bluuebunny/crossref_metadata_2025 huggingface dataset:
Synergy: working together with volunteers in community well woman clinics
Authors: Merrell Joy , Williams Anne
Published: March 2003

Synergy: working together with volunteers in community well woman clinics

Despite promotion of the participation of volunteers in community and primary care services, there are few British studies which have explored the benefits and challenges of collaborative working between volunteer and paid workers, and in particular, women’s experiences of volunteering within the National Health Service (NHS). The study presented here seeks to add to the limited, existing knowledge in this area. The experiences of volunteer and paid workers working together in two community well woman clinics are discussed, focusing on the benefits of working together for volunteers, paid workers and clients. Discussion is based on data collected over an 18‐month period of participant observation in two community well woman clinics, interviews with 26 volunteer and paid workers and a review of the clinics’ operational policy documents. Drawing on the concept of synergy, relationships between volunteer and paid workers are illuminated. In this paper it is argued that working together renders the opportunity for volunteer and paid workers to share insights, perspectives and approaches which enhance clients’ health assessments. It provides an added value dimension to client care and yields benefits for the service provider. The implications of the study for practice and policy are considered.
Nurses’ and physicians’ narratives about long‐term non‐malignant pain among men
Authors: Paulson Margareta , Danielson Ella , Norberg Astrid
Published: March 2003

Nurses’ and physicians’ narratives about long‐term non‐malignant pain among men

The aim of this study was to illuminate the meaning of skilled nurses’ and physicians’ lived experiences in their encounters with men suffering from long‐term, non‐malignant pain of at least 6 months duration. Seventeen nurses and four physicians participated in the study. A phenomenological‐hermeneutic method was used. In the analysis three themes, ‘needing to be manly’, ‘struggling for relief from pain’ and ‘needing human support’ emerged. The phenomenon ‘confirmation’ was especially important in all three themes. This study indicates that confirmation of the theme ‘needing to be manly’ means that nurses’ and physicians’ must have such a relationship with these men that they really feel respected. Confirmation of the theme ‘struggling for relief from pain’ means that the care givers must convince these men that they really believe each unique individual’s narratives. Confirmation of the theme ‘needing human support’ means that nurses and physicians have to behave in such a way that these men are convinced that the caregivers really care about them. When the men felt confirmation they dared to disclose their pain experiences more honestly. This is a preliminary prerequisite for nurses’ and physicians’ potential to help these men.
Evaluation of reflective learning in a psychodynamic group of nurses caring for terminally ill patients
Authors: Von Klitzing Waltraut
Published: March 2003

Evaluation of reflective learning in a psychodynamic group of nurses caring for terminally ill patients

The development of a psychodynamic group comprising seven female nurses was studied for 1 year (31 sessions). The group was part of a 1‐year postgraduate training in patient‐centred nursing. The members of the group all worked on the same unit; none of them left the unit or the group during the study. As the nurse–patient relationship is considered to be crucial for patient‐centred nursing, the group sessions focused on the problems which the nurses experienced in their relationships with the patients. The objective of the group‐work was to improve the nurses’ ability to reflect on these relationships. The purpose of the study was to evaluate the group sessions, concentrating on the characteristics of patients selected for discussions, group process over time, and impact of specific patient characteristics on the group‐work. Transcriptions of the tape‐recorded group sessions were made for systematic analysis. A category system was developed and validated to rate reflection about the patient, the nurses themselves and the nurse–patient relationship. The results showed that the nurses over‐proportionally selected terminally ill patients, as well as patients who were female and within a similar age range as themselves. These results could be due to an identification with these patients, causing increased psychological stress on the nurses. Throughout the year, the nurses’ verbal activity and their reflections about their patients increased, whereas their reflections about themselves decreased. The need to withdraw and protect oneself by focusing more on the patient than on oneself might have been a strategy the nurses used to cope with growing stress.
Empathy has not been measured in clients’ terms or effectively taught: a review of the literature
Authors: Reynolds William J. , Scott Brian , Jessiman Wendy C.
Published: March 2003

Empathy has not been measured in clients’ terms or effectively taught: a review of the literature

Empathy, the ability to communicate an understanding of a client’s world, is said to be a crucial component of all helping relationships. The first part of this paper focuses on the failure of measures of empathy to reflect clients’ views about the ability to offer empathy. It is argued that, if clients are able to perceive the amount of empathy in helping relationships, they are able to advise professionals about how to offer empathy. The second part of this paper examines the inconclusive research evidence that existing courses have enabled professionals to offer empathy, and the disagreement about how empathy is best taught. The literature reviewed in this paper substantiates these observations.
Placing empowerment research within an action research typology
Authors: Sturt Jackie
Published: March 2003

