bluuebunny/crossref_metadata_2025 huggingface dataset:
Late adolescent female smoking
Authors: Seguire Marilyn , Chalmers Karen I.
Published: March 2003

Late adolescent female smoking

Although there have been intense efforts to reduce the prevalence of cigarette smoking in the past three decades, smoking continues to be a critical public health problem. An area of particular concern is the increasing number of young women who are smoking. Gender specific research usually does not examine factors affecting smoking behaviours. Information on late adolescent female smoking is not readily found in the literature. The aims of this study were to explore the smoking patterns and processes of late adolescent females and to explore factors which may or may not be helpful in assisting them to stop smoking. A qualitative ethnographic approach was used to uncover the perceptions of 25 adolescent girls of their behaviour. Data were collected using tape‐recorded semi‐structured interviews and a questionnaire. Items for the questionnaire were derived from the Manitoba Youth Smoking Survey and from the Fagerstrorn Nicotine Tolerance Scale. Qualitative analysis resulted in four stories about smoking: the start story, the smoking story, the quit story, and the looking to the future story. Although many of the findings are congruent with the existing literature, much of the data reflected the purposive nature of smoking in late adolescent girls. Study findings support the need for holistic approaches to health promotion to ameliorate factors affecting smoking behaviour.
Caring for adolescent females with anorexia nervosa: registered nurses’ perspective
Authors: King Susan J. , Turner De Sales
Published: March 2003

Caring for adolescent females with anorexia nervosa: registered nurses’ perspectives

This phenomenological study was undertaken to explore in depth the experiences of registered nurses caring for adolescent anorexic females within paediatric wards of general hospitals in Victoria, Australia. A qualitative design underpinned by the philosophy of Edmund Husserl was employed for this study. Audio taped in‐depth interviews with five registered nurses working within the public health care system were conducted. Using Colaizzi’s procedural steps of analysis, six themes of meaning were explicated. They were: (a) personal core values of nurses; (b) core values challenged; (c) emotional turmoil; (d) frustration; (e) turning points; and (f) resolution. These themes, when taken together, described the essence of the journey undertaken by registered nurses who cared for adolescent anorexic females. The findings of this study indicated that there is a need for extensive registered nurse preparation, on‐going support, and development of education programmes to enable registered nurses to care for these patients with greater understanding. Further, the participants identified the need for new care regimes and protocols to be developed that incorporated new ways of thinking. They also expressed a desire to be have greater involvement in the planned care of their patients.
Spousal perspective of Parkinson’s disease in middle life
Authors: Habermann Barbara
Published: March 2003

Spousal perspective of Parkinson’s disease in middle life

An interpretive study in America explored the experience of living with a partner who has Parkinson’s disease (PD) in middle life. Challenges experienced by eight spouses and their ways of coping with these challenges were examined. The convenience sample of five wives and three husbands were 44–58 years and had been married 4 months to 30 years. Spouses described the most significant challenges as watching their partner struggle and be frustrated; and renegotiating their lives. The coping strategies most frequently used were maintaining their own life, encouraging their partner to stay active and involved, and seeing the challenges they experienced as secondary. The context of living with a partner with Parkinson’s disease is illuminated and strategies that spouses find most effective in coping with their partners illness are identified.
Invisible nursing: exploring health outcomes at a global level. Relationships between infant and under‐5 mortality rates and the distribution of health professionals, GNP per capita, and female literacy
Authors: Robinson Jane , Wharrad Heather
Published: March 2003

Invisible nursing: exploring health outcomes at a global level. Relationships between infant and under‐5 mortality rates and the distribution of health professionals, GNP per capita, and female literacy

AimsTo explore the relationship between the global distribution of health professionals (physicians and nurses), gross national product per capita (GNP), female literacy and the health outcome indicators of infant, and under‐5 mortality rates using available data from United Nations’ (UN) sources. To consider the reliability and validity of the variables included, and the implications of the findings for health policy and practice, and for further research.DesignUsing a database on 155 countries, regression analyses were performed using GNP, female literacy, numbers of physicians per 1000 population and numbers of nurses per 1000 population as independent variables, and infant mortality (IMR) and under‐5 mortality rates (u5MR) as dependent variables.ResultsLinear regression analyses give R2values for the two mortality indicators (IMR and u5MR) of 63% and 66% for physicians and 51% and 52% for nurses. Multiple linear regression analyses reveal a more complex picture. Countries with high ratios of physicians and nurses to population relative to their GNP also tend to show low IMRs and u5MRs. However, when female literacy is included in the model, the majority of these outlying countries move back towards the regression line. Nurses disappear from the model altogether when regressed with physicians, GNP per capita and female literacy for both outcome indicators.ConclusionsDespite the acknowledged need for caution in the validity and reliability of the UN data sources used in the analyses, interesting positive relationships are identified between the input variables and mortality outputs. The implications for future health policy, practice and research are considered. These include the need for more reliable, comprehensive and up‐to‐date data sets.
Stigma of visible and invisible chronic conditions
Authors: Joachim Gloria , Acorn Sonia
Published: March 2003

