bluuebunny/crossref_metadata_2025 huggingface dataset:
Health professionals’ perspectives on service delivery in two Northern Ireland communities
Authors: Mason Carolyn , Orr Jean , Harrisson Sheila , Moore Ronnie
Published: March 2003

Health professionals’ perspectives on service delivery in two Northern Ireland communities

This research builds on the findings of an ethnographic study of health inequalities in two small, rural communities in Northern Ireland. Through further analysis of existing data, this second study aimed to explore health professionals’ perspectives on issues of service delivery relevant to government policy on primary care. Anthropological fieldwork was conducted for two consecutive 4‐month periods during 1995 and 1996 in one predominantly Catholic and one predominantly Protestant town. To preserve confidentiality, the locations have been given the pseudonyms, respectively, of Ballymacross and Hunterstown. Research tools included fieldwork journals and a fieldwork diary, meetings with key informants, tape‐recorded interviews, group discussions, participant observation and use of secondary material such as census data, local newspapers and community health profiles. Interviews with 15 health workers revealed that there was not a coherent approach to achieving health gain, little collaborative enterprise and minimal interaction between the different professional groups. The National Health Service (NHS)‐employed primary care professionals, more than local community workers, appeared to be demoralized, exhausted and suspicious of the business‐orientated health service. In this respect, the primary care‐led NHS appeared not to be working. It is concluded that a shared health agenda should be developed by NHS‐employed primary care professionals and local community workers to create a health‐inducing environment at community level. This needs to be complemented by the establishment of formal mechanisms for inter‐agency working at local, professional and government levels.
Measurement of communication skills in cancer care: myth or reality?
Authors: Booth Katie , Maguire Peter , Hillier Valerie F.
Published: March 2003

Measurement of communication skills in cancer care: myth or reality?

Despite wide agreement about the importance of effective communication in cancer care there is continuing evidence of the need for nurses, doctors and colleagues to be helped to improve their communication skills. Consequently, there has been a growing demand for effective methods for evaluation of communication training programmes. This paper discusses theoretical perspectives in this field and describes the rationale underpinning the development of a detailed objective method of assessing interviews between health professionals and cancer patients. The method enables an utterance by utterance rating of transcribed interviews to be made which can be used to construct profiles of interviewer and patient behaviours and interactions. All categories were developed from interviews drawn from a large sample of participants (n=206) at counselling skills workshops. Six domains have been identified and these are: grammatical style; the purpose of each technique; what is being discussed, the degree of feeling expressed; explicit avoidance; and the use made of patients’ cues. Each domain contains a mutually exclusive set of categories. In addition the method enables the sequence of events to be plotted. Using these methods, examples from published studies will be given to show how the processes of interaction within a health care interview can be better understood, thus enabling the most effective techniques to be taught, the effectiveness of different teaching methods to be assessed and how changes brought about by training have the potential to make a significant clinical difference to patients.
Natural science and nursing science: where do the horizons fuse?
Authors: Whittemore Robin
Published: March 2003

Natural science and nursing science: where do the horizons fuse?

The natural sciences have an influential effect on society, contemporary world‐views, and other scientific disciplines. A brief history of the major advances in the natural sciences and the associated philosophies provides a platform for scholarly discourse regarding the subsequent influence on nursing epistemology. The concepts of knowledge and understanding are differentiated and a cautionary word is expressed not to cast aside the natural sciences and their corollary philosophies as nursing embarks upon its epistemological journey into the 21stcentury. Aesthetics is presented as a possible fusion of horizons of nursing and natural science.
Can a standardized needs assessment be used to improve the care of people with severe mental disorders? A pilot study of ‘needs feedback’
Authors: Lockwood Austin , Marshall Max
Published: March 2003

Can a standardized needs assessment be used to improve the care of people with severe mental disorders? A pilot study of ‘needs feedback’