Placing empowerment research within an action research typology

The focus of this paper is to use three action research typologies to consider retrospectively, and understand, the processes of an empirical study. The typologies are used to plot the changing emphasis of collaborative action research with a primary health care team that addressed their health promotion practice. The study implemented self‐efficacy theory into the health promotion practice of a primary health care team and developed a self‐efficacy framework for smoking cessation. The framework had some success in aiding practitioners in their work despite the patients’ disinterest in smoking cessation. Two action research types can be identified within the study, a technical/experimental approach which surrounded the use of a researcher‐led theoretical agenda, whereas the research facilitation was informed by critical theory and was classified as an enhancement/empowering action research type. This paper demonstrates the conflicting natures of these types which, in this study, resulted in positive outcomes associated with the experimental/technical approach but only at the expense of professional empowerment. The findings of this study imply that theoretically‐led empowering action research was an incompatible combination in this instance and this potential conflict needs to be addressed by researchers engaging in collaborative research relationships with practitioners.
The Childbirth Self‐Efficacy Inventory: a replication study
Authors: Sinclair Marlene , O’Boyle Colm
Published: March 2003

The Childbirth Self‐Efficacy Inventory: a replication study

In 1993 Lowe developed the Childbirth Self‐Efficacy Inventory (CBSEI). This is a self‐administered, 62‐item, Likert tool which measures women’s confidence in their ability to cope with labour. The tool is valid and reliable for use in American culture but had not been tested in Northern Ireland, therefore a replication study was deemed necessary. The research study set out to replicate Lowe’s study and to test the potential application of this tool in clinical midwifery practice. A convenience sample comprising a cohort of 126 women attending an urban maternity unit in Northern Ireland formed the study population and a response rate of 64% was achieved. The tool was administered antenatally, intranatally and postnatally. The predictive validity of the instrument was tested to determine actual coping behaviours in labour (Pearson’s r=0·3963, P < 0·00 for active labour; r=0·5149, P < 0·00 for second stage labour). This work confirms the CBSEI as a measurement of confidence in women’s ability to cope in labour. The authors recommend the utility of the CBSEI in midwifery practice as a tool for the identification of women who will require extra support in labour and pregnancy.
An evaluation of patients’ quality of life before, 6 weeks and 6 months after total hip replacement surgery
Authors: Knutsson Susanne , Engberg Ingegerd Bergbom
Published: March 2003

An evaluation of patients’ quality of life before, 6 weeks and 6 months after total hip replacement surgery

Annually, throughout the world, more than 800 000 primary total hip replacement surgery procedures are performed on patients suffering from hip joint arthrosis. Since 1991, ≈11 000 of these procedures are performed annually in Sweden. This study aimed to investigate any changes in the patients’ life quality 6 weeks and 6 months after their total hip replacement surgery had been performed, compared to that immediately prior to the operation. It also aimed to examine the reason for surgery, the types of prostheses used, postoperative pain, complications and the actual usage of ambulation support. The Sickness Impact Profile self‐appraisal instrument, together with personal patient interviews have been used as the basis of the research. A total of 51 patients responded to the quality of life instrument prior to their operation, 47 of these participated 6 weeks after the operation, and 40 patients 6 months after the operation. Significant differences in patients’ total, physical and psychosocial quality of life 6 months postoperatively compared to the situation prior to the operation were found, but not between the situation before and 6 weeks after the total hip replacement surgery. The majority of patients were of the opinion that it was more important that the pain had disappeared or decreased, than any overall increase in the quality of life. Postoperative complications occurred within 6 weeks, and even after 6 months some patients still suffered from these.
An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service
Authors: Marsden Janet
Published: March 2003