Stigma of visible and invisible chronic conditions

Nurses deliver care to people with various forms of chronic illnesses and conditions. Some chronic conditions, such as paraplegia, are visible while others, such as diabetes, are invisible. Still others, such as multiple sclerosis, are both visible and invisible. Having a chronic illness or condition and being different from the general population subjects a person to possible stigmatization by those who do not have the illness. Coping with stigma involves a variety of strategies including the decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal. We present a beginning framework that describes the relationship between the elements of stigma and the decision to disclose or hide a chronic condition based on its visibility or invisibility. The specific aims were to combine the results from a meta‐study on qualitative research with a review of the quantitative literature, then develop a theoretical framework. Although an understanding of how patients cope with stigmatizing conditions is essential for nurses who aim to deliver comprehensive individualized patient care, there is little current literature on this subject. The relationship between visibility and invisibility and disclosure and non‐disclosure remains poorly understood. A framework to facilitate a deeper understanding of the dynamics of chronic illnesses and conditions may prove useful for practice.
Determinants of absconding by patients on acute psychiatric wards
Authors: Bowers Len , Jarrett Manuela , Clark Nicola , Kiyimba Frank , McFarlane Linda
Published: March 2003

Determinants of absconding by patients on acute psychiatric wards

Absconding by patients from acute psychiatric wards is a high risk behaviour and has been linked to harm to self and others. Previous research on the characteristics of absconders has been overly reliant on officially generated statistics and small numbers of variables, limiting the conclusions that may be drawn. This paper reports on a prospective study of absconders from 12 acute admission wards in three English National Health Service Trusts over 5 months, compared to a control group matched for ward. Extensive data on absconder and control characteristics were collected from case records and from nursing staff. Absconders were significantly different from controls in many respects. Absconding is linked to other forms of non‐compliant patient behaviour, e.g. medication refusal and involvement in violent incidents. Significant variations in the rates of absconding were found between different wards, and between different consultant psychiatrists. Predictive factors were identified by logistic regression. Study in the diverse fields of non‐compliance should be brought together as these phenomena are likely to be interrelated. Further investigation is required to determine exactly what it is that consultant psychiatrists and ward nurses do that affects absconding rates.
Adults with terminal illness: a literature review of their needs and wishes for food
Authors: Hughes Nic , Neal Richard D.
Published: March 2003

Adults with terminal illness: a literature review of their needs and wishes for food

Food refusal can be a source of conflict between dying people and their caregivers. This review examines: the nature and purpose of food; some reasons for and implications of anorexia in terminal illness; ethical principles underpinning responses to declining appetite and food refusal; social transactions between dying people and their caregivers in relation to needs and wishes for food; and the need for further empirical research. The nature and purpose of food in human societies has been studied extensively by anthropologists but the knowledge gained is not often imported into health care practice, where eating is seen from a medical rather than an anthropological perspective. Food refusal may be a consequence of anorexia which is the result of physiological or psychological changes or it may be a deliberate choice in acceptance of impending death. Ethical principles underpinning responses to declining appetite and food refusal have been studied extensively and clear guidance obtained about what would be appropriate behaviour in given circumstances. There is little published empirical work on social transactions between dying people and their caregivers in relation to needs and wishes for food. As the contribution made to effective care‐giving by high‐quality interpersonal relationships is widely recognized, further knowledge about how best to sustain such relationships in these important circumstances would be useful. Moreover, as such interpersonal relationships often occur in an institutional context, it may be that more can be learnt from close examination of social transactions about how best to structure organizational processes to maximize autonomy and comfort for patients at the end of life. Further research is indicated.
Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance
Authors: Isaacson Janalee , Smith‐Blair Nan , Clancy Richard L. , Pierce Janet D.
Published: March 2003

Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance

Many patients who are on mechanical ventilation are on ventilator modes called pressure support ventilation (PSV) and continuous positive airway pressure (CPAP) particularly when they are being weaned. As the diaphragm is responsible for approximately 75% of breathing, it is important to promote diaphragm shortening to optimize weaning from mechanical ventilation. The purpose of our 1998 quasi‐experimental study was to explore the effects of PSV and CPVP on diaphragm shortening. An animal model was utilized using four Sprague–Dawley rats from the same litter purchased from Sasco (Kansas City, USA). Also measured in this study were intrathoracic pressure (ΔITP), positive inspiratory pressure, respiratory rate, tidal volume, end‐tidal carbon dioxide, central venous pressure (CVP) and mean arterial pressure (MAP). Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague–Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end‐tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed. These results support that higher levels CPAP may hinder diaphragmatic function thus prolong mechanical ventilation. The purpose of this pilot study was to explore the effects of PSV and CPAP on diaphragm shortening. Also measured were ΔITP, positive inspiratory pressure, respiratory rate, tidal volume, end‐tidal carbon dioxide, CVP and MAP. Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague–Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end‐tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed.
Journey towards recovery following physical trauma
Authors: Richmond Therese S. , Thompson Hilaire J. , Deatrick Janet A. , Kauder Donald R.
Published: March 2003

Journey towards recovery following physical trauma

Convalescence and recovery following illness are of central importance to nursing. These themes have been explored increasingly in the literature. The focus, however, has been primarily on the process of integrating chronic illness into one’s life. Recovery from physical injury is rarely addressed. A body of work focusing on physical trauma demonstrates that recovery is often not complete after injuries that have not been viewed as disabling. To illuminate understanding of recovery following physical trauma, the purpose of our 1997 study was to describe more thoroughly the nature of recovery. A total of 63 adults, in a convenience sample, who survived serious physical trauma, were interviewed 2·5 years after injury using an open‐ended semistructured interview guide. Three themes were identified: event, fallout, and moving‐on. These themes provided the organizing structure for exploring the journey to recovery. This journey, as disclosed by the seriously injured, does not necessarily correspond with the views of most trauma clinicians. Traumatic events create a line of demarcation, separating lives into before and after. The event becomes the starting point of a journey to resume one’s life. The event itself is more than the trauma; it is the perceptual and contextual experience that needs to be incorporated into a person’s essence. Fallout from the injury is multifaceted and includes physical, psychological, social, and spiritual dimensions. Moving‐on in this journey is nonlinear as survivors recognize their lives are forever different. The survivors’ accounts suggest that nurses should carefully consider the question, ‘What is successful recovery?’
Parents and partners: lay carers' perceptions of their role in the treatment and care of adults with cystic fibrosis
Authors: Lowton Karen
Published: March 2003

Background.  Cystic fibrosis (CF) is the most common autosomal recessive genetic disease in Caucasian people, traditionally conceptualized as a condition whereby sufferers died in childhood. However, the current median survival age of 30 and a predicted median survival age of 40 for those born with the disease over the last decade ensure that families members will assist hospital staff with treatment and care well into most patients' adulthood.

Aims.  This study explores the perceptions and experiences of lay care‐giving amongst parents and partners of adults with CF who were being treated at a specialist CF centre in England.

Methods.  Thirty‐one relatives of adults with CF were interviewed in their own homes using an interview topic guide. All interviews were audiotape recorded and transcribed verbatim. Analysis of data was assisted by ATLAS‐ti, a software package for qualitative research.

Findings.  Two main themes surrounding lay carers' role in treatment and care were identified. Firstly, the notion of lay carers giving ‘expert’ care, both in hospital and at home was recognized. Parents' expertise was greater than that of partners until the patient required intensive hospital interventions, when partner expertise increased. Secondly, the degree of lay carers' felt inclusion in the hospital consultation appeared to depend on the nature of their relationship with the patient and the patients' health state.

Conclusion.  Lay carers are routinely performing tasks for adults with CF that were once the remit of trained nurses. Families need higher levels of nursing and social support when certain treatments are used at home. Attention needs to be directed to how lay carers of adult patients can be included in hospital consultations.
Biological correlates of Reiki Touchsm healing
Authors: Wardell Diane Wind , Engebretson Joan
Published: March 2003

Biological correlates of Reiki Touchsm healing

Background. Despite the popularity of touch therapies, theoretical understanding of the mechanisms of effect is not well developed and there is limited research measuring biological outcomes.

