bluuebunny/crossref_metadata_2025 huggingface dataset:
Come rain or shine: the combined effects of physical stresses on physiological and protein‐level responses of an intertidal limpet in the monsoonal tropics
Authors: Williams Gray A. , De Pirro Maurizio , Cartwright Stephen , Khangura Kiki , Ng Wai‐Chuen , Leung Priscilla T.Y. , Morritt David
Published: August 2010

1. Traditional approaches to understanding species responses to environmental conditions have focused on the isolated effects of single stressors, despite the fact that in nature organisms experience a variety of conditions.

2. In tropical monsoonal areas, intertidal animals can face hot desiccating conditions during emersion preceded, or followed by, intense rainfall. The combined effects of these stresses on physiological responses and protein profiles were investigated in a limpet,Cellana grata.

3. With short exposure (60 min) to single stressors, heat stressed limpets had elevated heart rates and more concentrated haemolymph and mantle water osmolalities than under normal temperatures or awash. Animals under rain had reduced haemolymph and mantle water osmolalities, but similar heart rates to unstressed animals.

4. After 120 min, unstressed animals did not differ in their physiological responses. Heat stressed limpets, however, had faster heart rates and more concentrated haemolymph and mantle water osmolalities, whilst those under rain had the lowest osmolalities, but similar heart rates to unstressed animals.

5. Limpets under rain followed by heat stress had faster heart rates, but lower haemolymph and mantle water osmolalities compared to animals under normal temperatures or heat stress. Limpets that were heat stressed, followed by rain, had similar heart rates to animals awash, under rain or normal temperatures but lower haemolymph osmolalities than other treatments, with the exception of limpets under rain.

6. There was a positive relationship between haemolymph and mantle water osmolalities, except for animals under rain, where mantle water osmolality was lower than the haemolymph, suggesting some isolation of body fluids from the external medium.

7. Haemolymph protein/peptide mass spectra of heat stressed animals (either before or after rain) were similar, while all other treatments differed, suggesting differential expression and regulation of proteins.

8. Heat stress invokes a more active physiological and protein level response than rain, but their combination had an interactive effect on limpets’ metabolism.

9. Identifying the effects of multiple stresses at a variety of biological levels highlights the interactive effects which impact species, and provides a more complete understanding of how species may respond to environmental changes in their natural habitats.
Conceptual behaviour of Chinese mothers in relation to their newborn infants
Authors: Chao Yu‐Mei (Yu)
Published: August 2010

A study of 20 mothers was conducted to determine the cognitive operations used by Chinese mothers in conceptual behaviour toward their newborn infants. Mothers' spontaneous speech, referring to the newborn infants during the feeding sessions, comprised the data for analysis. A total of 2300 records of behaviour were produced as mothers used orienting, evaluating and delineating operations in conceptualizing their newborn infants. Four aspects of the newborn infant namely, appearance, physical state, body function and social characteristics were important to these new mothers. Mothers tended to use orienting behaviour more frequently (P < 0.001) than both evaluating and delineating behaviours as they conceptualized irfants' body functions and physical state. Delineating behaviour was significantly (P < 0.001) more important in relation to infants' appearance than to other aspects of the infants. Mothers' parity seemed to be a significant variable (P < 0.05) only when mothers evaluate the infants' appearance. Comparison between Chinese and American maternal conceptual behaviour revealed that American mothers, in general, tended to use evaluating and delineating behaviour more frequently than Chinese mothers; but no significant difference in using orienting behaviour was found. As for the four aspects of the infant, there was no significant difference in two groups as they conceptualized infants' appearance and social characteristics. However, a significant difference (P < 0.05) was found in relation to infants' physical state and body functions.
Hysterectomy: a study in coping with recovery
Authors: Webb Christine , Wilson‐Barnett Jenifer
Published: August 2010

This article reports on part of a descriptive study of recovery from hysterectomy which was set within a cognitive‐phenomenological theory of coping. Women's pessimistic beliefe in old wives' tales and the possible effects of hysterectomy were modified as they experienced operation and recovery! The majority made a good recovery in health and activity terms, and according to their own assessments. However information provided by staff and social support from partners, families and friends were low in quality and quantity, and the data includes some evidence that lack of support may have interfered with progress after hysterectomy. Implications of the study for nursing practice and research are discussed in conclusion.
Governing childbirth: the wider view
Authors: Mason John
Published: August 2010