An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service

Service changes in the accident and emergency service at Manchester Royal Eye Hospital in England resulted in a telephone triage‐based referral service for health care professionals. It became clear that this service needed evaluation in order to assure both providers and users of the service that this referral strategy, based on experienced nurse practitioners making decisions about patient priority, was safe and effective. The evaluation was extended to encompass the other area of the service where telephone referrals tend to be directly from patients. A mixed method was used. Information gained within the telephone triage conversation was compared with a final diagnosis through retrospective analysis of secondary data; the documentation of those patients who were not given access to the service initially was followed‐up to ensure that this decision was safe and a number of nurses were questioned about telephone information gathering, using partially structured interviews. The study showed that nurse practitioners within the accident and emergency service were able to elicit accurate information from the telephone triage conversation on which to base a decision about patient access in most cases (76% over the whole service). This resulted in the appropriate prioritization of patients. No patient who needed urgent access to the service was denied it. The decisions made to deny urgent appointments to a number of patients were safe in all cases. It appears that one of the problem areas in the gathering of information for prioritization purposes is in the nurses’ telephone triage discussions with some, but by no means all, doctors. Some general practitioners seemed unwilling to discuss the patient and give accurate information to a nurse and this is an area which appears to need some further work.
How women receiving adjuvant chemotherapy for breast cancer cope with their treatment: a risk management perspective
Authors: Cowley Lorraine , Heyman Bob , Stanton Michelle , Milner Susan J.
Published: March 2003

How women receiving adjuvant chemotherapy for breast cancer cope with their treatment: a risk management perspective

Retrospective interviews were undertaken with 12 women who had received an 18‐week course of adjuvant chemotherapy for positive node breast cancer 1 year previously, and who had not experienced cancer recurrence. The nonstandardized interviews covered women’s preconceptions about adjuvant chemotherapy, their information needs, and the impact of treatment. The qualitative data analysis drew upon the theoretical ideas of patient career, trajectory projection and qualitative risk analysis. Some women regarded adjuvant chemotherapy as no more than an ‘insurance policy’. This perception may have arisen because doctors, attempting to minimize patient anxiety, did not discuss the high risk of disease recurrence which they faced. Other women equated adjuvant with curative chemotherapy, and anticipated hair loss or almost certain death. The women tried to cope with the physical and mental suffering associated with adjuvant chemotherapy through normalizing strategies, such as keeping a brave face, maintaining previous patterns of life, looking for humour and restructuring time. However, the rapid alterations in physical and mental state resulting from cycles of adjuvant chemotherapy resulted in a ‘rollercoaster’ experience for women which made normalization more difficult. Health professionals caring for women who must cope with uncertain future trajectories need to manage a risk communication dilemma. A strategy of fully informing women about the risks they face may cause anxiety or depression, and even impede recovery, given the evidence for psychological influences on health outcomes. But, if women do not understand the medical thinking on which their treatment is based, their misconceptions may be equally damaging.
Language, discourse and the chronotope: applying literary theory to the narratives in health care
Authors: Harden Jane
Published: March 2003

Language, discourse and the chronotope: applying literary theory to the narratives in health care

One of the most significant developments in nursing has been the recognition of the power of the narrative approach. Narrative knowing has evolved from both the patient and the nurse experience. In the case of the individual, it can be told through case history (clinical) and life story (theory‐building). The life story of the individual as a patient represents him or her to the nurse and is in turn responded to through appropriate care. Alternatively, the life story of the individual as research participant represents him or her to the researcher and is in turn responded to through appropriate interpretation. The value of the narrative is that the ‘otherness’ of the teller/writer can be regarded by the listener/reader. There resides a major tension, however, whether in theory building or the practice setting: meaning What this paper argues, is that the emphasis placed on the subject to provide an authentic story of their life is misguided, whether in the care setting or in interpretive research. My contention is that we need to develop a less naive understanding of the complexities of the language with which the individual speaks. This can be achieved by adopting post‐structural analyses of the spoken or written word, from both the originator’s and recipient’s experiences. By reconceptualizing such narratives as ‘autobiographies’ it is possible to borrow from the field of literary criticism a tool known as chronotopic analysis to perform this task.
Dimensions of perioperative nursing for a national specialty nomenclature
Authors: Kleinbeck Susan V.M.
Published: March 2003

Dimensions of perioperative nursing for a national specialty nomenclature

Before nurses can develop a clinical database capable of evaluating quality of care or validating their impact on health or illness, they must describe the basic dimensions of their specialty. The purpose of this study was to define the dimensions of clinical perioperative nursing practice. Experienced perioperative nurses (n=239) were mailed a survey and asked to rank the frequency with which specific patient diagnoses occurred in their daily practice (1=never occurs; 5=occurs almost all the time) and the priority of treatment each diagnosis required (1=never requires attention of the nurse; 5=demands immediate attention of the nurse). Completion of the form indicated consent to participate in the study. Following a principal component analysis and theoretical discussion by perioperative experts, four dimensions of perioperative practice were delineated: (a) patient and family behavioural responses to surgery (26·7% of variance, α=0·92); (b) perioperative patient safety (10·1% of variance, α=0·89); (c) perioperative physiological response to surgery (5·7% of variance, α=0·87); and (d) the health systems required to deliver perioperative care. Dimensions extracted in this analysis served as the domains for the new perioperative nursing nomenclature.
New perspectives on vulnerability using emic and etic approaches
Authors: Spiers Judith
Published: March 2003