Aims. The aim of this study was to test a framework of relaxation or stress reduction as a mechanism of touch therapy.

Methods. The study was conducted in 1996 and involved the examination of select physiological and biochemical effects and the experience of 30 minutes of Reiki, a form of touch therapy. A single group repeated measure design was used to study Reiki Touch’ssm effects with a convenience sample of 23 essentially healthy subjects. Biological markers related to stress‐reduction response included state anxiety, salivary IgA and cortisol, blood pressure, galvanic skin response (GSR), muscle tension and skin temperature. Data were collected before, during and immediately after the session.

Results. Comparing before and after measures, anxiety was significantly reduced, t(22)=2·45, P=0·02. Salivary IgA levels rose significantly, t(19)=2·33, P=0·03, however, salivary cortisol was not statistically significant. There was a significant drop in systolic blood pressure (SBP), F(2, 44)=6·60, P < 0·01. Skin temperature increased and electromyograph (EMG) decreased during the treatment, but before and after differences were not significant.

Conclusions. These findings suggest both biochemical and physiological changes in the direction of relaxation. The salivary IgA findings warrant further study to explore the effects of human TT and humeral immune function.
The concept of spiritual care in mental health nursing
Authors: Greasley Peter , Chiu Lai Fong , Gartland Reverend Michael
Published: March 2003

The concept of spiritual care in mental health nursing

Aim. In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing.

Background. The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care.

Methods. A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing.

Results. According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person’s sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the ‘mechanics of nursing’.

Conclusions. The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.
From individual to group: use of narratives in a participatory research process
Authors: Aranda Sanchia , Street Annette
Published: March 2003

From individual to group: use of narratives in a participatory research process

Aims. This paper provides a theoretical understanding of narrative research and its use in research. It aims to expose the ways narrative research, when taken beyond the researcher’s lone analysis of text, can contribute to the development of clinical knowledge.

Background. Methodological approaches involving the construction of narratives are increasingly apparent in the nursing and allied health literature. Narratives, constructed from stories of nursing practice, become texts available for analysis. This is undertaken predominantly by a researcher engaged in a lone activity with little involvement of those contributing the stories.

Methods. This paper is drawn from a critical praxis study of nurse–patient friendship utilizing participatory research processes. The nurses involved in the study were co‐researchers in an indepth study of their relationships with patients.

Findings. The paper traces the movement from naïve story, through individual narratives during interviews with each nursing and demonstrates the changes in understanding about the narrative accounts that occurred during the participatory group process.

Conclusion. The nurses involved in this study were able, through the use of narrative stories reexamined in a group context, to develop new insights and understandings about their practice. Knowledge generated in these ways remains grounded in the real life world of clinical nursing and gives voice to the complexity of those aspects of nursing practice that are taken for granted.
Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study
Authors: Bailey Judi , Rose Pat
Published: March 2003

Axillary and tympanic membrane temperature recording in the preterm neonate: a comparative study

Study aims. The aim of this study is to compare axillary temperature recordings with those of the tympanic membrane, in healthy preterm neonates, to ascertain whether there is any significant difference between the two recordings, in particular in relation to postnatal age, and if so to evaluate the clinical implications.

Rationale. Immature thermoregulatory mechanisms, and small body size, mean preterm neonates are prone to temperature maintenance problems, and thermal stress is associated with increased morbidity and mortality. In order to ensure minimal handling, the ideal method of temperature recording would be rapid, painless and reproducible, and accurately reflect core temperature, whilst considering safety, comfort, ease of procedure and cost effectiveness. Recording of the tympanic membrane temperature is rapid and noninvasive, however, the accuracy of this method in preterm neonates has not been established.

Study design. A comparative descriptive design was used, to describe differences in the recorded temperature in healthy preterm neonates, of gestational age of 27–37 weeks, related to temperature recording method. A second comparison was undertaken to establish difference in mean temperature recordings dependant on postnatal age of the baby in days. The sample included all babies fitting the selection criteria, admitted to the Neonatal Unit during the study period. Following approval by the local research ethics committee tympanic membrane and axillary temperatures were recorded consecutively for 7 days (n=154), using the Genius Model 3000A tympanic thermometer and a glass and mercury thermometer.

