bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonpharmacological methods in relieving children’s postoperative pain: a survey on hospital nurses in Finland
Authors: Pölkki Tarja , Vehviläinen‐Julkunen Katri , Pietilä Anna‐Maija
Published: March 2003

Nonpharmacological methods in relieving children’s postoperative pain: a survey on hospital nurses in Finland

Aim of the study. The aim of this study was to describe nurses’ use of selected nonpharmacological methods in relieving 8–12‐year‐old children’s postoperative pain in hospital.

Methods. The convenience sample consisted of 162 nurses working on the paediatric surgical wards in the five Finnish university hospitals. An extensive questionnaire, including a five‐point Likert‐scale, on the nurses’ use of selected nonpharmacological methods and demographic data was used as a method of data collection. The response rate was 99%. Descriptive statistics as well as nonparametric Kruskall–Wallis ANOVA and the chi‐squared test were used as statistical methods.

Results. The study indicates that emotional support, helping with daily activities and creating a comfortable environment were reported to be used routinely, whereas the cognitive‐behavioural and physical methods included some less frequently used and less well known strategies. The results also show that attributes, such as the nurses’ age, education, and work experience, the number of children the nurses had, the nurses’ experiences of hospitalization of their children as well as the hospital and the place of work, were significantly related to the use of some nonpharmacological methods.

Conclusions. The nurses used versatile nonpharmacological methods in children’s postoperative pain relief, although some defects could be observed. More research is needed on the methods used by nurses to relieve children’s pain in different patient groups and the factors which hinder or promote nurses’ use of pain alleviation methods in the clinical practice.
Mutual relating: developing interpersonal relationships in the community
Authors: McCann Terence V. , Baker Helen
Published: March 2003

Mutual relating: developing interpersonal relationships in the community

Aim of the paper. This paper, which is part of a larger study that examined how community mental health nurses promoted wellness with young adult who were experiencing an early episode of psychotic illness, aims to explicate how nurses develop interpersonal relationships with these consumers.

Rationale. Research into the development of interpersonal skills is important because they are an essential foundation to the promotion of wellness in psychotic illness.

Design/methods. The study used Strauss and Corbin’s approach to grounded theory methodology. Concurrent data collection and analysis was undertaken incorporating interviews and observations. The study took place in the community, in rural and regional New South Wales, Australia, and involved consumers, significant others, and community mental health nurses.

Results. The findings show that several strategies are associated with mutual relating. Attempting to understand necessitates nurses trying to see it from insiders’ points of view, while acknowledging that they can never completely understand their illness experience. Being friendly indicates that the qualities of a friendly relationship should be implicit in a professional friendship. Tuning in involves taking account of and adjusting to consumers’ ways of dressing, communicating, and the types of approaches that consumers prefer. Revealing oneself is a process that helps put both consumers and nurses at ease, and helps dispel the perception consumers take part in a one‐sided relationship. Being there for them, is a particular type of obligation that entails nurses being accountable for the care they provide, being a spokesperson for consumers, if required, and avoiding collusion with others. Related to avoiding collusion, is the issue of maintaining confidentiality, particularly within the context of interacting with significant others.

Conclusion. The results of the study have implications for the way nurses develop and maintain interpersonal relationships with consumers, and this is affected by nurses’ personal and professional attributes.
Adherence to self‐care and glycaemic control among people with insulin‐dependent diabetes mellitus
Authors: Toljamo Maisa , Hentinen Maija
Published: March 2003

Adherence to self‐care and glycaemic control among people with insulin‐dependent diabetes mellitus

Aim of the study.  Factors associated with adherence to self‐care and glycaemic control were studied in 213 people with insulin‐dependent diabetes mellitus using a self‐report questionnaire and a biochemical indicator (glycosylated haemoglobin).

Methods.  The data were collected in the Oulu Health Center and the Central Hospital of Lapland in Northern Finland. The response rate was 76%. In order to verify the reliability and validity of the instruments, we used correlation coefficients, factor analysis and item‐total analysis. Internal consistency was checked by Cronbach’s α. The connections between self‐care and the background variables were examined by cross‐tabulation.

Findings.
 The majority of subjects accomplished their insulin treatment as scheduled, but had more difficulties with the other aspects of self‐care. According to the findings, a fifth (19%) of the respondents were neglecting their self‐care. The others undertook flexible (46%), regimen‐adherent (16%) or self‐planned self‐care (19%). The subjects who were adherent to self‐care had better metabolic control than those who neglected self‐care. According to logistic regression analysis, poor metabolic control (P=0·003), smoking (P=0·009) and living alone (P=0·014) were associated with neglect of self‐care. Gender, concurrent diseases and complications as a result of diabetes increased the risk, but had no significant association with adherence to or neglect of self‐care.