This paper seeks to ‘problematize’ the British government's wider intentions for public health, as they are shaped by free‐market economics and technological medicine A variety of epidemiological studies have revealed evidence of declining health among low socio‐economic populations who are particularly affected by economic and social changes The government is responding to the potential crisis by targeting specific groups of the most visible and costly victims of public ill‐health Recipients of health care with a lower public profile, such as pregnant women, are being subjected to the same policy Current governmental strategies are regarded as an example of a medically oriented approach that focuses on special strategies for pregnancy and birth but ignores the long‐term requirements for public health
A study to identify the attitudes and needs of qualified staff concerning the use of research findings in clinical practice within mental health care settings
Authors: Veeramah Ven
Published: August 2010

In 1972 the Report of the Committee on Nursing recommended that nursing should become a research‐based profession Although, it is acknowledged that research has made a significant contribution to the body of nursing theory since then, it has had little impact on clinical practice The present study is a small exploratory survey to assess the attitudes and needs of qualified nurses working within mental health care settings concerning the use of research findings in practice A total of 150 questionnaires were sent to trained nurses working within a defined geographical area in the south‐east of England and 118 were returned, giving a response rate of 78% The main findings suggest that although the vast majority of nurses in the study have a very positive attitude towards research, very few actually make significant use of research findings to enhance their clinical practice Some of the variables that seem to contribute to this state of affairs are lack of the necessary research appreciation skills to critically evaluate research findings and apply them in practice, not enough relevant research studies available in the clinical areas, and inadequate support from managers However, most of the nurses in the study said that they would be involved with research activities if the time was provided for them to do so
The relationship between a medium secure environment and occupational stress in forensic psychiatric nurses
Authors: Kirby Stephan D , Pollock Philip H
Published: August 2010

The present study investigated occupational stress levels in forensic psychiatric nurses within a medium secure unit for mentally disordered offenders and examined the possible relationships between aspects of the ward environment and identified stress levels Data were obtained through self‐report measures and unit statistics using a sample of 38 nurses on two secure (high and medium) wards No significant differences in levels of occupational stress or perception of ward environment were observed between nurses on the two wards Global ward atmosphere scores were compared with those of a maximum secure facility in the USA, showing the unit to be highly therapeutic Occupational stress scores for all nurses were compared with normative regional data and showed elevated scores on broad view of control, satisfaction and type A behaviour No demographic or ward environment variables were found to be associated with these high scores Interpretations and implications are discussed
Hysterectomy: British National Health Service and private patients have very different experiences
Authors: Chappie Alison
Published: August 2010

One in five women in the United Kingdom will have a hysterectomy by the time they reach the age of 65 This paper explores the experiences of women as they seek advice in outpatient clinics, as they go into hospital for surgery, and as they return home to convalesce Differences in doctor‐patient communication between private sector and National Health Service patients are discussed The results of this study point to the inadequacy of current practice in providing information to patients about this potentially serious operation
Cardiac nurses’ preparedness to use self‐help groups as a support strategy
Authors: Hildingh Cathrine , Fridlund Bengt , Segesten Kerstin
Published: August 2010

Self‐help groups are lay, mutual support groups in which people who share some long‐term existential problems in their lives meet regularly to support each other empathetically These groups can be viewed as supplementary sources of support outside patients’ existing social networks As such, it is of importance to be aware of them when planning nursing care The aim of this study was to examine cardiac nurses’ preparedness to use self‐help groups as a support strategy A qualitative research method was used and 12 registered nurses from two coronary care units were interviewed The findings showed that nurses’ knowledge of social support, self‐help groups and of patients’ social circumstances as well as their attitudes to their own roles as nurses were of importance in their preparedness to use self‐help groups as a support strategy Lack of knowledge of social support and self‐help groups affected the nurses attitudes towards lay care and was probably the reason for not using self‐help groups as a support strategy Most of the nurses were well informed about their patients’ social circumstances, they had an explicit family nursing approach and were not at all against further expansion of their nursing role However, there is a need for education in innovative ways of working that respond to and interact with informal support networks if nurses are to be able to contribute to empowerment of their patients
A study of the perception and experiences of critical care nurses in caring for potential and actual organ donors: implications for nurse education
Authors: Watkinson G E
Published: August 2010

This paper describes a research study designed to explore the knowledge, perceptions and attitudes of practising critical care nurses towards caring for ‘brain stem dead’ cadaver organ donors and their families The influence of formal nurse education and experiential learning were investigated together with what nurses felt could better prepare them for this role Data were collected through self‐completion questionnaires from 103 critical care nurses This was instrumental in forming a semi‐structured interview schedule whereby seven respondents were interviewed The findings of the study suggest that nurses are very favourable towards organ donation and this correlated with their knowledge of brain stem death (P<0 024) Nurses with between 6 and 10 years critical care experience had a significantly higher knowledge base (P<0 05) than those of less or greater experience Nevertheless, when challenged some nurses were less comfortable with the concept of brain stem death and caring for these patients A degree of cognitive dissonance was identified Discussion revealed that all nurses need to have a better understanding of their role in organ donation, no matter what nursing discipline they practice This may help to expel some of the myths that have, undeservedly, become established and given the donor process a rather sinister image
A view from somewhere: the presence and function of religious commitment in nursing practice
Authors: Cusveller Bart S
Published: August 2010