The care programme approach (CPA) was introduced in the United Kingdom in 1991 to ensure that the needs of people with mental health problems are met appropriately. Many community psychiatric nurses (CPNs) act as ‘key workers’ under the CPA. Recent evidence suggests that the CPA is not particularly effective at meeting the needs of this vulnerable group, but it might be possible to enhance the CPA by introducing a more ‘needs‐led’ approach to the planning of nursing care. ‘Needs feedback’ is a technique for enhancing the CPA. Needs feedback begins with a standardized assessment of patients’ psychiatric and social needs by a nurse specialist. The patient’s CPN is then provided with information on: (a) the needs identified; (b) why these needs have been identified; (c) the interventions required to meet the identified needs; and (d) how these interventions may be obtained. In the pilot study reported in this paper, 20 patients with severe mental disorder were evaluated before and after their CPN received needs feedback. All patients were living in the community and being managed by CPNs under the CPA. Outcome was assessed 6 months after the feedback in terms of: mental state, social behaviour and number of ‘unmet’ needs. Needs feedback was found to be compatible with the CPA in that it proved acceptable to CPNs and patients. Significant improvements were seen in the number of ‘unmet’ needs and the level of anxious/depressive symptoms. Improvements approaching significance were seen for social functioning and negative psychiatric symptoms, but not for positive psychiatric symptoms. This pilot study suggests that needs feedback may improve the quality of nursing assessment and care planning within the CPA. Further controlled investigations of needs feedback are justified.
Combining methodological approaches in research: ethnography and interpretive phenomenology
Authors: Maggs‐Rapport Frances
Published: March 2003

Combining methodological approaches in research: ethnography and interpretive phenomenology

This paper provides a detailed account of two methodological approaches commonly used in qualitative research: ethnography and interpretive phenomenology. It traces both methodologies through the various stages of a research study — data collection, analysis and validation, before considering the most appropriate methods of reconstructing the participant experience for the given audience. The author puts forward a case for the combination of methodological approaches through the triangulation of data, suggesting that this can enhance our understanding of nursing. In the case of ethnographic and phenomenological data, triangulation may enable the researcher to highlight their interpretation of the phenomenon under review, whilst at the same time considering that phenomenon in terms of the participant group, their cultural background and day‐to‐day experiences.
Hermeneutic‐phenomenology: providing living knowledge for nursing practice
Authors: Van der Zalm Jeanne E. , Bergum Vangie
Published: March 2003

Hermeneutic‐phenomenology: providing living knowledge for nursing practice

The phenomenological approach has gained popularity among nurse researchers as an alternative investigative method to those used in the natural sciences. As more nurse scholars and nurse researchers utilize phenomenology as a research approach, it becomes critical to examine the implications this may have for nursing knowledge development and for the utilization of that knowledge in practice. In this paper, an examination of the results of phenomenological inquiry is presented and compared with the types of knowledge considered important for nursing by Carper and White. It is clear that phenomenology contributes to empirical, moral, aesthetic, personal, and socio‐political knowledge development. Its contribution is not in developing predictive and prescriptive theory, but in revealing the nature of human experience. Although interpretive inquiry, such as hermeneutic phenomenology, does not prescribe action for use in clinical practice, it does influence a thoughtful reflective attentive practice by its revealing of the meanings of human experience.
Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping
Authors: Rodney Vic
Published: March 2003

Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping

This study examined the relationship between aggressive behaviour displayed by people with dementia and nurse stress. This was achieved by re‐examining the relationships between the hardy personality (total hardiness), primary appraisal (challenge and threat appraisal), secondary appraisal (coping options available), and coping methods (action and palliative coping) from the perspective of nurse stress in response to aggressive behaviour displayed by people with dementia. One hundred and two nurses from 15 nursing homes and hostels were sampled by way of a questionnaire. Hierarchical regression was performed to analyse the strong hypothesized relationships between the variables examined. Results indicated that resident aggression was significantly related to an increase in nurse stress (M=34·79,
SD=7·93). Of the variables examined, only threat appraisal was significantly related to nurse stress (β[94]=0·48, P < 0·05). Perceiving the possibility of aggressive behaviour by the resident as threatening was found related to a high stress level in nurses sampled.
Experiences of micturition problems, indwelling catheter treatment and sexual life consequences in men with prostate cancer
Authors: Jakobsson Liselotte , Hallberg Ingalill Rahm , Lovén Lars
Published: March 2003

Experiences of micturition problems, indwelling catheter treatment and sexual life consequences in men with prostate cancer

