify the contribution of the nurse within the multi‐professional rehabilitation team.

Background. The requirement for nurses to work effectively within the multi‐professional rehabilitation team is increasingly important with the higher incidence of chronic disease, growing numbers of older people and enhanced survival from major trauma.

Methods. A 2‐year qualitative investigation was undertaken centred on three contrasting condition case studies (fractured neck of femur, rheumatoid arthritis and stroke). Clients were theoretically sampled, with their ‘rehabilitation pathway’ through different services providing the window through which the nurse’s contribution was explored. Multiple methods and points of data collection were used, including observation, face to face interviews (clients, carers and staff) and record review. To enhance generalisability, a series of national expert workshops were undertaken with four groups: users, carers and carers’ organizations; nurses; members of the multi‐professional team; and educationalists.

Findings. Six interlinked roles for the nurse were identified: assessment, co‐ordination and communication, technical and physical care, therapy integration and therapy carry‐on, emotional support, and involving the family. Of particular significance is the creation of a supportive environment for rehabilitation to occur. Some nurses undertook aspects of all of these roles at any one time while others were only involved in one or two areas. While nurses expressed a desire to integrate therapy into their care delivery, the actual achievement of this goal was variable.

Conclusions. Key elements of the nurse’s contribution within rehabilitation should aim to maximize client choice to enhance independent living in the client’s future environment. At a nursing educational policy level the nurse needs to have a full understanding of the principles and models of rehabilitation. At a practice level, the nurse’s role must be valued and recognized, by nurses themselves and other team members.
What is the evidence on evidence‐based nursing? An epistemological concern
Authors: French Peter
Published: March 2003

What is the evidence on evidence‐based nursing? An epistemological concern

Aim. This paper adopts an epistemological perspective in order to support the assertion that there is very little evidence to support the existence of evidence‐based nursing as a distinct construct or process.

Rationale. This analysis of concept meaning is based on the theory of symbolic interactionism. By adopting this theory the commonalities and inconsistencies in the use of evidence‐based symbolism by nurses and other health care professionals can be used to evaluate the perceived meaning of the term.

Methods. A frequency analysis of relevant key words in one publications data‐base demonstrates the increasing use of evidence‐based terminology and its euphemistic status visa vi research. An epistemological analysis is conducted on a sample of concept clarification statements taken from the popular literature, defining the nature of `evidence' and `evidence‐based practice'.

Findings. The results of the frequency analysis show that the keywords `evidence‐based medicine' revealed 5612 papers, evidence‐based practice (EBP) 432 papers, evidence‐based nursing 47 papers, evidence‐based health care 60 papers, and evidence‐based decision making 43. Almost all of these papers have been published since 1995 and the earliest use of the symbol `evidence‐based' is 1992. There is also an increase in papers adopting `evidence‐based' symbolism along with a commensurate decrease in the use of the term `research' in the nursing context.

Conclusion.  `Evidence‐based practice' is commonly a euphemism for information management, clinical judgement, professional practice development or managed care. There is insufficient evidence to demonstrate that evidence‐based nursing is a single construct or process that can be distinguished from its concomitants. The term adds little more to the existing long standing traditions of quality assurance and research‐based practice. Nurses must avoid the inefficiency brought about by the `intense enthusiasm followed by sad disenchantment' that has been associated with other attempts to introduce innovation in health care delivery (Fienstein & Horowitz 1997).
The application of vignettes in social and nursing research
Authors: Hughes Rhidian , Huby Meg
Published: March 2003

The application of vignettes in social and nursing research

Aim. The aim of this paper is to review the potential for, and the limitations of, the use of vignettes in research that seeks an understanding of people's attitudes, perceptions and beliefs, particularly with regard to sensitive subjects such as health care.

Background. Vignettes, in the form of text or pictures presented to research participants to prompt responses to interview questions, are widely used throughout the social sciences although their use in nursing research is less developed.

Review focus. This review paper begins by addressing the differences between vignettes and real life processes. The following sections explore some of the practical advantages and pitfalls of using vignettes in social and nursing research.

Conclusion. The paper demonstrates how vignettes can be very useful research tools yielding valuable data when studying people's attitudes, perceptions and beliefs in social and nursing research.
Intuition and the development of expertise in surgical ward and intensive care nurses
Authors: King Lindy , Clark Jill Macleod
Published: March 2003

Intuition and the development of expertise in surgical ward and intensive care nurses

Aim. The aim of this study was to explore and identify nurses' clinical expertise in surgical ward and intensive care settings in England. One of the objectives of the study and the focus of this paper was the exploration of these nurses' understanding and use of intuition in the context of their practice.

Background. Since 1980 many studies have investigated qualified nurses' use of intuition within aspects of their practice. However, it was Benner's (1982, 1984) seminal work that firmly established the relationship between intuition and expert clinical practice. Since that time a possible relationship between intuitive components of decision‐making and nonexpert nurses' practice has remained relatively unexplored until recently.

Methods. This constructivist qualitative study incorporated observation and interview to explore 61 qualified nurses' expertise through their assessment of patients following major surgery.

Findings. Specific findings highlighted refinement in nurses' use of intuitive and analytical elements of decision‐making across the four identified levels of expertise. The most fluent and effective use of intuitive and analytical components of decision‐making was found in the expert group.

Concluding remarks. These results are discussed in relation to current understanding of the components of expert decision‐making in nursing practice. Both intuitive and analytical elements should be recognized in any model that seeks to depict the true nature of nurses' decision‐making as they develop clinical expertise.
Deciphering the 4 D's: cognitive decline, delirium, depression and dementia – a review
Authors: Insel Kathleen C. , Badger Terry A.
Published: March 2003

Deciphering the 4 D's: cognitive decline, delirium, depression and dementia – a review

Purpose. The purpose of this paper is to assist advanced practice nurses to recognize, identify, and diagnose cognitive change in older adults.