New perspectives on vulnerability using emic and etic approaches

The concept of vulnerability has not been developed theoretically from a nursing perspective. It has been viewed epidemiologically as population‐based relative risk with little consideration of its experiential qualities. The purpose of this paper is to analyse critically the use of the term vulnerability using elements of concept clarification and a critical literature review. A new perspective of vulnerability is offered based on differentiating between the concepts of risk and experience. Risk consists of assumptions from etic or external evaluation of relative danger while lived experience informs an emic or personal interpretation. Assumptions related to the etic view include normative social values, objective harm and endangerment, and social sanction for intervention. An emic view of vulnerability is based on experiential perception of challenge to personal integrity and the universal and mutual nature of the phenomenon. Questions about the evaluation of harm, potential for growth, subjectivity and objectivity, social sanction and capacity for action, can help clarify the range between these two dimensions.
Wound care in the community setting: clinical decision making in context
Authors: Hallett Christine E. , Austin Lynn , Caress Ann , Luker Karen A.
Published: March 2003

Wound care in the community setting: clinical decision making in context

Sixty‐two community nurses in northern England of grades B and D to H were interviewed by a team of four researchers. The interviews were semi‐structured, and were tape‐recorded, fully transcribed and content analysed. They were conducted as part of a larger study, the aim of which was to examine community nurses’ perceptions of quality in nursing care. One of the main themes the work focused on was decision‐making as an element of quality. Data relating to wound care were considered from the perspective of the insights they offered into clinical decision‐making. Data were interpreted in the light of a literature review in which a distinction had been made between theories which represented clinical decision‐making as a linear or staged process and those which represented it as intuitive. Within the former category, three sub‐categories were suggested: theorists could be divided into ‘pragmatists’, ‘systematisers’ and those who advocated ‘diagnostic reasoning’. The interpretation of the data suggested that the clinical decisions made by community nurses in the area of wound care appeared largely intuitive, yet were also closely related to ‘diagnostic reasoning’. They were furthermore based on a range of sources of information and justified by a number of different types of rationale.
Fit for purpose: the relevance of Masters preparation for the professional practice of nursing. A 10‐year follow‐up study of postgraduate nursing courses in the University of Edinburgh
Authors: Whyte Dorothy A. , Lugton Jean , Fawcett Tonks N.
Published: March 2003

Fit for purpose: the relevance of Masters preparation for the professional practice of nursing. A 10‐year follow‐up study of postgraduate nursing courses in the University of Edinburgh

Continuing education is now recognized as essential if nursing is to develop as a profession. United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) consultations are currently seeking to establish appropriate preparation for a ‘higher level of practice’ in the United Kingdom. The relevance of Masters level education to developing professional roles merits examination. To this end the results of a 10‐year follow‐up study of graduates from the Masters programme at the University of Edinburgh are reported. The sample was the entire cohorts of nurses who graduated with a Masters degree in the academic sessions from 1986 to 1996. A postal questionnaire was designed consisting of mainly closed questions to facilitate coding and analysis but also including some open questions to allow for more qualitative data to be elicited. The findings indicated clearly that the possession of an MSc degree opened up job opportunities and where promotion was not identified, the process of study at a higher level was still perceived as relevant to the work environment. This applied as much to the context of clinical practice as to that of management, education or research. The perceived enhancement of clinical practice from a generic Masters programme was considered a significant finding. Also emerging from the data was an associated sense of personal satisfaction and achievement that related to the acquisition of academic skills and the ultimate reward of Masters status. The concept of personal growth, however, emerged as a distinct entity from that of satisfaction and achievement, relating specifically to the concept of intellectual sharing, the broadening of perspectives and the development of advanced powers of reasoning.
Sense of coherence: quality of life before and after coronary artery bypass surgery — a longitudinal study
Authors: Karlsson Ingela , Berglin Eva , Larsson Pär A.
Published: March 2003

Sense of coherence: quality of life before and after coronary artery bypass surgery — a longitudinal study