Men with prostate cancer (n=25) were interviewed, focusing on experiences of micturition problems, indwelling catheter treatment and sexual life consequences. Narrations were found to be practical and technical descriptions rather than emotional, and experiences were described with reduction and negligence regarding personal well‐being and the impact of problems. Phenomenological‐hermeneutic analysis was used and findings ordered in subthemes and themes of meaning. Micturition problems, catheter treatment and sexual life problems were all phenomena that radically affected the clients’ autonomy and life quality and changed the life continuum. Impact from the disease was either accepted or not and related to what had already been borne in life. Experiences were linked together, each of them giving rise to feelings of physical deterioration and fear of ridicule, and hidden from others. Maintaining self‐image and social role was important and connected with the degree of perceived deprivation of life content. Responsibility for medical decisions was left to professionals while everyday problems with micturition, catheters and sexual life were regarded as the men’s sole responsibility. Findings were interpreted to mean that comparing the personal situation with that of others worse off made the life situation look better. The clinical implication of this study was that because the men came forward with their problems when given time to talk in their own way these areas should be given time and interest in the nursing care. Interpretation did not provide a unified picture of problems. Thus, nurses will have to seek men’s individual experience actively and give legitimacy to patients’ problems by opening up opportunities to speak about otherwise concealed problems. Then it may be possible to provide solutions that may ease the men’s burdens.
The rhetoric vs. the reality in child care and protection: ideology and practice in working with fathers
Authors: Taylor Julie , Daniel Brigid
Published: March 2003

The rhetoric vs. the reality in child care and protection: ideology and practice in working with fathers

Within child care and protection, practitioners can be paralysed by a fundamental gap between the rhetoric and the reality in engaging fathers in their children’s care. In an earlier paper we argued that there is a lack of an effective framework to guide practice with fathers in child care and protection work. We examined how health visitors and social workers could begin to assess how fathers could be categorized as either (or both) a risk or an asset to the child. Based on a review of the literature we now explore the limitations of current models of practice and trace the theoretical strands that influence them, drawing from the legal framework, attachment theory and models for anti‐oppressive practice. We then highlight messages for practice with fathers for health care professionals involved in child protection. The working context for this paper is Scotland, although we believe that the ideas may be extrapolated to other geographical areas.
Community development: a critical review of approaches to evaluation
Authors: Billings Jennifer Ruth
Published: March 2003

Community development: a critical review of approaches to evaluation

With the growing interest in community‐based initiatives, this discussion paper focuses upon the evaluation of community development. It reviews three areas and highlights the complex and contentious nature of evaluation in this field. Commencing with approaches to evaluation, it critically reviews proposed methods and suggests that, rather than provide clarity and guidance, the competing designs are confusing for the potential researcher. Second, the discussion moves to evaluative terms that are applied to community development, suggesting that there is a mismatch between professional and lay interpretations with an ultimate impact upon the validity of their measurement. It uses the terms community and empowerment to make these differences more explicit. Finally, the paper argues that, although the aim of community‐based initiatives is to bring about community health gain, gauging the pervasiveness of discreet project work is testing. It concludes by suggesting that a move away from an evaluative model based upon empowerment towards one which considers health and social capital may be a way forward.
Dialysis as ‘deus ex machina’: a critical analysis of haemodialysis
Authors: Bevan Mark Thomas
Published: March 2003

Dialysis as

‘deus ex machina’: a critical analysis of haemodialysis

An unexpected power saving a seemingly hopeless situation, god from the machinery. (The Concise Oxford Dictionary 1991)

This paper examines the context of dialysis from a critical and philosophical standpoint. The traditional attitude of dialysis as an all‐saving medical wonder is examined. An alternative interpretation is offered using the analogy of ‘experiment’ to emphasize the uncertainty, power and control surrounding the treatment of end‐stage renal disease. In order for the experiment (of dialysis) to occur, variables (patients) need to be controlled. Control can be found in the social structures around the experiment of dialysis which provide an environment conducive to its success.
Patients’ perceptions of seclusion: a qualitative investigation
Authors: Meehan Tom , Vermeer Cathryn , Windsor Carol
Published: March 2003

Patients’ perceptions of seclusion: a qualitative investigation

Twelve patients receiving acute in‐patient psychiatric care in Queensland, Australia, participated in semi‐structured interviews to elicit their perceptions of seclusion. All respondents had experienced time in seclusion within the 7 days prior to interview. Interviews were audiotaped, transcribed and analysed using content analysis. Five major themes emerged: use of seclusion, emotional impact, sensory deprivation, maintaining control and staff–patient interaction. The prevailing negativity towards seclusion underscores the need for ongoing critical review of its use. In particular, the relationship between patient responses to seclusion and the circumstances in which seclusion takes place requires greater consideration. Interventions such as providing information to patients about seclusion, increased interaction with patients during seclusion, attention to privacy and effective debriefing following seclusion may help to reduce the emotional impact of the practice.
German nursing students’ knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS cases
Authors: Lohrmann Christa , Välimäki Maritta , Suominen Tarja , Muinonen Ulla , Dassen Theo , Peate Ian
Published: March 2003