As western society becomes increasingly pluralistic, nurses are confronted by fundamental controversies, such as those moral, philosophical or religious in nature One strategy to deal with such pluralism is to dismiss a nurse's fundamental moral, philosophical or religious commitments as unprofessional bias In this paper, however, I would like to analyse the presence and function of religious commitment, in particular to see if it could have a justified and relevant function in nursing care This function will be elicited by interpreting nursing care as a practice and applying a certain theory of theorizing, focusing on the function of ‘control beliefs’, of which professionalism is one particular set
Evaluating individual performance in higher education: a new challenge for nurse educators
Authors: Mackenzie Ann E , Mackenzie Terence
Published: August 2010

In response to the demands for more accountability and efficiency in higher education, of which nurse education is now a part, this paper explores the evaluation of individual performance It considers the purposes of staff appraisal and draws upon a study of criteria for self‐appraisal of teachers and upon experience gained in introducing teacher appraisal into schools Different teaching environments are discussed and the additional demands upon academic staff in universities in terms of research are considered in the light of the recent Research Assessment Exercises Particular consideration is given to the performance of nursing departments in the 1992 exercise and to the implications for staff appraisal Successful procedures for evaluating individual performance in schools that might transfer to higher education are identified and strategies that might be adopted by nursing departments are suggested This paper argues that evaluation of individual performance is a worthwhile departmental function which, when successful, may help to create an atmosphere more conducive to the eventual successful introduction of total quality management to the institution as a whole It concludes that the extra substantial demands upon staff time and energy, at a time when nursing departments are trying to establish themselves in the higher education sector, might be alleviated if the groundwork already undertaken in schools is put to good use
The relevance of the Dutch system of maternity care to the United Kingdom
Authors: Mander Rosemary
Published: August 2010

The Dutch system of maternity care is occasionally held up as an example to be emulated by health care providers in the United Kingdom There are, however, certain differences between maternity care in the two countries which prevent the direct transfer of a system of maternity care from the Netherlands to the UK The countries are different in terms of their geography and social class distribution The organizational frameworks within which maternity care is provided demonstrate important differences The midwives are from a different background, undergo a different preparation and face crucially different working arrangements There are also certain, largely cultural, differences between mothers in the two countries Despite these discrepancies, much may be learned by those involved in maternity care in the UK from their Dutch counterparts and the Dutch system of care
Outcomes management in neonatal nursing clinical practice
Authors: Petryshen Patricia , Stevens Bonnie
Published: August 2010

One approach for evaluating the quality and cost of patient care is through outcomes management Outcomes management in a neonatal environment will be described within a structure‐process‐outcome framework Outcomes will be presented from three perspectives administrative, economic and clinical The relevance and implications of outcomes management will be discussed
Home treatment of patients with cystic fibrosis using the‘Intermate’: the first year's experience
Authors: Bramwell Elizabeth C , Halpin David M G , Duncan‐Skingle Fran , Hodson Margaret E , Geddes Duncan M
Published: August 2010

Home treatment of patients with cystic fibrosis has many attractions and is becoming increasingly popular The investigators have studied the use, results and costs of the first year of operation of a home‐care intravenous antibiotic service using the‘Intermate’infusion device in a prospective study using questionnaires, spirometric and weight measurements Ninety‐three patients received 166 courses of intravenous antibiotics in full or in part at home during 1991 The average length of treatment was 12 5 days and on average 70% of the treatment was given at home The mean percentage predicted FEVt and FVC improved after treatment and the mean improvement was not significantly different to that produced by hospital treatment Breathlessness, sputum volume, appetite, ability to sleep, mood, energy and overall well‐being, as assessed by questionnaire, showed significant improvements after home treatment The median time spent mixing and administering drugs was 10–19 hours and visiting the hospital was 7–12 hours The median number of days of lost income to patients or their carers was 0 days The majority of the patients were extremely satisfied with the treatment and supervision that they received Using the home care service, 1442 in patient days were saved The investigators conclude that home care using‘Intermates’improves a patient's lung function and quality of life
An overview of the oral complications of adult patients with malignant haematological conditions who have undergone radiotherapy or chemotherapy
Authors: RGN Sara Coleman
Published: August 2010