Conclusion.  The findings demonstrated that adherence to self‐care does not always lead to good metabolic control, but neglect of self‐care is likely to lead to poor metabolic control.
Health education, behavioural change and social psychology: nursing’s contribution to health promotion?
Authors: Whitehead Dean
Published: March 2003

Health education, behavioural change and social psychology: nursing’s contribution to health promotion?

Aims.  To critically review the complex processes that underpin the modification of a client’s health‐related behaviour. This paper also seeks to contextualize the operational differences between health‐educating and health‐promoting activities – as a means of rationalizing current practice.

Background.  In ‘health promotional’ encounters, there is a plethora of evidence that suggests that nurses work predominantly within a ‘traditional’ preventative framework of practice. The prevalence of a culturally inherent biomedical framework, governing most nursing practice, tends to reduce health‐related client interventions to little more than one‐off, reductionist information‐giving exercises. The expectation on clients to respond to and subsequently modify their health behaviour, when presented with such information, is unrealistic in most cases. Nurses are often unaware of the extremely complex human phenomena associated with modifying health‐related behaviours and the resultant change processes. In nursing‐related health encounters, the planned or unplanned intervention and the subsequent outcomes are mostly viewed within a too simplistic and superficial context.

Design.  A selective review of the relevant literature.

Conclusion.  Where many nurses believe themselves to be health promotionalists, the likelihood is that they are instead more likely to be traditional health educationalists. Not that this is the main problem, in itself – but if nursing is to progress on this issue, it must first become more effective in delivering its current health education initiatives. Armed with further knowledge and understanding of their practices, health educators are far more likely to achieve a degree of success in their behavioural‐change encounters as well as approach the intervention with a far more realistic expectation of outcome. Without this further understanding, it is argued that the integration of health educational initiatives into nursing practice will generally do little or nothing to change the health status of clients.
A study of practising nurses’ perceptions and experiences of intimacy within the nurse–patient relationship
Authors: Williams Angela
Published: March 2003

A study of practising nurses’ perceptions and experiences of intimacy within the nurse–patient relationship

Aim. This study investigated the perceptions and experiences of intimacy within the nurse–patient relationship.

Background. Intimacy is an increasingly recognized nursing concept, which is intrinsically related to the therapeutic potential of nursing. However, the nature of intimacy as practised in nursing remains largely unexplored. A qualitative design was used and a purposive sample of 10 nurses was involved. Data were collected by means of semistructured interviews and diaries.

Findings. Content analysis of the data yielded five categories relating to the nature of intimacy, involvement, resources, affinity for the patient and the rejection of intimacy. This paper focuses on the first of these categories. Intimacy emerged as a complex concept and included the subcategories of disclosure, levels of disclosure, sharing personal experiences, patient dependency and vulnerability, instrumental touch and intimacy and intimacy as an inappropriate term for the nurse–patient relationship. These findings are discussed in the light of existing theories and recommendations made for further research to expand and develop the issues highlighted.

Conclusions. The paper concludes by highlighting the complexity of the concept and identifies some of the constraints to intimacy in practice such as insufficient resources, the health care system and role changes.
Women’s narratives during the acute phase of their myocardial infarction
Authors: Svedlund Marianne , Danielson Ella , Norberg Astrid
Published: March 2003

Women’s narratives during the acute phase of their myocardial infarction

Aim. The purpose of this study was to illuminate the meaning of lived experiences during the acute phase of an acute myocardial infarction (AMI).

Method. Ten women (< 60 years old) afflicted with AMI narrated their experiences during their stay in the coronary care unit (CCU). The interview texts were interpreted using a method with a phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Three themes were then extracted from the text.

Findings. One theme was ‘oneself as vulnerable’ with the subthemes: ‘the feeling of being dependent upon others’, ‘the feeling of being insulted’ and ‘the feeling of being a troublesome person’. Another theme was ‘oneself as distanced’, with the subthemes: ‘not facing the reality’, ‘captive in an unreal situation’, and ‘inhibition out of concern for others’. The last theme was: ‘oneself as making sense’ with the subthemes: ‘acquirement of some insight’ and ‘discovery of a new meaning with life’.