German nursing students’ knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS case

This study describes German nursing students’ (n=180) knowledge and attitudes relating to HIV/AIDS, their homophobia level, willingness to care for people with AIDS, and their approach to possible sexual risk behaviours. A questionnaire was used to collect the data (response rate 97.8%). The results indicated that the nursing students had a rather high knowledge level concerning AIDS. However, there were gaps of knowledge, such as regarding AIDS immunopathology or the symptoms of the disease. Single nursing students and those having cared for a person with AIDS had a more thorough knowledge about the disease. In general, the attitudes towards AIDS and people with AIDS were tolerant and positive, and homophobia was only found with a small minority. Students having positive attitudes towards people with HIV/AIDS had less homophobia compared to those having negative attitudes towards persons suffering from AIDS. Those with positive attitudes were more willing to care for patients with HIV/AIDS, while those with a high homophobia level were less willing to do so. In addition, students having a high AIDS knowledge level tended less towards negative attitudes and homophobia than those with a low level of knowledge. The implications of the research for nursing education will be discussed.
The extent of nursing research utilization in general medical and surgical wards
Authors: Rodgers Sheila E.
Published: March 2003

The extent of nursing research utilization in general medical and surgical wards

There has been extensive speculation about the lack of research utilization in nursing but little attempt to quantify this phenomenon outside of North America. The current demands for evidence‐based practice necessitate research utilization as one element of the process. As part of a larger project, this study aimed to describe the extent of research utilization by registered nurses in general medical and surgical wards in the Scottish Health Service. A postal survey was conducted for nurses to self‐report their level of utilization of 14 research‐based practices. The 14 practices represented examples of direct, indirect and methodological utilization of research. A research utilization score was constructed for each of the 14 practices and a total mean score constructed for all 14 practices. A random two‐stage stratified sampling resulted in a total sample of 936 nurses from 25 hospitals. A 73% response rate was achieved. The total mean research utilization score for all nurses across all 14 nursing practices suggests that on average, nurses had heard, believed in and were beginning to use the practices. The sampling technique over‐represents nurses in large hospitals and charge nurses, hence a weighting calculation on all scores was completed. There was little difference in weighted and unweighted scores. Scores on individual practices ranged from 60% (405/680) of nurses never having heard of a practice to 85% (574/680) always using a practice. This approach provides a valid and reliable method of assessing the extent of nursing research utilization. In several of the practices, nurses are making significant attempts at research‐based practice. The level of research utilization compares favourably with research completed in North America and provides a baseline for United Kingdom and other country studies.
Innovations in the nursing care of the chronically ill: a literature review from an international perspective
Authors: Temmink Denise , Francke Anneke L. , Hutten Jack B.F. , Van Der Zee Jouke , Abu‐Saad Huda Huijer
Published: March 2003

Innovations in the nursing care of the chronically ill: a literature review from an international perspective

This literature review focuses on substitution‐related innovations in the nursing care of chronic patients in six western industrialized countries. Differences between primary and secondary care‐orientated countries in the kind of innovations implemented are discussed. Health care systems are increasingly being confronted with chronic patients who need complex interventions tailored to their individual needs. However, it seems that today’s health care professionals, organizations and budgets are not sufficiently prepared to provide this kind of care. As a result, health care policy in many countries targets innovations which reduce health care costs and, at the same time, improve the quality of care. Frequently, these innovations are related directly to the ‘substitution of care’ phenomenon, in which care is provided by the most appropriate professional at the lowest cost level, and encompass advanced nursing practice, hospital‐at‐home care and integrated care. The main conclusion of this paper is that integrated care innovations are implemented in both primary care as well as in secondary care‐orientated countries. However, innovations in hospital‐at‐home care and advanced nursing practice are primarily implemented in primary care‐orientated countries. Whether these innovations positively influence the quality of care, costs of care or patients’ use of health care facilities remains rather unclear.
An evaluation of nurse rostering practices in the National Health Service
Authors: Silvestro Rhian , Silvestro Claudio
Published: March 2003