The aim of this review is to look at mouth‐care in adult patients with malignant haematological conditions and in particular those with disturbed immunity or bone marrow depression due to radiotherapy or chemotherapy The oral assessment tools available will be discussed Different products used and research to support their use will be examined, as well as any staging systems for their introduction to the patient's schedule The awareness of the nurses who use them will also be investigated Patient education has been found to be the most important aspect of mouth‐care in the haematology patient undergoing radiotherapy or chemotherapy Further research into the area of developing a specific tool for use with haematology patients with oral problems is highlighted here, as is further liaison with dental hygienists Aspects of this review may apply more generally to other patients undergoing radiotherapy or chemotherapy
Organizational environment and the support of patient autonomy in nursing home care
Authors: Mattiasson Anne‐Cathrine , Andersson Lars
Published: August 2010

This study examined how patient autonomy is associated with the organizational environment in nursing homes, particularly the organizational climate, organization of work and selected staff characteristics, such as age and experience of health care Staff from 13 nursing homes in the county of Stockholm, Sweden, were included The organizational climate was described by staff from two of the nursing homes that, on the basis of staff judgement, were rated as creative, and from two of the nursing homes that were rated as lacking innovation Regarding organization of work, which included the number of patients who required to be fed, together with the incidence of pressure sores and indwelling urinary catheters, there appeared to be no difference in care from both types of nursing home The statistical analyses showed that nursing homes characterized as significantly creative supported patient autonomy to a high degree, and that the staff's experience with health care was associated with the organizational climate
The validity of Qualpacs
Authors: Norman Ian J , Redfern Sally J
Published: August 2010

The validity of the quality assessment instrument Qualpacs is discussed The literature reviewed addresses the sensitivity, scoring and scope of the instrument, operational decisions and cost and policy implications Specific attention is given to the reliability and validity of Qualpacs and methodological challenges of convergent validity testing The study, which was funded by the Department of Health, England, employed a multiple triangulation research design to assess the validity of the instrument Qualpacs was compared to two other instruments (Monitor and Senior Monitor) and to other quality of nursing care data derived from observation of patients' activities and nurse‐patient interaction, and interviews with patients and nurses on their perceptions of quality of care The results support Qualpacs as a relatively valid instrument in that it displayed greater convergent validity than Monitor or Senior Monitor Convergent validity was stronger when compared to Senior Monitor and the Monitor DG3 schedule than the other Monitor schedules Comparison with the observation of nurse and patient activities and interactions supported Qualpacs for medical and surgical wards but not for elderly care wards Congruence between Qualpacs’items and the views of patients and nurses provides evidence in support of construct validity of the instrument
Helping the vulnerable or condoning control within the family: where is nursing?
Authors: Cody Ann
Published: August 2010

The World Health Organization urges nurses to heed the health needs of the vulnerable groups ‘to permit all citizens to lead socially and economically productive lives’ The characteristics of vulnerable adults and children are linked to relationship problems (Browne et al 1988) within the family Because of the diverse nature of families, it is not surprising that there is some ambiguity and complexity to the concept of vulnerability This paper explores vulnerability within families through the explanations for domestic violence and child abuse, and concludes with the implications for nursing practice
BOOK REVIEWS
Authors: Clarke Liam
Published: August 2010

Books reviewed in this Article:

Effective language in health and social work by Richard Pugh

Counselling People with Disfigurement by E Bradbury

Clinical Effectiveness From Guidelines to Cost‐Effective Practice Conference Papers Foreword by Professor Sir Duncan Nichol
Time to think: temporal considerations in nursing practice and research
Authors: Jones Aled R.
Published: August 2010

Time to think: temporal considerations in nursing practice and research

Aims of the study/paper. To explore the meaning of nursing time, both as it is represented in the literature and interpreted within nursing practice. To explore how nursing time may be better conceptualized through exploring non‐nursing literature and the use of theory derivation.

Background/Rationale. The dynamic of time is one of the most important influences upon nursing behaviour, yet temporal issues have attracted very little attention in the literature regarding nursing practice, theory and research.

Design/Method. In the course of this literature review an attempt is made, via the process of theory derivation, to clarify the meaning of ‘nursing time’, and how nursing time is valued and perceived by others.

Results/Findings. The literature reveals misconceptions and a lack of value of nursing time, possibly indicative of the dominance of linear models of time (such as clock and calendar time), and the historical ascendancy of medicine and the positivistic sciences over nursing. It is proposed here that nurses exist and practice within nonlinear, complex and parallel temporal worlds; these are considered by examining research data that illustrates a moment in nursing time. Exploring this moment gives an opportunity to introduce some terms and concepts that may be useful in the future conceptualization of nursing time.