Conclusion. The reported comprehensive understanding revealed the phenomena guilt and shame. These, in combination with the experience of being in an unreal situation and the withholding of feelings may have led to a deterioration of communication. It seems that relatives and the staff at CCU were not allowed to share the burden of being afflicted with an AMI.
Improvements in the quality of co‐ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes
Authors: Achterberg Wilco P. , Holtkamp Chantal C. M. , Kerkstra Ada , Pot Anne Margriet , Ooms Marcel E. , Ribbe Miel W.
Published: March 2003

Improvements in the quality of co‐ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes

Aim. To study the effect of implementation of the Resident Assessment Instrument (RAI) on the quality of co‐ordination of nursing care in Dutch nursing homes.

Background. The Resident Assessment Instrument (RAI) was designed to improve the quality of care and quality of life in nursing homes. Until now, only noncontrolled studies on the effects of implementation of the RAI have been carried out.

Design/methods. Quasi‐experimental; intervention wards with RAI compared with wards with no intervention. We used the co‐ordination of nursing care instrument, which includes measures for case history, care plan, end of shift report, communication, patient allocation and patient report. The scores on these scales represent the quality of nursing procedures on a ward. The measurements were done 1 month before and 8 months after RAI‐implementation in 18 wards in 10 nursing homes in the Netherlands.

Results. Out of 348 somatic patients on the participating wards who met the inclusion criteria and signed an informed consent, 278 could be measured at the first and 218 at the second data collection. 175 residents could participate twice. We used a meta‐analysis technique to study the mean differences between eight couples of RAI/control wards before and after the intervention. The mean difference scores showed significant positive improvement in the RAI group for case history, there were minor (not statistically significant) improvements for all other scores and the total score. These results are encouraging especially in light of the fact that RAI‐implementation in all the experimental wards did not proceed according to plan, owing to staffing and software problems.

Conclusions. We conclude that the RAI has the potential to improve the quality of co‐ordination of care in nursing homes.
Planning strategies for the avoidance of pitfalls in intervention research
Authors: Pruitt Rosanne H. , Privette Arlene B.
Published: March 2003

Planning strategies for the avoidance of pitfalls in intervention research

Background. With the exception of large clinical trials, few studies in nursing and other social sciences test interventions. The discipline of nursing needs to maintain a full range of research designs for continued knowledge development. Intervention research presents unique opportunities and challenges for the novice as well as the seasoned researcher. Some of these methodological challenges include the complex nature of human subjects and interventions, including many factors that interfere with the study variables. Preliminary studies often reveal challenges that may not always be predicted or reflected in research texts. These challenges may be as important as the study results for success in future research efforts.

Purpose. Difficulties encountered in intervention research and suggested strategies for maintaining the integrity of the study are addressed. These challenges include maintaining an adequate sample size, intervention demands, measuring variables, timing issues, and experiencing unexpected events.

Findings and conclusions. Strategies presented include the importance of extensive planning, minimizing subject expectations and rewarding efforts, attention to control group members, incorporating retention strategies, expanding knowledge of variables and the study population, preliminary studies as well as anticipating unexpected events. The need for enhanced communication among nurse researchers, educators and clinicians is addressed. In the current health care arena, nurse researchers must understand organizational dynamics and marketing strategies. Collaborative research efforts can increase the visibility of nursing research as well as funding opportunities.
Adaptation of an instrument to measure the informational needs of men with prostate cancer
Authors: Templeton Hazel R.M. , Coates
Published: March 2003

Adaptation of an instrument to measure the informational needs of men with prostate cancer

Aim of the study. The aim of this study is to adapt an instrument suitable for assessment of the informational needs of men with prostate cancer.

Background. In recent years prostate cancer has become an important public health problem world‐wide with considerable social and economic consequences. It is reported that it is the most common cancer affecting British men, with an average lifetime risk of occurrence of one in twelve.

Design/methods. Methodological research was conducted to develop an instrument to assess the informational needs of men with prostate cancer on hormonal manipulation therapy (HMT) regarding their disease and treatment. The Toronto Informational Needs Questionnaire (TINQ‐BC) (Galloway et al. 1997) was modified for use with this client group and was applied to a sample of 90 men generated from three urology centres in Northern Ireland.