An evaluation of nurse rostering practices in the National Health Service

The scheduling of nursing time on hospital wards is critical to the delivery of patient care, resource utilization and employee satisfaction. Over the past decade many hospital wards in the United Kingdom (UK) have moved away from the traditional planning of rosters by a single manager, towards more participative processes known as self‐rostering and team rostering. This paper tests the hypothesis, developed from the literature, that the three types of rostering approach may be positioned along a continuum. Self‐rostering at one extreme, is conducive to staff empowerment, motivation and roster effectiveness, whilst departmental rostering, at the other, leads to perceived autocracy, reduced empowerment, lower levels of staff motivation and roster effectiveness. Team rostering is positioned mid‐way on this continuum. This paper reports the findings of an empirical study of nurse rostering practices in the UK National Health Service (NHS), with a view to developing an understanding of the implications of implementing these three rostering approaches and testing the above hypothesis. The survey of rostering practices in 50 NHS wards, and in‐depth case studies of seven wards, revealed that each of the three rostering approaches has benefits and limitations and a picture emerges quite different from that implied by the research hypothesis. Whilst the literature suggests that the choice of rostering approach determines the level of perceived autocracy, staff motivation and roster effectiveness, it is proposed in this paper that selection of rostering approach should be contingent upon operational context. The paper concludes with a framework which stipulates that the choice of rostering approach for a ward should be determined on the basis of four contingent variables, namely, ward size, demand variability, demand predictability, and complexity of skill mix. It is recommended that departmental rostering be applied in large wards with complex rostering problems, whilst team rostering is more appropriate for medium sized wards, and self‐rostering appropriate for small wards.
Hospital nurses’ job satisfaction, individual and organizational characteristics
Authors: Adams Ann , Bond Senga
Published: March 2003

Hospital nurses’ job satisfaction, individual and organizational characteristics

Using the Ward Organizational Features Scales (WOFS), relationships between aspects of the organization of acute hospital wards, nurses’ personal characteristics and nurses’ job satisfaction are examined among a nationally representative sample of 834 nurses in England. The analysis contributes to a growing body of evidence demonstrating the importance of interpersonal relationships to nurses’ job satisfaction. In particular, the positive contribution of the cohesiveness of ward nursing staff is highlighted, but the potential for many current NHS staffing strategies and work environments to undermine the development of cohesive working relationships is also noted. Other influential factors are nurses’ relationships with medical staff, perceptions of their workload and their evaluation of the appropriateness of the system of nursing being practised. The importance of measuring nurses’ subjective assessments of their work environment is emphasized. A weak association was found between grade and job satisfaction. Individual nurse characteristics were found not to be associated with job satisfaction.
Re‐thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework
Authors: Burton Christopher R.
Published: March 2003

Re‐thinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework

The dramatic effects of a stroke can have far‐reaching implications for patients and carers. Effective recovery involves a considerable array of coping strategies that facilitate and promote engagement in the social world. Their development is a long‐term process that requires considerable effort, motivation and enterprise on the part of patients and their families. Traditional approaches to the provision of stroke rehabilitation services, however, appear to be underpinned by frameworks that are short‐term in outlook. As a consequence, nursing interventions often focus on the progression of the patient through the care system, rather than on facilitating future recovery. Much of the work of stroke recovery is consequently done by patients and their families at home, with little provision of ongoing professional help and advice. This paper explores the application of the Corbin and Strauss Chronic Illness Trajectory Framework for stroke. In particular, the major concepts of the framework are applied to a vignette derived from a longitudinal study of patients’ experiences of recovery. The trajectory framework is shown to be a useful structure that has the potential to enhance the appropriateness of nursing interventions for stroke patients. However, the validity of the framework can only be established through its application and evaluation in clinical practice. The purpose of this paper is to contribute to a debate that encourages consideration of the framework's utility for nurses to enhance the stroke rehabilitation experience.
Nurses’ experiences of being present with a patient receiving a diagnosis of cancer
Authors: Dunniece Una , Slevin Eamonn
Published: March 2003

Nurses’ experiences of being present with a patient receiving a diagnosis of cancer

This paper reports the findings of a study which describes the experiences of nurses who were present with a patient when they received a diagnosis of cancer, cancer recurrence or prognosis of terminal cancer. Semi‐structured interviews were conducted with six nurses who had experience of caring for patients with cancer in an acute surgical setting. Data were analysed using a phenomenological descriptive approach. Participants’ descriptions revealed the following seven core themes: ‘What if it was me?’; divergent feelings; being there; becoming closer; method of disclosure; time as an influence and learning by reflection. Possible implications for nursing practice and education are discussed and recommendations are made for future research.
On the use of narratives in nursing research
Authors: Frid Ingvar , Öhlén Joakim , Bergbom Ingegerd
Published: March 2003