Conclusions. It is recommended that attention to such factors as the complex temporal dynamics inherent within health care in general, and nursing in particular, should be considered within the domains of nursing practice and research. This may help in distinguishing the fundamental identity and nature of nursing within health care and health care professions.
Benner and Wrubel on caring in nursing
Authors: Edwards Steven D.
Published: August 2010

Benner and Wrubel on caring in nursing

Aims. To explain the distinction between intentional and ontological care; to explain the distinction, within the category of ontological care, between deep care and identity constituting care and to show how the latter form of care is of relevance to nursing theory and practice.

Background. The idea of intentional care is familiar in much writing on care within nursing literature. Within Benner and Wrubel’s book The Primacy of Caring, Stress and Coping in Health and Illness the idea of ontological care is exploited. But many interpret their claims on this topic as claims concerning intentional care. The present paper tries to clarify this misunderstanding.

Conclusion. The notions of intentional and ontological care are each important within nursing theory and practice. But it is also important to understand how they differ. And it is equally important to appreciate how the idea of ontological care applies to nursing practice.
Informal caring in late life: a qualitative study of the experiences of older carers
Authors: McGarry Julie , Arthur Antony
Published: August 2010

Informal caring in late life: a qualitative study of the experiences of older carers

Aim of the study. This study examined the experiences of informal carers who were aged 75 years and over.

Background. It has been estimated that 13% of those aged over 65 years are providing some form of informal care. Although there is a substantial body of work reporting the experiences of informal carers, little attention has been paid to the specific situation faced by older carers.

Design and methods. Potential study participants were identified during one round of annual over‐75 health checks carried out in one large general practice. Data were collected through personal interviews, which were transcribed and analysed using a thematic approach.

Results. Fifty‐eight carers were identified and 14 were approached to take part in the study. Of the 14 interviewees, 13 were caring for a spouse and one was caring for a sibling. There were 10 female and four male carers in the study (age range 76–92 years). Themes to emerge from the interviews were categorized under four headings: (1) the organizational demands and structure of the caring relationship, (2) informal support networks, (3) formal services and (4) the constancy of caring and the need for the role of carer to be recognized.

Conclusions. The over‐75 health check may provide a valuable tool to identify older carers who are not known to care providers. This paper concludes that nurses can take a lead role in working with this group in three ways. Firstly, in identifying older carers; secondly, in developing strategies to assist older carers in their caring role and finally, in responding swiftly to crises that can develop among this vulnerable group.
Group support for couples coping with a cardiac condition
Authors: Stewart Miriam , Davidson Karina , Meade Darlene , Hirth Alexandra , Weld‐Viscount Patty
Published: August 2010

Group support for couples coping with a cardiac condition

Background/Rationale. Support groups of peers were designed to convey support specific to stressful situations encountered by persons with a first‐time myocardial infarction and by their spouse or partners. There were no previous published support intervention studies focused on the couple. Survivors and spouses (n=28) participated in a pilot study which tested the effect of a 12‐week support group intervention.

Design. The support groups for couples were cofacilitated by a peer and professional. The facilitators recorded field notes, while participants completed weekly diaries about the intervention activities. Following the intervention, participants were interviewed individually and facilitators were interviewed jointly about the perceived effect of the intervention and influencing factors. This article focuses on the facilitators’ and participants’ perceptions of intervention processes and outcomes.

Findings. Support processes in the group included social comparison, social learning, and social exchange. Three types of support – emotional, information, and affirmation – were provided. All participants were satisfied with the support intervention and referred to the positive effect on their coping, confidence, outlook, and spousal relationship. Factors that influenced the intervention effect were participant input, cofacilitation, similarity of group members, and the provision of information and support.

Conclusions. Future interventions could consider similarity of peers, leadership, and optimum timing and duration.
The symptom experience of women with chronic illness
Authors: O’Neill Eileen S. , Morrow Laura L.
Published: August 2010

The symptom experience of women with chronic illness

Aim of the study: This integrative review examined how women interpret, cope with, and manage chronic illness symptoms.

Background: Women with chronic illness report more symptoms and poorer physical health than men. They also enter the health care system later and sicker than their male counterparts. One possible reason for their increased morbidity and mortality is gender differences in interpreting and managing symptoms.

Method: The inclusion criteria that guided this review were that: (a) the study was published between January 1, 1990 and December 31, 1999; (b) participants were women with at least one chronic health problem; and (c) the study addressed symptom perception, symptom evaluation, and/or symptom management. Databases were searched using women, symptoms, chronic illness, coping, and research as key words.

Findings: One hundred and ten published studies were reviewed, yielding 35 journal articles reporting on 32 separate studies that met the inclusion criteria. The analysis identified important gender differences in symptom experience. While studies of coping with symptoms are well represented in the literature, symptom strategies and the cultural meaning of symptoms are understudied.