Background/rationale. Optimal cognitive function is important for continued independence, and yet changes in cognition are frequently unrecognized among older adults. Cognitive change in older adults can be observed due to age‐related cognitive decline, the development of acute confusion (delirium), depression, dementia and/or a combination of these. When the aetiological source for alterations in cognitive function is delirium or depression, the potential for reversibility mandates that the reason for the cognitive change be identified with steps taken to remedy the situation. Also, early recognition of dementia is an important factor in obtaining timely and appropriate care. These conditions can exist concurrently and may fluctuate making deciphering the reason for the cognitive change problematic.

Conclusions. It is essential to understand how the 4 `D's' are expressed and to recognize the potential contributing factors to an observable change in cognitive function for diagnosis and treatment. Recommendations for obtaining a person's history are included.
Nursing as means of governmentality
Authors: Holmes Dave , Gastaldo Denise
Published: March 2003

Background.  This paper conceptualizes nursing as a health profession in transformation at the beginning of the 21st century. We frame our analysis using Michel Foucault's concept of governmentality. While extensively quoted and used in other disciplines, the work of the late French philosopher has been cited infrequently in the nursing literature. Yet a closer look at his work reveals how Foucault offers a relevant entry point for revisiting nursing theory and nursing practice.

Aim of paper.  The aim of this paper is to reflect on nursing practice as it is inscribed within the state's modus operandi. We discuss the prevalent notion that nurses are powerless and suggest they do exercise power in many ways and that they are a powerful group.

Results.  In this paper we show how nursing is a means of governmentality of individuals and of the population because its practices contribute to the management of society through a vast range of power techniques. These techniques range from disciplining individuals to promoting discourses that construct desirable subjectivities. Within this perspective, the emergence of political aspects of nursing theory and nursing practice are made explicit.

Conclusion.  We explore the limits and potentials of the concept of governmentality to the understanding of nursing as a health profession. This concept can generate a form of critical immobilism, but also promotes a more politically complex understanding of nursing practice.
A qualitative study of the experiences of a group of Hong Kong Chinese women diagnosed with postnatal depression
Authors: Chan Sally Wai‐Chi , Levy Valerie , Chung Tony K.H. , Lee Dominic
Published: March 2003

Aim of the study.  To examine the lived experiences of a group of Hong Kong Chinese women diagnosed with postnatal depression.

Background.  Postnatal depression affects approximately 1 in 10 childbearing women in Hong Kong. However, most studies of postnatal depression have been carried out in Western societies and no qualitative research was found describing the experience of Hong Kong Chinese mothers with postnatal depression.

Design.  A phenomenological study was conducted. Data were collected by semi‐structured interviews. A purposive sample of 35 women diagnosed with postnatal depression was interviewed. Interview data were analysed following Colaizzi's phenomenological methodology.

Results.  Themes that emerged describing participants' experiences included trapped in the situation, ambivalent towards the baby, uncaring husband, and controlling and powerful in‐laws. Women felt hopelessness, helplessness and loss of control. They were trapped in a situation that had no way of escape except by violent means, such as homicide or suicide. Feelings towards the baby were ambivalent, both hate and love. Several women had injured, or had thought of injuring or killing, their babies and/or themselves. Women's unhappiness was attributed to a noncaring husband, and controlling and powerful in‐laws. Generally, women did not seek help until their depression was diagnosed by screening tests.

Conclusion.  This study has revealed insights into how women experienced postnatal depression in Hong Kong, and what they perceived as contributing to their depression. These insights may be used to guide interventions for women and their families to raise awareness regarding the support childbearing women need.
Development and testing of a Faces Scale for the assessment of anxiety in critically ill patients
Authors: McKinley Sharon , Coote Katherine , Stein‐Parbury Jane
Published: March 2003

Background.  Many patients experience anxiety during treatment in an intensive care unit, but intensive care patients are often not able to respond to existing validated measures of anxiety such as the Brief Symptom Inventory. We have developed a new single item Faces Anxiety Scale made up of drawings of five faces.

Aims.  The aims of this study were to: (i) assess the ability of intensive care patients to respond to the Faces Anxiety Scale; and (ii) investigate whether the scale yields ordinal and interval data.

Ethics.  The project was approved by two Human Research Ethics Committees. Patients were included in the study if they gave informed consent.

Instruments and methods.
 (i) Intensive care patients (
n
= 40) were asked to respond to the Faces Anxiety Scale, the anxiety subscale of the Brief Symptom Inventory, and a numerical analogue anxiety scale; and (ii) Hospital and University staff and students (
n = 75) were asked to place the five faces in rank order. A further 100 staff members and students were asked to place each face at a point on a 60‐cm triangular wedge according to the level of anxiety they thought the face showed.

Results.
 The Faces Anxiety Scale elicited more responses from intensive care patients than the numerical analogue anxiety scale the or anxiety subscale of the Brief Symptom Inventory (36 vs. 25 vs. 17, respectively,
P < 0·0001). In the testing of the order of the scale items, 93% of respondents independently placed the scale items in the order of least to most anxiety as intended in the design of the scale. In the testing for equality of intervals respondents placed the faces relatively equidistant, with no overlap of 95% confidence intervals around the mean distances.

Conclusion.  The Faces Anxiety Scale has minimal subject burden, elicits self report from intensive care patients more often than other simple scales, and has evidence of the interval scale properties of rank order and equality between the points on the scale.