The attention to patient outcome has nowadays extended from morbidity and mortality to an aspect of patients’ benefits in terms of quality of life. One factor crucial for quality of life is coping capacity, in this study represented by the sense of coherence concept. Physical status and emotional state (often measured by comprehensive instruments not always suitable for clinical use) are also additionally used to reflect quality of life. The purpose was therefore to study sense of coherence and emotional state as indirect measures of quality of life in relation to coronary artery bypass grafting surgery. One hundred and eleven patients were studied by a developed questionnaire on five occasions in relation to the surgery: the week before the angiography, the day before surgery and then at 3, 6, and 12 months post‐operatively. The main findings were: (1) The sense of coherence was changed (more than ±10%) from before to 1 year after surgery in 41% of the patients, which is contrary to the theory of sense of coherence as a stable personality characteristic in adults. (2) Experience of depressed mood, stress, and anxiety decreased significantly from before to after surgery. (3) Beneficial outcome with regard to sense of coherence was significantly related to less experience of loneliness, depressed mood, stress and anxiety, and to less experience of chest pain 1 year after surgery. In conclusion, sense of coherence and emotional state variables, are suggested to be valuable as measurements of quality of life in relation to coronary artery bypass grafting surgery.
Nursing, empathy and perception of the moral
Authors: Reynolds  , Scott  , Austin Wendy
Published: March 2003

Nursing, empathy and perception of the moral

Over the last 15–20 years we have witnessed a dramatic interest in the moral domain of clinical practice. There has also been a growing focus on the patient as an individual whose individuality and perspective must be respected. It is argued in this paper that a key to both these concerns is a consideration of the role of empathy in both perceiving the moral aspects and issues of practice, and in providing adequate support for patients. In this paper the meaning and components of empathy are discussed in the context of human receptivity and preconditions of moral performance. However, we also draw attention to empirical studies which suggest that even following adequate educational preparation, if the clinical environment and the structures within which care is delivered are not supportive, the practitioner’s ability to perceive the moral is limited. In such circumstances, patients are in danger of receiving less than appropriate care — from both the moral and professional perspective.
Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery
Authors: Sloan Graham , White Craig A. , Coit Frank
Published: March 2003

Cognitive therapy supervision as a framework for clinical supervision in nursing: using structure to guide discovery

Cognitive therapy has an undisputed evidence base upon which its clinical application flourishes. This approach is now a well‐recognized and widely adopted method used in the treatment of a diversity of psychological problems. More recently, prominent innovators of this psychotherapy have devised a framework to guide the clinical supervision of cognitive therapists. In keeping with its therapeutic application, the cognitive therapy framework for supervision is focused, structured, educational and collaborative. It serves to enhance the therapeutic proficiency of the cognitive therapist. In contrast, the supervision models reported in the recent nursing literature are less precise in their mission and when evaluated their contribution to nursing is shown to be dubious. Following an overview of the supervision models commonly cited in the nursing literature, a more focused comment on the evaluative research concerning Proctor's three‐function interactive model will be offered. It is suggested that the unconvincing research findings may be related to the conceptual muddle surrounding clinical supervision, and the expectation for clinical supervision to deliver more than an opportunity for the progression of our therapeutic integrity. From this, a cognitive therapy supervision framework is described and suggested by the authors as a structure from which supervisors can guide discovery.
Who cares? Offering emotion work as a ‘gift’ in the nursing labour process
Authors: Bolton Sharon C.
Published: March 2003

Who cares? Offering emotion work as a ‘gift’ in the nursing labour process

The emotional elements of the nursing labour process are being recognized increasingly. Many commentators stress that nurses’‘emotional labour’ is hard and productive work and should be valued in the same way as physical or technical labour. However, the term ‘emotional labour’ fails to conceptualize the many occasions when nurses not only work hard on their emotions in order to present the detached face of a professional carer, but also to offer authentic caring behaviour to patients in their care. Using qualitative data collected from a group of gynaecology nurses in an English National Health Service (NHS) Trust hospital, this paper argues that nursing work is emotionally complex and may be better understood by utilizing a combination of Hochschild's concepts: emotion work as a ‘gift’ in addition to ‘emotional labour’. The gynaecology nurses in this study describe their work as ‘emotionful’ and therefore it could be said that this particular group of nurses represent a distinct example. Nevertheless, though it is impossible to generalize from limited data, the research presented in this paper does highlight the emotional complexity of the nursing labour process, expands the current conceptual analysis, and offers a path for future research. The examination further emphasizes the need to understand and value the motivations behind nurses’ emotion work and their wish to maintain caring as a central value in professional nursing.
Using web‐based discussion as a teaching strategy: bioethics as an exemplar
Authors: Ellenchild Pinch Winifred J. , Graves Janet K.
Published: March 2003