Conclusions: Five categories of practice implications emerged from the data. These included physical functioning, coping, self‐care, roles and relationships, and socio‐cultural issues. Within each category specific directions for nursing practice were developed.
Relaxation and music to reduce postsurgical pain
Authors: Good Marion , Stanton‐Hicks Michael , Grass Jeffrey A. , Anderson Gene Cranston , Lai Hui‐Ling , Roykulcharoen Varunyupa , Adler Patricia A.
Published: August 2010

Relaxation and music to reduce postsurgical pain

Aims: We investigated the effects of relaxation, music, and the combination of relaxation and music on postoperative pain, across and between two days and two activities (ambulation and rest) and across ambulation each day. This secondary analysis of a randomized controlled trial was conducted from 1995 to 1997.

Background: After surgery, patients do not always receive sufficient relief from opioids and may have undesired side‐effects. More complete relief (10–30%) was found recently with adjuvant interventions of relaxation, music, and their combination. Comparison of effects between days and treatments have not been examined longitudinally.

Methods: With a repeated measures design, abdominal surgery patients (n = 468) in five US hospitals were assigned randomly to one of four groups; relaxation, music, their combination, and control. With institutional approval and written informed consent, subjects were interviewed and taught interventions preoperatively. Postoperative testing was at ambulation and rest on days 1 and 2 using visual analogue (VAS) sensation and distress of pain scales.

Results: Multivariate analysis indicated that although pain decreased by day 2, interventions were not different between days and activities. They were effective for pain across ambulation on each day, across ambulation and across rest over both days (all P < 0·001), and had similar effects by day and by activity.

Conclusions: Nurses can safely recommend any of these interventions for pain on both postoperative days and at both ambulation and rest.
Clinical supervision and support for nurses: an evaluation study
Authors: Teasdale Kevin , Brocklehurst Neil , Thom Natasha
Published: August 2010

Clinical supervision and support for nurses: an evaluation study

Aim. To assess the effects of clinical supervision and informal support on qualified nurses.

Rationale. Earlier small‐scale research studies have provided conflicting evidence about the impact of clinical supervision, hence the need for this larger‐scale study.

Design. Survey design drawing on an opportunity sample of 211 qualified nurses from 11 randomly selected hospital and community NHS Trusts in one region in England. Quantitative data collection used the Maslach Burnout Inventory (MBI) and the Nursing in Context Questionnaire (NICQ), while qualitative data were based on written critical incidents. The analysis compared supervized with unsupervized nurses.

Findings. The critical incident analysis revealed that supervized nurses continued to use informal support networks as well as their supervision sessions to discuss clinical issues. The MBI found no significant differences in levels of burnout between supervized and unsupervized nurses. However, the NCIQ detected some statistically significant differences, with supervized nurses reporting a more listening and supportive management, coping better at work and feeling that they had better access to support than unsupervized nurses. Closer analysis found that this positive finding was particularly strong among the more junior supervized nurses.

Conclusion. Where resources are limited, it is better to concentrate on providing clinical supervision to more junior grades of nurses as a valued form of support during their early years as qualified practitioners.
Development and evaluation of a moral distress scale
Authors: Corley Mary C. , Elswick R. K. , Gorman Martha , Clor Theresa
Published: August 2010

Development and evaluation of a moral distress scale

Aim of the study:This methodological research developed and evaluated the moral distress scale from 1994 to 1997.

Background/Rationale:Although nurses confront moral questions in their practice daily, few instruments are available to measure moral concepts. The methodological design used a convenience sample consisted of 214 nurses from several Unites States hospitals. The framework guiding the development of the moral distress scale (MDS) included Jameton’s conceptualization of moral distress, House and Rizzo’s role conflict theory, and Rokeach’s value theory. Items for the MDS were developed from research on the moral problems that nurses confront in hospital practice. The MDS consists of 32 items in a 7‐point Likert format; a higher score reflects a higher level of normal distress.

Results:Mean scores on each item ranged from 3·9 to 5·5, indicating moderately high levels of moral distress. The item with the highest mean score (M=5·47) was working where the number of staff is so low that care is inadequate. Factor analysis yielded three factors: individual responsibility, not in the patient’s best interest, and deception. No demographic or professional variables were related to moral distress. Fifteen percent of the nurses had resigned a position in the past because of moral distress.

Conclusions:The results support the reliability and validity of the MDS.
Arguments for ‘British Pluralism’ in qualitative health research
Authors: Johnson Martin , Long Tony , White Alan
Published: August 2010

Arguments for ‘British Pluralism’ in qualitative health research

Aims of the study. This paper examines the argument that certain qualitative research methods can be used in ‘pure’ forms. Whilst rigid adherence to particular published procedures might be possible, we argue that in many cases this is neither necessary nor more likely to increase the validity of the research outcome.