On the use of narratives in nursing research

Narratives have always been a path to knowledge in nursing care but are a recent element within nursing research. Therefore, this article deals with the narrative and its use within nursing research. First, the use of narratives in nursing care and nursing research is examined. Second, Paul Ricoeur's narrative theory with its dimensions of interpretation, time, action and ethics is presented as a possible methodological basis. Third, the use of Ricoeur's narrative theory in nursing research is examined, showing that, at present, support mainly comes from Ricoeur's text interpretation theory. Finally, a nursing research approach to the narrative, based on the life‐world, is suggested.
The biological sciences in mental health nursing: stakeholders’ perspectives
Authors: Jordan Sue , Philpin Sue , Davies Shân , Andrade Maria
Published: March 2003

The biological sciences in mental health nursing: stakeholders’ perspectives

To date, relatively little attention has been paid to optimizing the development of education programmes to support safe and effective health care professionals. In particular, the wider stakeholders, particularly health service users, are rarely consulted on the knowledge base expected of practitioners. We report here on an evaluation, involving students, lecturers, nurses and service users, aimed at reviewing the bioscience component of the preregistration mental health nursing course. Students and lecturers agreed that the current common foundation course in bioscience was biased towards the adult branch students, and failed to meet the needs of mental health nurses. The mental health lecturers’ solution to the ‘bioscience problem’ was to curtail the input. In contrast, service users described serious shortfalls in professionals’ abilities to inform them of common side‐effects of medication; these problems were attributable to inadequate educational preparation. The knowledge deficits identified could be rectified by making pharmacology an important part of the mental health education programme. However, for the curriculum to accommodate applied pharmacology, its supporting bioscience, and essential preparation in psychosocial interventions, some restructuring of the biological science programme for mental health nurses will be necessary. Our findings suggest that such restructuring should be informed by service users’ views of their needs.
Patient satisfaction with urodynamics: a qualitative study
Authors: Shaw Chris , Williams Kate , Assassa Philip R. , Jackson Clare
Published: March 2003

Patient satisfaction with urodynamics: a qualitative study

This qualitative study was undertaken to assess patients’ views of the urodynamic investigation. The aim was to identify the dimensions important to patients in evaluating satisfaction with this type of procedure and ways in which care could be improved. Unstructured interviews were carried out by four trained interviewers with 21 people (17 female and 4 male) who had undergone the urodynamic investigation at various gynaecology, urology and continence outpatient clinics. The interviews were audio‐taped and transcribed verbatim. The data was then coded and a thematic analysis carried out. The main theme to emerge was focused on patients’ feelings about the procedure. This consisted of a combination of anxiety and embarrassment. Anxiety was because of fear of the unknown and embarrassment at the intimate nature of the procedure and lack of privacy. The interpersonal and communication skills of the health care professional were central in alleviating these negative feelings. The establishment of a friendly relationship based on equality and mutual respect and trust was important in preventing anxiety and embarrassment. A number of practical issues were identified that would contribute to improving the service for patients. It was found that nurses possessed all the attributes required to provide an effective service and recommendations were made that nurses specializing in continence care should take a more active role in urodynamic investigations.
Measuring the socialization of graduate and diplomate nurses using the Corwin Role Orientation Scale
Authors: Taylor Heidi R. , Westcott Elizabeth , Bartlett Helen P.
Published: March 2003

Measuring the socialization of graduate and diplomate nurses using the Corwin Role Orientation Scale