Results. A t‐test demonstrated a statistically significant difference between the recordings (P < 0·05), tympanic membrane recordings being higher. However, analysis of variance indicated that this difference was not associated with postnatal age, and thus the presence of vernix in the auditory canal (P > 0·05). The findings were not, however, deemed clinically significant in that no change in care or treatment resulted from differences in temperature recordings.

Conclusions. Whilst the findings cannot be applied to sick preterm neonate, it was concluded that tympanic membrane temperature recordings in healthy preterm neonates are safe, accurate, easy, and comfortable for the baby, and appropriate with this client group provided staff are trained in the technique.
Myth of empowerment in chronic illness
Authors: Paterson Barbara
Published: March 2003

Myth of empowerment in chronic illness

Aims. This article presents several findings of a study, conducted between 1996 and 1998, to investigate self‐care decision making in diabetes.

Rationale. The underlying assumption of many practitioners is that an invitation to people with chronic illness to participate as equal partners is sufficient to guarantee their empowerment.

Design. Using grounded theory, the research examined self‐care decision making using a convenience sample of 22 Canadian adults with longstanding type 1 diabetes nominated as expert self‐care managers. Participants audiotaped their decision making as it occurred for 3 weeks over the course of one calendar year. These audio‐recordings were followed by an interview to clarify participants’ decision making and factors that affected their decisions.

Findings. Participants identified several covert and subtle ways that practitioners contradict their stated goal of empowerment in their interactions with diabetics. Participants revealed that despite their intention to foster participatory decision making, practitioners frequently discount the experiential knowledge of diabetes over time and do not provide the resources necessary to make informed decisions.

Conclusion. The article concludes with a discussion of the implications of the findings for practice.
Between joy and sorrow: being a parent of a child with developmental disability
Authors: Kearney Penelope M. , Griffin Tim
Published: March 2003

Between joy and sorrow: being a parent of a child with developmental disability

Aim. This study explored the experiences of parents who have children with significant developmental disability.

Background. Prevailing societal and professional assumptions of parental crisis and maladjustment in response to the ‘tragedy’ of having a disabled child did not accord with the authors’ practice experience. Whilst parents confronted numerous difficulties, most of them appeared to manage with optimism and remarkable resourcefulness.

Research design. The study, using an interpretive methodology informed by phenomenology, intensively explored the experiences of six parents of children with significant developmental disability.

Findings. Although they experienced much anguish and sorrow, the parents also spoke of hope, love, strength and joy. Interpretation of the parents’ experiences revealed the themes of ‘joy and sorrow’, ‘hope and no hope’ and ‘defiance and despair’, mediated by ‘the tensions’.

Conclusions. This phenomenological interpretation provides insight and understanding into the parents’ experiences and has implications for practice, education and research in nursing.
Swedish nurses’ attitudes towards research and development within nursing
Authors: Björkström Monica E. , Hamrin Elisabeth K.F.
Published: March 2003

Swedish nurses’ attitudes towards research and development within nursing

Aim of the study. The aim was to develop and test an assessment instrument in order to study attitudes towards research and development within nursing among randomly selected professional nurses, registered nurses (RNs).

Background. The investigation was initiated because of the development within nursing and nursing education in Sweden towards better knowledge about research for the last four decades.

Methods. A questionnaire was designed, consisting of three parts: (1) demographic data, (2) attitude scale and (3) research awareness. Appropriate psychometric statistics were used such as factor analysis and parametric as well as nonparametric statistics to compare groups. The form was distributed to 407 randomly selected RNs.

Results. The response rate was 71% (n=289). The respondents were from four different examination years, representing four different nursing education systems in Sweden. Factor analysis (Maximum Likelihood and Oblimin rotation) gave seven factors with a total variance of 58% and Cronbach’s α between 0·60 and 0·84. The factors were labelled ‘Research language’, ‘Need of research knowledge’, ‘Participation’, ‘The Profession’, ‘Meaningfulness’, ‘Study literature’ and ‘Developing – Resources’. The results indicated that the respondents in general had positive attitudes towards nursing research. There were significant differences between the examined groups. The group examined in 1966 appeared as the least positive group. Forty‐six per cent never or seldom utilized nursing research findings in their daily practice. About half of the respondents never read research reports.