Methodological purity. In examining the works of well‐known claimants to particular research approaches such as grounded theory and phenomenology we show that purity of method is uncommon. In particular it is possible to demonstrate that all published qualitative methods are subject to their own underlying relativist philosophy. The implication of this is that all are social constructions and that their execution will necessarily be negotiated in time and context.

Conclusion. We conclude that analysis of varied examples of qualitative research shows methods to be more flexible than is often admitted. What we describe as ‘British Pluralism’ is an attempt to accept this reality whilst maintaining rigour through integrity, clear accounts, reflexivity and constructive critique of one’s own work and that of others.
Patients referred to a pain management clinic: beliefs, expectations and priorities
Authors: Allcock Nick , Elkan Ruth , Williams Jacky
Published: August 2010

Title.  Patients referred to a pain management clinic: beliefs, expectations and priorities

Aim.  This paper is a report of a study to explore patients’ pain‐beliefs and emotions at the point of referral to a pain clinic, their expectations of the clinic and their priorities for improvement in aspects of their lives affected by pain.

Background.  Chronic pain is a common experience and, although the percentage of people with pain referred to pain clinics is increasing, they often experience complex journeys through the healthcare system. Patients’ beliefs about pain have been shown to influence their experience of pain and treatment outcomes, with a focus on the organic cause of pain reported.

Methods.  Three focus groups were convened with 18 participants. Ten statements about pain were distributed to each participant and ranked according to their priorities. The data were collected in 2002–2003.

Findings.  The participants’ beliefs were dominated by the search for a firm diagnosis and cure. Participants held three main beliefs; that the cause of the pain must be established; that other people do not believe in the pain of a person without a firm diagnosis; and that painkillers are a way of ‘fobbing you off’. Participants had little knowledge and few concrete expectations of the pain clinic. Their main priorities for improvement were ‘less pain’, ‘some pain free times’, and being able to do more ‘everyday things’.

Conclusion.  Staff delivering pain management services must understand patients’ beliefs and expectations and explain their own perspectives in order to provide a sound basis for working together.
Nurses’ experiences of drug administration errors
Authors: Schelbred Anne‐Berit , Nord Randi
Published: August 2010

Title.  Nurses’ experiences of drug administration errors

Aim.  This paper is a report of a study to describe the experiences of nurses who had committed serious medication errors, the meaning these experiences carry, and what kind of help and support they received after committing their error.

Background.  Medication administration is an important nursing task. Work overload, combined with increased numbers and dosages of medication prescribed, puts nurses at risk of making serious errors. A drug error has the potential for disastrous consequences for patients. What is sometimes disregarded is the effect on the nurse involved. The majority of research on nurses and medication errors is framed within biomedicine, law and management.

Methods.  An explorative, descriptive design was adopted and 10 in‐depth interviews were conducted in 2003 with nurses who had committed a medication error. The text was analysed using a phenomenological method.

Findings.  Serious medication errors can have a great impact on nurses, both personally and professionally. Reactions from significant others were central to the final outcome for nurses who made drug errors. They wanted to share their experiences, but this required confidence and trust. Nurses were generally willing to accept responsibility for their errors.

Conclusion.  Strategies should be developed so that errors can be managed in a constructive manner, which includes exploring underlying causes and the counselling and support needs of the nurses involved.
Nursing and patient safety in the operating room
Authors: Alfredsdottir Herdis , Bjornsdottir Kristin
Published: August 2010

Title.  Nursing and patient safety in the operating room

Aim.  This paper is a report of a study to identify what operating room nurses believe influences patient safety and how they see their role in enhancing patient safety.

Background.  Research in health care shows that work experience, communication and the organization of work are key factors in patient safety. This study draws on Reason’s definitions of active and latent errors to conceptualize the complex issues that affect patient safety in the operating room.

Method.  The study reported here is part of an action research project at a university hospital in Iceland. Semi‐structured interviews were conducted in 2004 with eight nurses, followed by two focus groups of four nurses each in 2005. Data were analysed using interpretive content analysis.

Findings.  Securing patient safety and preventing mistakes were described as key elements in operating room nursing by all survey participants. In the interviews, the nurses identified the existing culture of prevention and protection that characterizes operating room nursing as crucial in enhancing safety. The organization of work into specialty teams was considered essential. Increased speed of work in an environment where enhanced productivity is imperative, as well as imbalance in staffing, was identified as the main threats to safety.