The nature of United Kingdom (UK) nursing education has changed significantly as the responsibility has been transferred from hospitals to the University sector. More information is needed on the outcome of the Project 2000 diploma and degree courses given the rapidly changing health care context. This paper focuses on the role socialization of graduate and diploma nurses. As part of a larger study, this research investigated the role orientations of 52 nursing graduates and 28 diplomates from two different universities at three time points; on graduation and at 6 and 12 months postgraduation. The Corwin Role Orientation Scale was selected and modified for the study. It comprised of three separate scales measuring professional, bureaucratic and service orientation. The data from the two groups of nurses were examined to identify nurses’ ideal role orientations and role discrepancies over the transitionary period from graduate to qualified nurse. Although the results showed observed differences between the groups over time, none of these differences were statistically significant. The findings raise a number of questions about the value of the instrument as a measure in the contemporary nursing context. Furthermore, each of the Corwin subscales had a low internal reliability. A possible explanation may be that the instrument, which was developed in the United States of America (USA) in the 1960s, and modified, for this study, has little relevance for contemporary UK nursing. The study findings are also limited by the small size of the sample. In spite of these limitations, the study suggests there are few differences between the role orientations and socialization experiences of UK nursing graduates and diplomates. Indeed, both programmes commonly take place in university settings and students receive the same amount of clinical experience. Further instrument development and exploratory research is recommended to identify the role socialization and orientations of UK nurses through larger national studies.
The questioning skills of clinical teachers and preceptors: a comparative study
Authors: Phillips Nicole , Duke Maxine
Published: March 2003

The questioning skills of clinical teachers and preceptors: a comparative study

Aim of the study. The purpose of this study, conducted as partial requirement for a Master of Nursing Studies Degree, was to explore, describe and compare the level of questions asked by clinical teachers and preceptors.

Background. Questioning is one of many teaching/learning strategies thought to facilitate the development of critical thinking skills which are integral to nursing practice. As such the type and number of questions asked have implications for student learning. Currently in Melbourne, Australia, many undergraduate nursing degree courses utilize both clinical teachers and preceptors to facilitate student learning in the clinical setting.

Design. A comparative descriptive design was used. Participants were given three acute care patient scenarios involving an undergraduate nursing student, as part of a questionnaire, and asked to identify the questions they would ask the student in relation to the scenario.

Findings. Data revealed that the clinical teachers had considerably more years of experience in their role and higher academic qualifications than did the preceptors. The clinical teachers also asked a greater number of questions overall and more from the higher cognitive level. Despite this, the findings suggest that both clinical teachers and especially preceptors need to increase the number of higher level questions they ask.

Conclusions. Based on the findings of this study, it is evident that there is a need for further comparative studies into the questioning skills of clinical teachers and preceptors. Also, these two groups require education about the importance of higher level questioning for student learning as well as how to ask questions generally.
How nurses manage time and work in long‐term care
Authors: Bowers Barbara J. , Lauring Cathy , Jacobson Nora
Published: March 2003

How nurses manage time and work in long‐term care

Aims of the study. The aim of this study was to better understand the ways in which conditions of work, including staffing, affect how nurses in long‐term care (LTC) facilities do their jobs and the quality of care they provide.

Background. The research reported here was performed in the context of public policy debates about the relationship between staffing levels and quality in LTC.

Methods. In 1995 and 1996, interviews and participant observation were used to examine how 18 licensed nurses employed in two LTC facilities in the midwestern United States experience their day‐to‐day work.

Results. Time was an extremely salient work condition for the nurses interviewed. Under conditions of too little time and many interruptions, nurses compensated by developing strategies to keep up or catch up. These strategies included minimizing the time spent doing required tasks, creating new time and redefining work responsibilities. Although these strategies allowed nurses to complete the tasks for which they were accountable, there were adverse consequences for nurses and residents. Nurses realized that time demands often made it impossible to provide care of high quality. They expressed their ideas about quality care as the notion of ‘should do’ work. In effect, time pressures forced them to forego the ‘should do’ work to complete the ‘must do’ work.

Conclusion. Increased staffing could improve the quality of care in LTC facilities.
Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses
Authors: Laakso Sami , Routasalo Pirkko
Published: March 2003

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses

Aim. The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home.

Background. This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution’s management.

Methods. The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care.

Findings. Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision‐making authority more freely than before. They treated residents as individuals and gave them a greater say in decision‐making. They felt responsible for the development of the workplace as a collectivity.

Conclusions. Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.
Shifting meaning of asylum
Authors: Montgomery Phyllis
Published: March 2003

Shifting meaning of asylum

Aim(s). This paper offers an expanded way of looking at the idea of asylum from the perspective of Soja’s conceptualization ofThirdspace(Blackwell Publishers, Oxford 1996). Implications for research are discussed.

Background. Soja proposes a different way to think about space. He writes not of dialectics but instead of trialectics which reconstructs space. Soja rejects the binarism of either/or logic about space suggesting a creative combination of both/and also. In this instance, the binary logic of either hospital or community asylum is opened to new possibilities of thinking about the space of asylum.