Results/findings. Construct and content validity of the instrument was established. Internal consistency reliability using Cronbach’s α was calculated and found to be satisfactory (0·92). Using confirmatory factor analysis, factor loadings ranging from 0·37 to 0·90 were obtained and considered satisfactory. The subsections of the TINQ‐BC categorized as Disease, Investigative tests, Treatment, Psychosocial and Physical needs were confirmed as individual factors. These results indicate that this instrument can be validly applied to this client group. As the instrument was initially developed in Canada and successfully used in the United Kingdom (UK), it is suggested that this instrument also has the potential for cross‐cultural application. It has the potential to be used as a clinical reference instrument to assess the informational needs of this patient group. Health care professionals must be aware of the domains of information that these men perceive important so that educational interventions can be accurately and appropriately planned.
Psychosocial correlates of fluid compliance among Chinese haemodialysis patients
Authors: Pang Shuk‐King , Ip Wan‐Yim , Chang Anne M.
Published: March 2003

Psychosocial correlates of fluid compliance among Chinese haemodialysis patients Aims. The present study was designed to determine the psychosocial correlates of fluid compliance among patients receiving haemodialysis at two Hong Kong renal dialysis centres.

Background. There has been little consistency in the findings of correlations among any psychosocial variables and compliance behaviour. There is a need to further study these variables in an attempt to predict haemodialysis patient compliance to fluid restriction.

Methods. Ninety‐two Chinese haemodialysis patients completed the Center for Epidemiological Studies Depression Scale (CES‐D), The Multidimensional Health Locus of Control Form C Scale (MHLC), the Social Support Questionnaire, Short Form Scale (SSQ6) and a self‐designed socio‐demographic questionnaire. Daily interdialytic weight gain (DIWG) measure was used as an indicator of fluid compliance.

Results. The prevalence of compliance behaviour of Chinese haemodialysis patients was higher than that reported in western studies. There were significant negative correlations found between DIWG and total score on internal health locus of control and social support satisfaction score. However, internal health locus of control did not predict a significant portion of the DIWG variance. Significant predictors of DIWG included satisfaction with social support, comorbidity and monthly family income. Satisfaction with social support was the largest predictor of DIWG.

Conclusions. The present findings suggest that assessing family income, comorbidity, and satisfaction with social support may be useful in identifying haemodialysis patients potentially at risk for difficulties in compliance with fluid restriction.
The accessibility of research‐based knowledge for nurses in United Kingdom acute care settings
Authors: Thompson Carl , McCaughan Dorothy , Cullum Nicky , Sheldon Trevor A. , Mulhall Anne , Thompson David R.
Published: March 2003

The accessibility of research‐based knowledge for nurses in United Kingdom acute care settings

Background. The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions.

Aim. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use.

Design. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals.

Results. Three perspectives on accessibility were identified: (a) the humanist – in which human sources of information were the most accessible; (b) local information for local needs – in which locally produced resources were seen as the most accessible and (c) moving towards technology – in which information technology begins to be seen as accessible. Nurses’ experience in a clinical specialty is positively associated with a perception that human sources such as clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely to perceive local guidelines, protocols and on‐line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text‐based resources available to nurses on the wards had any explicit research base. These, and the remainder were out of date (mean age of textbooks 11 years), and authorship hard to ascertain.

Conclusion. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles could act as ‘conduits’ through which research‐based messages for practice, and information for clinical decision making, could flow. This role should be explored and enhanced.
A social cognitive model for health education/health promotion practice
Authors: Whitehead Dean
Published: March 2003

A social cognitive model for health education/health promotion practice

Aim. To investigate the place and validity of contemporary social cognitive models for health education practice in nursing settings and, in doing so, develop and put forward a specific model for this purpose.

Background/rational. The last decade or so has seen a marked increase in the amount of health educational/health promotional activities that nurses are expected to undertake. This has followed on from concerted calls to make health education a familiar and recognized part of nursing practice. Despite this, past and current evidence identifies that nurses have been, and continue to be, ineffective and inconsistent health education practitioners. Where health education activity does take place it tends to centre specifically on social cognitive behavioural change strategies. Subsequently, it is argued here that any failure on the part of nurses successfully to apply health educational initiatives into practice has been compounded by the lack of any nursing‐specific social cognitive model process. This paper seeks to redress this imbalance by putting forward the case for such a model, developing it, and demonstrating how it can be incorporated into the practice setting.

Method. A systematic review of the literature has been conducted and the article draws upon this in order to develop an evolving theoretical perspective for health education practice. The proposed model has evolved from this new perspective. Development of this model has drawn on contemporary social cognitive behavioural models – using them as a means to develop a further conceptual framework for nursing.