Conclusion.  Operating room nurses have a common understanding of the core of their work, which is to ensure patient safety during operations. The work environment is increasingly characterized by latent error, i.e. system‐based threats to patient safety that can materialize at any time. Interventions to enhance patient safety in operating room nursing are needed.
Improving decision‐making in caring for people with epilepsy and intellectual disability: an action research project
Authors: Vallenga Dineke , Grypdonck Mieke H.F. , Tan Francis I.Y. , Lendemeijer Bert H.G.M. , Boon Paul A.J.M.
Published: August 2010

Title.  Improving decision‐making in caring for people with epilepsy and intellectual disability: an action research project.

Aim.  This paper is a report of an action research study aimed at improving decision‐making concerning risks in people with epilepsy and intellectual disability and the empowerment of participants to sustain this improvement.

Background.  Residents of long‐stay units in specialized epilepsy centres suffer severe epilepsy and are often intellectually disabled. Professional caregivers have to find a balance between risk‐taking and protection, as both can have a negative effect on quality of life. Clients, their representatives and caregivers are involved in this decision‐making process.

Method.  A participative action research project was conducted. Data were gathered continuously over a 22‐month period in 2004–2006 by interviews, observation, written reports of meetings and personal stories.

Findings.  The action research resulted in an ongoing process of improvement. Problems in decision‐making about risk were clarified. The importance of consensus about risks and commitment to risk management between all involved became apparent. Phases in risk management were discerned and used to adjust caregiving to clients’ needs and capacities Assessment of client risk became more systematic and ‘steps to an individual framework for decision‐making’ were developed as a tool for a systematic approach.

Conclusion.  Using an action research model to improve decision‐making provided the preconditions for improving decision‐making and risk management and suggesting a way to improve this process in this and other institutions.
Establishing a new service role in tuberculosis care: the tuberculosis link worker
Authors: Craig Gillian M. , Booth Helen , Hall Jo , Story Alistair , Hayward Andrew , Goodburn Ann , Zumla Alimuddin
Published: August 2010

Title.  Establishing a new service role in tuberculosis care: the tuberculosis link worker

Aim.  This paper is a report of a study to develop a social outreach model of care, including the role of a link worker in developing collaborative care pathways, for marginalized groups with tuberculosis.

Background.  Social risk factors such as homelessness and substance misuse are associated with poor treatment outcomes. Models of interprofessional practice to address the health and social care of patients are needed to improve outcomes.

Methods.  A process evaluation involving a prospective cohort study of 100 patients and interviews with eight agencies involved in their care was conducted in London between January 2003 and April 2005. Outcome measures included a profile of patient need to guide service development; referrals to care providers; goal attainment; social improvement and treatment outcomes; and agencies’ views on the benefits of link working.

Findings.  The median age of the sample was 32·4 years and 62% were males. Reasons for referral to the link worker included housing need (56%); welfare benefits (42%); immigration (29%) and clinical management issues (28%). One‐third of the patients were referred to other agencies. Goals, as agreed in the care plan, were attained totally or partially for 88% (59/67) of patients and 78% of patients successfully completed treatment. Barriers to attaining goals included service criteria which excluded some groups of patients and, in some cases, a patient’s inability to follow a course of action.

Conclusion.  Link workers can mitigate some of the social risk factors that complicate the treatment of tuberculosis by enabling integrated health and social care.
Scholarly nursing practice from the perspectives of experienced nurses
Authors: Riley Joan , Beal Judy A. , Lancaster Diane
Published: August 2010

Title.  Scholarly nursing practice from the perspectives of experienced nurses

Aim.  This paper is a report of a study to describe scholarly nursing practice from the perspectives of experienced nurses.

Background.  Theoretically, nursing scholarship has been well‐described in the literature and flourishes in academic environments. Nursing organizations and nurse leaders worldwide have embraced the value of and need for scholarship to advance the profession. However, the concept of scholarship has yet to be empirically examined within the practice setting from the perspectives of experienced nurses.

Method.  A qualitative descriptive research design was used. Semi‐structured interviews were conducted with 36 experienced nurses purposively sampled from four acute care hospitals in north‐eastern United States of America. The focus of the interviews was to understand how these nurses viewed themselves and their practice. The data were collected between 2004 and 2006 and analysed using content analysis.

Findings.  Participants clearly articulated personal attributes and professional behaviours that characterized scholarly nursing practice. Two overarching inter‐related categories emerged: ‘Who I Am’ and ‘What I Do’. Themes within ‘Who I Am’ were Active Learner, Out of the Box Thinker, Passionate about Nursing, Available and Confident. Themes within ‘What I Do’ were Being a Leader, Caring, Sharing Knowledge with Others, Evolving and Reflecting on Practice.

Conclusion:  Scholarly nursing practice needs to be empirically examined worldwide. Additional studies should focus on scholarly nursing practice with nurses in varying stages of career development, in various types of practice settings, and in different cultures.