Conclusions. The value of hearing the stories of those living with long‐term mental illness is to obtain an emic perspective of their space of asylum.
Women’s experiences of ‘being diagnosed’ with a long‐term illness
Authors: Kralik Debbie , Brown Marina , Koch Tina
Published: March 2003

Women’s experiences of ‘being diagnosed’ with a long‐term illness

Aims. In this paper we share women’s storied accounts of ‘being diagnosed’ with a long‐term illness. The purpose of the paper is to raise awareness of health professionals that receiving a medical diagnosis is a potentially calamitous event, challenging self‐identity.

Background. The three authors were involved in three separate inquiries which explored women’s experiences of living with illness. The authors realized that ‘being diagnosed’ was a common memorable event for the women across the inquiries. The literature around receiving a diagnosis was scarce.

Design. This paper is the result of secondary analysis of data from three different projects where we researched women living with long‐term illness. In this paper, we focus on the experience of ‘being diagnosed’ as we share and show women’s perceptions of receiving a medical diagnosis.

Findings. Receiving a medical diagnosis of a long‐term illness was a memorable event in the women’s lives. Many women felt alone with their illness, often without adequate information to find meaning in the relationship between their familiar self and their new identity as a woman living with illness. They felt vulnerable and lost as they tried to understand the meanings and consequences that the diagnosis held for their present and their future. Informational needs may be specific and individual. For many, receipt of a diagnostic label was momentous and should not be underestimated, despite the initial feeling of chaos, many women felt validated.

Conclusion. Receiving a medical diagnosis is one event where health care professionals could be on standby. It is important to take the woman’s articulation of the event seriously. Open, genuine communication, with willingness on behalf of the health professional to listen would be affirming for women who are coming to terms with the diagnosis of a chronic illness.
Informational basis for expert intuition
Authors: Effken Judith A.
Published: March 2003

Informational basis for expert intuition

Aim.Intuition has been cited as an integral part of nursing clinical expertise. Responding to the recent scholarly debate over the status of expert nursing intuition as part of the art or science of nursing, this article proposes an alternative view that may provide an informational basis for what has been described phenomenologically as intuition.

Rationale. Two reasons for the dispute over the status of nursing intuition as `art' or `science' are proposed: The first is methodological. The second relates to intuition's close link with perception and underlying assumptions about perception. By examining intuition through an ecological psychology framework, the problem takes on a different character, one that is no longer focused solely on the expert's cognitive (or perceptual) processes, but also on the information provided by the patient and the context of care.

Conclusions. This perspective has several implications for nursing. By investigating information sources (i.e. higher order variables or constraints) in the nurse‐patient encounter, the problem of intuition may be clarified, and perhaps simplified. We may find that what nurse researchers have called `intuition' is whatGibson (1966,1986) termed `direct perception.' Intuition as direct perception is information‐based and lawful. Finally, although some aspects of intuition may be hard‐wired through evolution, intuition as direct perception can be developed through education and extensive, deliberate practice with appropriate exemplars. Characterized as direct perception, intuition is an observable, lawful phenomenon that is measurable, potentially teachable, and appropriately part of nursing science.
Emotion work in midwifery: a review of current knowledge
Authors: Hunter Billie
Published: March 2003

Emotion work in midwifery: a review of current knowledge

Aim of the paper. To review the literature relating to emotional labour in the workplace and identify potential sources of emotion within midwifery work.

Rationale. There is substantial evidence to indicate that the quality of the relationship between midwife and woman is significant in determining the quality of the childbirth experience for women. Despite this, there is a notable lack of research regarding midwives’ experiences of participating in this relationship, and even less regarding the emotional issues involved.

Method. Literature review of relevant midwifery, nursing and sociological literature. Discussion of the theoretical perspectives provided by sociological and nursing research relating to the management of emotion at work and critical consideration of their application to an analysis of midwifery work.

Findings. Although these theoretical perspectives may offer significant insights of relevance to midwifery, there is much more that needs to be uncovered. Midwifery work has the potential for creating high levels of emotion work and current changes in the organization of United Kingdom (UK) maternity care may further increase this.

Conclusion. It is essential that midwives develop their understanding of emotion at work in order to improve their own working lives, and to meet the needs of childbearing women and their families. More research is needed in this field to develop a body of knowledge to inform midwifery education and practice.