Conclusion. Social cognitive behavioural models are valuable tools that nurses can incorporate routinely into existing frameworks of practice. The proposed model is designed to make the adoption of health‐related behavioural change in clients easier and more realistic. If the current situation continues whereby social cognitive behavioural models are not adopted as a concerted and routine part of nursing practice, then nursing may well continue to fall behind other health professions in the discipline of health education.
A qualitative study of nursing staff members’ interpretations of signs of gerotranscendence
Authors: Wadensten Barbro , Carlsson Marianne
Published: March 2003

A qualitative study of nursing staff members’ interpretations of signs of gerotranscendence

Aims. This study was conducted in Sweden and investigated whether nursing staff working with old people could recognize signs of gerotranscendence and, if so, how they interpreted such signs. Another aim was to describe how the staff addressed and cared for older people, 65 and older, showing signs of gerotranscendence.

Background. The theory of gerotranscendence is a theory that, present a new understanding of the ageing process. Gerotranscendence is regarded as a natural developmental process, and the term transcendence implies a shift in an older person’s meta‐perspective and a new outlook on reality.

Methods. Proceeding from Tornstam’s description of signs of gerotranscendence, an interview guide was designed, qualitative interviews performed and the theory of gerotranscendence was used as the basis for the qualitative analysis.

Findings. Findings showed that staff working with old people noticed signs of gerotranscendence. However, their interpretations were highly variable; in some cases such signs were interpreted as what might be interpreted as ‘pathological’. This is probably because the staff had no theoretical tools with which to make other interpretations. Some signs were interpreted as common and in some cases as ‘normal’. These could be theoretically understood from either an activity or developmental perspective.

Conclusions. Staffs’ need an interpretative framework allowing them to understand the signs they sometimes observe in older people. Having an interpretative framework in which these signs are seen as normal aspects of ageing would enable staff to develop a different attitude towards older people and another approach to caring for them.
Initiation factors for substance abuse
Authors: Al‐Kandari Fatimah H. , Yacoub Khawlah , Omu Florence
Published: March 2003

Initiation factors for substance abuse

Aim. The study reported in this paper investigated factors that led to the initial use and abuse of drugs in 237 addicts receiving treatment at the Psychological Medicine Hospital, Kuwait.

Method. A self‐administered questionnaire was designed to elicit information regarding socio‐demographic data and initiation patterns. Questions about initiation patterns were related to personal, familial and social variables in addition to accessibility to drugs.

Results. Almost all the sample were male (99·2%) and 42·6% were married. The findings were grouped into (1) factors associated with drug abuse and (2) initial/significant factors for drug abuse. One way ANOVA showed that there was a significant statistical association between current age and source of drug. Also, there was a significant statistical association between the age of the addict when first started on drugs, and the source of drugs. Multiple regression analysis was also computed for initial significant factors. One factor ‘excessive unsupervised free time’ was statistically significant.

Recommendations. Strategies for primary, secondary and tertiary interventions in addition to recommendation for further studies are suggested.
Children’s rights: a decade of dispute
Authors: Lowden Jacqueline
Published: March 2003

Children’s rights: a decade of dispute

Aim. This paper attempts to raise issues surrounding children’s rights against a backdrop of ethical principles and their subsequent interpretation and application in practice.

Method. Key words have been used to search a selection of electronic databases and a range of ‘grey’ literature has been reviewed.

Background. Over a decade ago the United Nations (1989) Convention on the Rights of the Child was ratified, with the exception of two member states (UNICEF 2000). The Human Rights Act (Department of Health 1998) became law in October 2000 in the United Kingdom (UK). Despite a decade of recommendations, guidelines and legislation, children’s rights, particularly consent to health care, remain complex and inconsistent. As we move into a new era of human rights involving all members of society, it is timely for nurses in the UK to reflect on the challenges created in attempting to interpret the philosophy of such legislation because such complexity surrounds the interpretation of human rights for many other vulnerable clients within health care.

Findings. The interpretation of children’s rights continues to be influenced by the evolution of the meanings of childhood. Adults view children’s rights from multiple perspectives of best interest, which are determined by their beliefs about children’s ability to understand and consent to health care and treatment. An ability and right to consent appears not to be balanced by the right to withhold consent. Inconsistency and ambiguity persist in the law and its interpretation. Adults need to develop a more pragmatic approach to children’s rights. This requires better understanding of children and their experiences of health care.