Using web‐based discussion as a teaching strategy: bioethics as an exemplar

Nurses are required to be competent in the area of bioethics based on several accreditation standards. Bioethics courses are one strategy to develop such a competency. Bioethics education itself has various goals including the need to engage in discussion and the ability to debate diverse issues. Providing an educational experience that meets both disciplinary and topic needs can be challenging. On‐line conferencing through WebBoard 3·0, a web‐based discussion software program, within a graduate level bioethics course successfully contributed to meeting these needs. A technical description of the WebBoard is provided in the following discussion along with a description of the integration of this device into a bioethics course. The WebBoard conferencing allowed all students to enter the class discussion and especially facilitated discussion for reticent speakers and distance learners. Evaluations of the bioethics course from both the faculty and students’ perspectives were generally positive. Most students found the technique easy to use and liked the asynchronous format that allowed them to read and contribute at any hour of the day or night. Despite the labour intensive nature of this experience, the strategy ensured participation by every student, a major goal of the project. Developing an interdisciplinary situation would increase the value of such an experience.
The contexts of adherence for African Americans with high blood pressure
Authors: Rose Linda E. , Kim Miyong T. , Dennison Cheryl R. , Hill Martha N.
Published: March 2003

The contexts of adherence for African Americans with high blood pressure

African American men between the ages of 18 and 49 years have the lowest rates of awareness, treatment and control of high blood pressure (HBP) of all age/race/gender groups in the United States. A qualitative study was done to gain an understanding of urban black males’ experiences of living with HBP. In‐depth semi‐structured interviews were conducted with 19 black males. The interviews explored perceptions of health, health problems and priorities, and concerns of daily living that influenced appointment keeping and medication taking. The sample was a subset of 309 men participating in a 3‐year clinical trial to improve HBP control in an inner city African‐American population. Content analysis of transcribed interviews identified the following themes and related concerns: (a) personal contexts: meaning of health, high blood pressure and treatments; (b) social context: living as a young black male in an urban environment; and (c) cultural context of relating: patient–provider relationship can make a difference. Influencing participants’ responses were: interpreting symptoms; adjusting medication taking; protecting personal privacy; allocating limited resources; dealing with addiction; and feeling cared for by a health care provider. Adherence appeared to be multifaceted and changing depending upon: the men's social, economic and personal circumstances; empathetic and non‐judgemental assistance from providers; financial concerns and employment; and drug addiction. Findings are useful in refining high blood pressure interventions.
Personal control in pain relief during labour
Authors: Wright Marion E. , McCrea Hally , Stringer Maurice , Murphy‐Black Tricia
Published: March 2003

Personal control in pain relief during labour

Personal control is a central feature of women’s involvement in their childbirth experiences. To achieve this control tacit rules and guidelines are applied to define how women and the professionals who care for them should behave. This study investigated the extent to which women exercised control in pain relief during the first stage of labour by comparing (a) the rules which they held prior to childbirth (2–3 cm cervical dilatation) with those which they afterwards felt applied to their labour and (b) the rules held by the women before and after childbirth with those held by the midwives. In a quantitative study using a repeated measures design, a questionnaire was administered to 35 midwives and to 100 women prior to and within 24 hours following their delivery. Consistency of the women’s scores before and after childbirth, indicated by few statistically significant differences, tended to confirm their rules on control of pain relief. Some of the rules were held even more strongly following childbirth. A surprising finding was the even stronger agreement by midwives with some of the rules. There was a definite trend for many of the rules held by the women prior to childbirth to increase following birth towards those of the midwives. This could be the result of the experience of childbirth per se but the possibility that it was contributed to by the influence of the midwives cannot be ruled out and warrants further research. An interesting hierarchy in the rules for compliance with professional care has been highlighted.
Psychodynamic sources of resistance among student nurses: some observations in a human relations context
Authors: Gilmartin Jo
Published: March 2003

Psychodynamic sources of resistance among student nurses: some observations in a human relations context