Conclusion. The results indicated that the new instrument is sensitive for measuring professional nurses’ attitudes towards research and development in nursing. Even if the respondents had a positive attitude towards research and development, there was a poor application in their daily work. Further, the respondent’s age, the year of RN examination and acquisition of research skills seemed to be of importance for the attitudes.
Patterns of elderly spousal caregiving in dementia care: an observational study
Authors: Jansson Wallis , Nordberg Gunilla , Grafström Margareta
Published: March 2003

Patterns of elderly spousal caregiving in dementia care: an observational study

Aim.  The aim of this study was to escribe which caring activities eight spouses performed when caring for a partner with dementia, and in what way these activities were carried out.

Background.  Family caregivers are recognized as being the primary source of care for the community’s older people. The largest group is comprised of spouses, with wives as the predominant caregivers. This informal care seems to be more or less invisible and performed in silence within the family. Despite the wealth of studies, the essence of family caregiving is not well understood.

Methods.  Data collection was conducted by observing the dyads in their homes. A qualitative approach inspired by grounded theory was chosen to discover qualities and describe patterns of spousal caregiving in dementia care.

Results.  The analysis yielded four broad themes, which included nine categories. Findings from the study shed some light on the invisible aspects besides the traditional hands‐on caregiving.

Conclusion.
 The elderly carers were engaged in demanding and time‐consuming care ranging from supervision to heavy physical responsibility. They were caring for as well as about their partners. The study also showed that spouses were successful in managing their situation in different ways. The results reported in this article are unique as they come from direct observations in family home settings where a spouse cared for a partner with dementia. Knowledge about family caregiving is valuable for nurses as there is an emphasis on collaboration between family caregivers and professionals.
Nurse‐led intermediate care: an opportunity to develop enhanced roles for nurses?*
Authors: Wiles Rose , Postle Karen , Steiner Andrea , Walsh Bronagh
Published: March 2003

Nurse‐led intermediate care: an opportunity to develop enhanced roles for nurses?

Background.  Nurse‐led intermediate care units are being set up across the UK primarily as potential solutions to hospital bed crises.

Aims.  This paper draws on data collected as part of a comprehensive evaluation of one 10‐bedded nurse‐led unit (NLU) located in the South of England. It explores the potential for enhanced nursing roles provided by such units by focusing on the views of NLU nursing staff and other professional groups within the Hospital Trust where the unit is located.

Methods.  A total of 38 in‐depth audio‐taped qualitative interviews were conducted with NLU nursing staff and with a range of other professional groups (managers, acute ward nurses and doctors).

Findings.  These data indicated that models of nurse‐led postacute care do provide opportunities for nurses to develop enhanced nursing roles in which care associated with concepts of therapeutic nursing can be provided. However, even though the nurses derived satisfaction from their work on the NLU this model of care was seen by junior and middle grade nurses and other professional groups as being of low status. In contrast to senior nurses’ views, they did not equate work on the NLU with the continuing professionalization of nursing. Senior nurses viewed the route to developing nursing on the NLU as involving nurses as doctor substitutes (extended roles) rather than as working in separate but complementary therapeutic domains (enhanced roles).

Conclusions.  NLUs provide opportunities for nurses to develop enhanced roles in which they can work autonomously in providing elements of therapeutic nursing aimed at improving patient outcomes at discharge. However, education, training and leadership will be needed to ensure that such opportunities are well understood and are optimized to the benefit of nurses and their patients.
Patients’ perceptions of self‐determination as expressed in the context of care
Authors: Nordgren Stina , Fridlund Bengt
Published: March 2003

Patients’ perceptions of self‐determination as expressed in the context of care

Aim. The aim of this study was to describe patients’ perceptions of how self‐determination finds expression in the context of care.

Background. Self‐determination is an important concept within health care as well as an important patient right. New legislation on patient rights in Sweden and Europe is aimed at increased patient self‐determination.

Design and method. Data were collected through semi‐structured, tape‐recorded interviews with 17 strategically chosen patients within somatic care and analysed using a method inspired by phenomenography.

Results. The analysis found three descriptive categories of the informants’ perceptions: trusting, accepting and a feeling of powerlessness. The patients expressed a great sense of trust and confidence in the care provided and they accepted the health care procedures. At the same time, they expressed a feeling of powerlessness because of not being part of decision‐making, as well as lacking knowledge and information about treatment strategies. The patients wished to have the right of more self‐determination but lacked the strength and knowledge to be able to influence their own care.