Conclusion. Until adults develop a more pragmatic ideology in relation to children’s rights then a true respect for children’s autonomy will not be achieved. Consent will therefore remain an adult and legal prerogative.
Differences in urinary stress hormones in male and female nurses at different ages
Authors: Deane R. , Chummun H. , Prashad D.
Published: March 2003

Differences in urinary stress hormones in male and female nurses at different ages

Aim. The aim of this study was to assess the levels of urinary stress hormones in male and female nurses and to determine their contribution to sex‐determined health outcomes.

Rationale/background. While the use of questionnaires have shown that there is a high degree of stress in health care workers, these results are inconclusive. In this study a more objective approach was used by assessing the levels of urinary stress hormones, adrenaline, noradrenaline and cortisol. In premenopausal women oestrogen may attenuate sympathetic nervous system activity and the secretion of adrenaline and cortisol and therefore lower the stress response and incidence of stress‐related illnesses.

Methods. Three hundred and fifteen nurses of both sexes were separated into two age groups, 20–40 and 45–60 years, and for postmenopausal women into those taking or not taking hormone replacement therapy (HRT). Early morning urine sample were collected and stress hormones determined by high performance liquid chromatography (HPLC).

Results. Urinary cortisol, adrenaline and noradrenaline levels were all increased with age in both sexes, with a greater difference in the younger age group compared with the older group. These hormones were lower in premenopausal women compared with male nurses of similar age. The difference between the sexes in the high age group was less compared with the lower one. Postmenopausal women on HRT had lower levels of these hormones.

Conclusion. The age‐related changes were surprising but may be because of higher stress levels in the older groups of both sexes. However, the gender difference supports the view that oestrogen reduces sympathetic activity and the secretion of cortisol and adrenaline. HRT reduces the stress response and therefore may have additional benefits by reducing the level of stress‐related illnesses. These results were surprising but may suggest that oestrogen reduces the stress response in women and therefore offers protection against stress‐related disorders.
Student–teacher connection in clinical nursing education
Authors: Gillespie Mary
Published: March 2003

Student–teacher connection in clinical nursing education

Background. The trend toward humanistic nursing education has called for a transformed student–teacher relationship that fosters learning and growth of students and teachers. Although such a relationship has been claimed to form the basis for student–teacher connection and to be a positive influence on students’ learning outcomes, there is a paucity of research exploring these claims. Neither the nature of student–teacher connection nor the processes by which it occurs have been described.

Aims. A research study was undertaken to explore and describe undergraduate nursing students’ experiences of connection within the student–teacher relationship and the effects of student–teacher connection on students’ learning experiences in clinical nursing education.

Research design. The qualitative research approach of interpretive description was chosen for this study. Unstructured interviews and a focus group were used to collect data from eight undergraduate nursing students. Data were analysed using the process of constant comparative analysis, and revealed four interrelated major categories that formed a description of the students’ experience of student–teacher connection.

Findings. This article presents part of the findings of this study. After describing the nature of student–teacher connection, the discussion focuses on the influence of teachers and other factors on the formation of student–teacher connection. Relevance is given to this discussion by describing the outcomes of connection for students’ clinical learning experiences.
Getting your paper to the right journal: a case study of an academic paper
Authors: Van Teijlingen Edwin , Hundley Vanora
Published: March 2003

Getting your paper to the right journal: a case study of an academic paper

Background. The scientific community views the publication of academic papers as a means of disseminating information, ensuring transparency and good practice in terms of research utilization. However, the choice of journal in which to publish is frequently influenced by other, less obvious, factors. This paper describes the lengthy route taken to get a methodological paper about pilot studies into print.

Aim and method. This paper shares some of our experiences and discusses the lessons that we learned about the process of getting into print. A case study approach is adopted to help the reader understand the different influences on this process.

Findings. Our methodological paper was submitted to six different academic journals before it was finally accepted for publication. The choice of journal was influenced by the need to reach an appropriate academic audience, the estimated turn around time (the time taken between submission of a paper and its subsequent publication) and the level of academic credibility of the journal (often assessed by the journal’s Impact Factor). Publishing in ‘high impact’ academic journals assumed considerable importance for us in view of the UK Research Assessment Exercise (RAE). However, the consequence of going down the journal status hierarchy was that we lost about 1 year through submitting, rewriting according to each of the journal’s specific requirements and resubmitting. The case study also demonstrates that getting into print often depends on a range of factors, not just the quality of the written text.