The nurse–patient relationship is considered to be a crucial part of the daily routine for many nurses; however, little evidence is available regarding how student nurses cope with learning human skills. Few researchers have considered how students engage with or resist the learning process. The aim of this study is to examine interpersonal matters and explore psychodynamic sources of resistance encountered among student nurses in an interpersonal skills context. A qualitative approach was adopted with a focus on individual case studies, using the in‐depth interview as the major mode of data collection combined with observation. The four types of student that emerged from the data are emphasized, ranging from type 1 who were extremely reluctant to self‐disclose, to type 4 who were more confident and free‐flowing. The major characteristics pertaining to each type of student are outlined. While some characteristics seem to be related to childhood struggles and years of over‐adaptation, others relate to factors that influence the learning climate. Particular attention is given to the psychological understanding of their predicament, including accounts of childhood and self‐image. The implications for nurse education and limitations of this study are also considered.
Comparison of integrated and consultation‐liaison models for providing mental health care in general practice in New South Wales, Australia
Authors: Harmon Karen , Carr Vaughan J. , Lewin Terry J.
Published: March 2003

Comparison of integrated and consultation‐liaison models for providing mental health care in general practice in New South Wales, Australia

The characteristics of a new service providing integrated mental health care in general practice are described and comparisons made with an earlier consultation‐liaison (C‐L) psychiatry service in general practice, including the range and severity of psychiatric problems, levels of general practitioner (GP) and psychiatrist involvement, and patterns of care. Clinical audit checklists were completed by two experienced mental health nurses for the first 100 patients referred to the service, which was conducted in conjunction with 8 general practices in the Port Stephens region of New South Wales, Australia. The mean age of the first 100 referrals was 38·05 years, 63·0% were female, and 55·0% were referred from GPs. Outcome measures included: referral information, patients’ demographic and diagnostic characteristics, psychosocial functioning, psychotropic medication, management, and number of contacts with the mental health nurses. Relative to the earlier C‐L psychiatry service in general practice, the integrated service treated a broader range of diagnostic groups with higher levels of disability. There were higher rates of mood (48·0%) and psychotic (20·0%) disorders and lower rates of adjustment (2·0%) disorders. One‐third of patients were seen by an additional agency, other than the mental health nurses or GPs. Patients averaged 4·95 contacts with the mental health nurses, with marked variations according to diagnostic group. To date, the new service has been well received. It is highly accessible, acceptable to GPs and patients, caters for a broad range of psychopathology, including severe mental illness, and appears to be sufficiently versatile to be adaptable to a variety of treatment settings.
Women recovering from first‐time myocardial infarction (MI): a feminist qualitative study
Authors: Jackson Debra , Daly John , Davidson Patricia , Elliott Doug , Cameron‐Traub Elizabeth , Wade Vicki , Chin Christine , Salamonson Yenna
Published: March 2003

Women recovering from first‐time myocardial infarction (MI): a feminist qualitative study

Although myocardial infarction (MI) is a leading cause of death and disablement for women internationally, little is known about women’s recovery. This paper describes an exploratory descriptive study that was informed by feminist principles, and which aimed to explore the recovery experiences of a group of women survivors of first‐time MI in the initial period following discharge from hospital. A total of 10 female survivors were interviewed using an open‐ended semi‐structured interview schedule administered at 7, 14 and 21 days post‐hospital discharge. Findings revealed that recovery was experienced as a complex process, initially characterized by fear and uncertainty. Over the duration of the study these feelings were replaced with a more positive outlook, a return of energy, and a sense of confidence in the future. Participants identified an unmet need for reliable information which persisted over the duration of the study. The findings of this study have implications for nursing practice and research. Chief among these is the issue of effective provision of information to women following an acute MI. The importance of providing relevant information to be understood and retained by people experiencing crisis cannot be overstated. Equally important are the provision of opportunities for patients to have regular contact with health professionals to question and seek clarifying information. These findings should now be tested on larger populations.
A dirty business: caring for people who are a nuisance or a danger
Authors: Godin Paul
Published: March 2003

A dirty business: caring for people who are a nuisance or a danger

This paper argues that developments in chemical, administrative and legal methods of control, once confined to the asylum, now operate over mental patients in the community. Differences between the hospital and the community have thus been eroded. This paper therefore seeks to understand how mid‐twentieth century sociology, that informed an understanding of the asylum prior to its demise, can be usefully revisited to inform an understanding of the contemporary practice of community mental health nursing. It is argued that in their development, community mental health nurses (CMHNs) have endeavoured to associate themselves with the clean work of caring, rather than with the dirty work of coercive control. However, CMHNs now find themselves representing societal and psychiatric demands for the greater control of mental patients in the community to their clients. Issues of control and care (coercion and persuasion) in community mental health care nursing practice are thus considered in relation to theory regarding the imposition of power.
Data collection with adolescents
Authors: Dashiff Carol
Published: March 2003

Data collection with adolescents

Adolescence spans a wide time period during which development and its context influence behaviour and the strategies used for data collection. This article addresses problems that can be anticipated in data collection with adolescents. Problems are presented that are associated with adolescent developmental capacities, adolescent developmental change and stability, gender and ethnicity. Some problems are specific to certain settings or to certain data collection methods.