Conclusions. Patients’ perceptions of self‐determination suggest that, in their encounters with the professional care, knowledge is expressed as power. The feeling of a lack of self‐determination can be reduced by help and support from a nurse who allocates time for communication in order to learn the patient’s needs and reach a mutual understanding.
A psychoanalytically informed conversation with a woman and her husband following major surgery for cancer of her neck and torso
Authors: Jones Alun
Published: March 2003

A psychoanalytically informed conversation with a woman and her husband following major surgery for cancer of her neck and torso

Aims of the Paper. This paper explores psychoanalytic ideas of containment as described by Wilfred Bion and applies them understanding the concerns of a woman with serious illness and her husband. A case vignette shows psychoanalytic thinking in context. The paper explores verbatim exchanges that took place in a room just off a hospital ward and offers a psychoanalytically informed analysis.

Rationale. This discussion suggests that the impact of physical illness is such that there is potential for the seriously ill to saturate health workers in anxiety and raw feelings. To protect themselves, nurses and other health workers could sometimes unconsciously overlook the emotional care of people in favour of routines, physical aspects of care and other demonstrable methods of treatment.

Conclusions. Drawing on the work of Isabel Menzies Lyth, the discussion concludes by recommending that environments are needed in which a person with serious illness or family member can be helped to make sense of his or her experiences and so integrate them into a meaningful life continuum. Similar conditions are perhaps needed for nurses or other health workers. Appropriate methods of work discussions in clinical supervision might conceivably provide these important requirements.
Psychological aspects of breast reconstruction: a review of the literature
Authors: Harcourt Diana , Rumsey Nichola
Published: March 2003

Psychological aspects of breast reconstruction: a review of the literature

Aim. This paper critically examines the research literature relating to the psychological aspects of breast reconstruction. Particular attention is given to the role of specialist breast care nurses in supporting women faced with the decision of whether or not to opt for reconstructive surgery.

Background. Breast reconstruction is intended to offer psychological benefits (e.g. improvements to quality of life, body image, anxiety and depression) to women treated by mastectomy following diagnosis of breast cancer.

Methods. A literature search was carried out on the PSYCHINFO, MEDLINE and CINAHL databases using the terms ‘breast reconstruction’, ‘mastectomy’, ‘reconstructive surgery’, ‘breast surgery’, ‘breast implants’, ‘transverse rectus adominis myocutaneous (TRAM) flap’ and ‘Lat‐dorsi’. Further relevant articles were identified from the reference lists of papers detected by this literature search. Finally, proceedings of recent psychological and surgical meetings were scrutinized to identify any conference papers on this topic.

Findings. A thorough search of the existing literature revealed a lack of theoretically based studies examining breast reconstruction in terms of relevant psychological constructs, especially in relation to coping and decision‐making. This review highlights the methodological flaws with much of the existing research in this area, in particular the reliance upon retrospective designs and the inappropriate use of randomised controlled trials. Suggestions are given for further research in this topical area.

Conclusions. Existing research into the psychological aspects of breast reconstruction is limited and not sufficiently conclusive to inform changes to policy and the provision of care. More methodologically rigorous research is needed.
The implementation of a Pain Monitoring Programme for nurses in daily clinical practice: results of a follow‐up study in five hospitals
Authors: De Rond Marlies , De Wit Rianne , Van Dam Frits
Published: March 2003

The implementation of a Pain Monitoring Programme for nurses in daily clinical practice: results of a follow‐up study in five hospitals

Aims of the study. To study the effects of the implementation of a Pain Monitoring Programme (PMP) for nurses in daily clinical practice. In addition, nurses’ and physicians’ pain knowledge and attitudes were studied, as well as change in nurses’ pain knowledge after implementation of the programme.

Rationale. The rationale for the study was that many hospitalized patients suffer from pain and treatment of pain is often inadequate.

Background. Reasons for inadequate treatment of pain are the failure of nurses to assess pain on a daily basis and insufficient knowledge about pain and pain management in both nurses and physicians. The PMP tried to overcome these barriers by implementing daily pain assessment and educating nurses about pain and pain management.

Research methods. This follow‐up study was conducted in five hospitals. In total, 277 nurses and 115 physicians participated. The implementation and long‐term effects of the programme were measured with a pretest–post‐test design without a control group.