Conclusions. Getting a paper published may depend not only on the intrinsic quality of the paper, but also whether it is submitted to the ‘right’ academic journal. Moreover, if journals do not take certain papers (e.g. ones with negative findings or those reporting multi‐disciplinary studies) then this can lead to publication bias.
Promoting a good life among people with Alzheimer's disease
Authors: Zingmark Karin , Sandman P.O. , Norberg A.
Published: March 2003

Promoting a good life among people with Alzheimer's disease

Aim.  To illuminate the meaning of offering care and a place to live to people with Alzheimer's disease in a special care unit.

Rationale.  There is a need to gain a deeper understanding about so called `homelike' care settings, and about how to promote experiences of being at home in residents with Alzheimer's disease. The study is part of a long‐term study in a special care unit.

Methods.  The study comprises phenomenological hermeneutic interpretation of interviews with 10 care providers.

Results.  The analyses revealed a number of caring aspects such as, for example, `viewing dignity and striving to preserve a sense of self in the resident', `encouraging a sense of belonging', `offering relief' and `promoting a sense of power and control in the resident', although integrated and reflected in each other. The caring aspects constituted the themes confirmation, familiarity, communion and agency considered as dimensions of the good life.

Conclusion.  To avoid simplification in which, for example, the furniture from a certain decade become the standard for good care, it seems important to focus upon the meaning of the good life. Care that promotes a good life of people with Alzheimer's disease seemed relationship centred.
Clinical innovation for promoting family care in paediatric intensive care: demonstration, role modelling and reflective practice
Authors: Tomlinson Patricia S. , Thomlinson Elizabeth , Peden‐McAlpine Cynthia , Kirschbaum Mark
Published: March 2003

Clinical innovation for promoting family care in paediatric intensive care: demonstration, role modelling and reflective practice

Aim. To explore family caregiving problems in paediatric crisis care and methods that could be applied to move the abstraction of family care to development of specific family interventions.

Background and rationale. Family centred care has been accepted as the ideal philosophy for holistic health care of children, but methods for its implementation are not well established. In paediatric health crises, family care requires special sensitivity to family needs and a type of complex nursing care for which many practitioners are not sufficiently prepared. Developing family sensitive models of intervention and finding a strategy for transfer of this knowledge to clinical practice is an important challenge facing family nursing today. Social learning theory provides a rich background to explore these issues.

Conclusions. Specific techniques of role modelling and reflective practice are suggested as effective approaches to teach family sensitive care in clinical settings where families are part of the care environment.
Using the Zelen design in randomized controlled trials: debates and controversies
Authors: Homer Caroline S.E.
Published: March 2003

Using the Zelen design in randomized controlled trials: debates and controversies

Background. The use of the randomized consent design (commonly known as the Zelen design) is a controversial issue in randomized controlled trials. In the Zelen design, participants are randomly allocated prior to seeking consent. Those participants allocated to the intervention group are then approached and offered the intervention, which they can decline or accept. Zelen first proposed the design in 1979. It has been used infrequently since this time, although there are some notable exceptions in nursing, midwifery and some medical specialities.

Aim. This paper describes the Zelen design, including the two forms used (the single and double consent versions) and discusses the advantages and disadvantages of using such a design.

Methods. An explanation of the differences between the Zelen design and a conventional randomized controlled trial is presented. In a conventional design, detailed knowledge of the alternative interventions is given to the prospective participant. The participant gives consent and is allocated to one of the groups. In a Zelen design, participants are randomly allocated and then approached and offered the group to which they were allocated. The Zelen design is used firstly, to reduce disappointment bias in the conventional consent‐randomization process, and secondly, to remove subjective bias in the recruitment process.

There are concerns relating to the use of the Zelen design, including ethical concerns relating to the timing of random allocation and consent and the collection of clinical data.

Conclusion. It is hoped that by presenting issues pertaining to the Zelen design, other nursing and midwifery researchers may be prompted to consider its use when designing clinical research. The Zelen design is controversial, and debate about its merits and shortcomings is useful. This paper contributes to the ongoing debate.
Adolescent subjective well‐being and realized values
Authors: Rask Katja , Åstedt‐Kurki Päivi , Laippala Pekka
Published: March 2003

Adolescent subjective well‐being and realized values

Aims of the study. The purpose of this study was to describe adolescent subjective well‐being and realized values, and to examine the relationships between socio‐demographic variables, realized values and subjective well‐being from the adolescent perspective.