The application of theoretical and empirical knowledge about adolescent development can strengthen data collection instruments and procedures. Strategies to enhance data collection include carefully defining adolescence and tailoring procedures and protocols based on a theoretical understanding of the biological, cognitive and emotional development of adolescents in conjunction with an understanding of the characteristics of the research setting.

Adolescent research settings can pose challenges. Investigators must understand clinic routines in evaluating the feasibility of implementing protocols and collecting data where there are distractions and time constraints. In education settings, strategies must be used to collect data in a group context where peer pressure can affect responses. In home settings, ingrained response patterns and family norms can also impede obtaining valid perspectives from adolescents.

Ethnicity as well may play an important role that must be addressed when designing and implementing data collection with adolescents. Procedures and instruments selected to collect data need to address variations in ethnicity.
Action research in action: reflections on a project to introduce Clinical Practice Facilitators to an acute hospital setting
Authors: Kelly Daniel , Simpson Susan
Published: March 2003

Action research in action: reflections on a project to introduce Clinical Practice Facilitators to an acute hospital setting

Aims of the paper. The process and philosophical basis of action research are discussed in this article by reviewing the insights that were gained from a study designed to enhance the support available to junior nursing staff in an acute hospital setting.

Rationale. It has been well documented that newly qualified nurses require help to develop professional competencies. With this in mind, the role of Clinical Practice Facilitator was established within a National Health Service (NHS) Trust to enhance clinical skill acquisition and the professional development of newly registered nurses and health care assistants.

Design. In order to facilitate the inception, development and subsequent evaluation of these new roles, an action research approach was adopted. Strategies used to encourage collaboration and flexibility during the project are also discussed.

Results. The primary aims of the project were achieved and the authors suggest that the choice of action research was significant to the successful outcome. However, a number of issues arose which deserve more attention including the importance of the interpersonal skills of the action researcher and the value of action research to facilitate change which is relevant at both an individual and organizational level.
Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study
Authors: Kylmä Jari , Vehviläinen‐Julkunen Katri , Lähdevirta Juhani
Published: March 2003

Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study

Background. Hope, despair or hopelessness have been detected in several research reports as important elements of the lives of persons living with human immunodeficiency virus (HIV) (PLWH) or acquired immunodeficiency syndrome (AIDS) (PLWA). However, there is an obvious gap in the literature suggesting a need to study the overall dynamics of hope (including both hope and despair or hopelessness) along the HIV spectrum from PLWHs’ and PLWAs’ perspective.

Aim. The purpose of this study was to describe the dynamics of hope in living with HIV/AIDS.

Methods. The data were collected through interviewing 10 PLWHs/PLWAs and analysed using a grounded theory method.

Findings. The dynamics of hope is a multifaceted and complex combination of ‘hope’, ‘despair’ and ‘hopelessness’. It comprises balancing between ‘believing life to be worth living at the present and in the future’, ‘losing one’s grip and sinking into narrowing existence vs. fighting against sinking’ and ‘giving up in the face of belief in nonexisting future’. A dynamic alternation between hope, despair and hopelessness takes place in the presence of factors that contribute to the ‘folding’ and ‘unfolding’ possibilities in everyday life. Factors contributing to the folding possibilities include ‘losing’, ‘fear’, ‘uncertainty’, ‘problems in care’, ‘HIV/AIDS in close ones’, ‘difficulties in relationships’ and ‘negative public images and attitudes concerning HIV’. Factors contributing to the unfolding possibilities are ‘constructive life experiences’, ‘wishing not to have HIV while uncertain’, ‘constructive relationships’, ‘ability to control one’s life’, ‘finding the meaning of life and zest for life’, ‘caring’, ‘noticing one’s improved health and the continuance of life’, ‘increasingly positive attitudes concerning HIV‐positive people’ and ‘protection by law’.

Conclusions. The dynamics of hope discovered in this study present new conceptualization, where hope, despair and hopelessness are viewed in relation to each other. The emerged definitions may be used in clinical practice to identify these phenomena in individuals with HIV/AIDS. The discovered factors contributing to the folding and unfolding possibilities can be used in clinical practice to help the individuals along the dynamics of hope.