Results. Results showed that nurses carried out daily pain assessment in at least 75% of patients during the first 5 months of the intervention period, but in the remaining 2 months professional compliance gradually decreased. Both nurses and physicians are positive about daily pain assessment and want to continue with it. The level of nurses’ and physicians’ knowledge about pain and pain management is moderate. The programme increased nurses’ knowledge and satisfaction regarding the quality of pain treatment.

Discussion. Because professional compliance decreased after 5 months, incentives are needed to motivate nurses to continue with daily pain assessment. Continuous Quality Improvement may be a useful method to guide the implementation process.

Conclusions. Based on these results it can be concluded that it is possible to implement the PMP in daily clinical practice. Moreover, the beneficial effects of our programme on nurses’ knowledge and attitudes have been demonstrated. Therefore, participating hospitals were advised to continue and extend the programme and other hospitals are encouraged to implement it.
Leadership, organizational stress, and emotional exhaustion among hospital nursing staff
Authors: Stordeur Sabine , D'Hoore William , Vandenberghe Christian
Published: March 2003

Leadership, organizational stress, and emotional exhaustion among hospital nursing staff

Study’s rationale and objectives. We examined the effect of work stressors and head nurses’ transactional and transformational leadership on the levels of emotional exhaustion experienced among their staff.

Methodological design and research methods. A questionnaire was sent to all nurses of a university hospital. Usable returns were received from 625 nurses, giving a response rate of 39·2%. Data were treated using correlational analyses and multiple regression. The latter modelled stressors and leadership as predictors of nurses’ reported emotional exhaustion.

Measures. Work stressors were assessed using the Nursing Stress Scale (NSS) which comprises 34 items divided into three subscales (referring to stress from the physical, psychological, and social environment), and the role ambiguity (three items) and conflict (three items) scales. Leadership was measured with the Multifactor Leadership Questionnaire.

Results. In regression analyses, work stressors as a whole were found to explain 22% of the variance in emotional exhaustion whereas leadership dimensions explained 9% of the variance in that outcome measure. Stress emanating from the physical and social environment, role ambiguity, and active management‐by‐exception leadership were significantly associated with increased levels of emotional exhaustion. Transformational and contingent reward leadership did not influence emotional exhaustion.

Limitations. A limitation of this study is that it considered only the emotional exhaustion dimension of burnout. Also, as data were cross‐sectional in nature, conclusions regarding the direction of causality among variables cannot be drawn.

Conclusions. This study provided, for the first time, a test of the influence of leadership on burnout among nurses, taking into account the role of work stressors. Future research is needed to examine if the effects reported herein can be replicated using the two other dimensions of burnout (depersonalization and reduced personal accomplishment).
The development of an alternative method in the assessment of critical thinking as an outcome of nursing education
Authors: Daly William M.
Published: March 2003

The development of an alternative method in the assessment of critical thinking as an outcome of nursing education

Rationale. Critical thinking is currently a highly valued educational outcome throughout the educational spectrum, but particularly so in relation to higher and professional education. Nursing education worldwide is also embracing the construct critical thinking as a desirable educational outcome, to the extent that some commentators refer to the importance of critical thinking in nursing as a given. The body of evidence relating to the impact that nursing education has upon the development of critical thinking is currently inconclusive. Many commentators claim that this may be because the instruments used in many studies are not sufficiently domain‐specific.

Study aims. The primary purpose of this descriptive‐illuminative study was to explore and develop an alternative domain‐specific method for identifying critical thinking in student nurses’ reasoning processes.

Design. A longitudinal multimethod design incorporating across‐method triangulation has been utilized for this purpose. Data collection from a group of student nurses involved the combination of the Watson and Glaser (1991) critical thinking appraisal test and a researcher developed think aloud technique incorporating a videotaped client simulation, a cognitive task and stimulated recall strategy.

Findings. Findings indicate no significant differences in pre and postprogramme Watson–Glaser mean scores. With regard to the think aloud evidence the sample consistently displayed evidence of reasoning that reflected an absolutist epistemology portraying limited evidence of critical thinking. In instances where more complex reasoning was demonstrated there was evidence to suggest that metacognitive strategies may contribute to this phenomenon.

Conclusions. The findings make a further contribution to the assessment of critical thinking and raise interesting challenges to future curriculum development in nursing education, assessment of learning and nursing practice.