Rationale. Adolescent subjective well‐being was conceptualized by means of four different dimensions: satisfaction, ill‐being, knowledge and activities related to well‐being. The values were operationalized by eight core ideas from which a principal components analysis identified 10 factors representing the realized values.

Design. Data were gained by self‐report questionnaires from 245 adolescents from 7th and 9th grades, with a mean age of 14 years, in 13 secondary schools in southern Finland. The data were analysed statistically.

Findings. According to the findings, most of the respondents were satisfied with life. However, one out of 10 did not experience the joy of life. There was no statistically significant difference in global satisfaction between girls and boys. Total ill‐being among the adolescents was rare, but one out of four participants had fairly often worried about money and 17% were frequently unusually tired. Girls and pupils from the 9th class experienced more ill‐being than boys and pupils from the 7th class. The findings suggest that certain values such as personal equilibrium, safe family relations, and family type are predictors of adolescent global subjective well‐being.

Conclusions. While assessing and promoting adolescent well‐being it is important to pay special attention to the realization of values in life and not merely to appreciation of things. Implications for practice include the need to create opportunities for the realization of values when adolescents require health care services.
Unstructured interviews: challenges when participants have a major depressive illness
Authors: Moyle Wendy
Published: March 2003

Background.  There is debate about undertaking sensitive research with vulnerable populations. Primarily, the literature has focused on informed consent, confidentiality and the principle of beneficence, with little discussion about data collection methods.

Aim.  This paper discusses the challenges of conducting unstructured interviews when participants have a major depressive illness. Issues arose during a phenomenological study that explored the meaning of being nurtured with seven people who were hospitalized for depression.

Findings.  The depressive illness and treatment were found to impact on participants' articulation and recalling of their experience, and raised ethical concerns about their informed consent. Personal engagement with participants raised the ethical issue of research vs. therapy. Furthermore, participants being in a hospital complicated the necessity for privacy. The methodological issue of bracketing of assumptions was deemed to be important to ‘see’ the phenomenological relevance of patients' experiences.

Conclusion.  Knowledge and experience are required when conducting unstructured interviews. Debates about the challenges of unstructured interviewing needs to be highlighted in research texts to assist novice researchers. Support from an experienced research mentor would assist novice interviewers through the interview process and provide post‐interview debriefing.
Implementing audit in palliative care: an action research approach
Authors: Cooper Jan , Hewison Alistair
Published: March 2003

Aim.  To investigate the factors that influence the successful implementation of audit in a palliative care setting.

Background.  Quality assurance is a necessary component of contemporary health care. In the past, palliative care has not generally been subject to systems of audit and quality management. However in recent years the need for all health care organizations to have clear policies and procedures for maintaining quality has become more pressing.

Method.  An action research project was conducted to investigate the implementation of audit in a palliative care setting, which involved the application and modification of the Support Team Assessment Scale (STAS).

Findings.  A collaborative approach was adopted and this facilitated the identification of factors vital to successful introduction of the audit methodology into the unit. These included effective teamwork, the input of an external facilitator, good relationships with management and prompt and relevant feedback on progress. The use of STAS was fully integrated into the work of the unit and a robust programme of audit has been established.

Conclusion.  Combining the cyclical nature of action research methodology and the audit process with Lewin's change theory provided a clear conceptual framework for the research. This approach would be applicable in a range of health care settings to bring about improvements in quality management.
The temporal landscape of night nursing
Authors: Brown Reva Berman , Brooks Ian
Published: March 2003

Aims of the study.  The study arose secondarily from a study with a different primary purpose (to consider attitudes towards the implementation of changes to working practices). Its aim is to provide a ‘map’ of the temporal landscapes of night nurses.

Background.  Our temporal landscapes are made up of recognizable domains, with permeable borders – private time and public time, home time and work time, past, present and future time, cyclical time. Just as a geography of space contains recognizable natural features – rivers, deserts, mountains – and features created by human beings – canals, roads, skyscrapers – so our temporal landscape contains natural features – day and night, the seasons – and features created by us – the ordering of social, economic, legal, and organizational time into, among others, the practices of family life, financial periods, and workloads.

Methods.  Data were collected during longitudinal ethnographic research – observation, formal interviews, informal conversations – with the emphasis on areas such as shift work, workload, and the temporal aspects of caring.

Conclusions.  The result is the production of a map, albeit a rough one, of the temporal landscape inhabited by night nurses as they go about their working lives.