bluuebunny/crossref_metadata_2025 huggingface dataset:
Information and support needs of women with primary relatives with breast cancer: development of the Information and Support Needs Questionnaire
Authors: Chalmers Karen I. , Luker Karen A. , Leinster Samuel J. , Ellis Ian , Booth Katie
Published: March 2003

Information and support needs of women with primary relatives with breast cancer: development of the Information and Support Needs Questionnaire

Aims of the study. The aim was to develop and pilot test a newly developed measure, The Information and Support Needs Questionnaire (ISNQ), for use with women with primary relatives with breast cancer.

Background/rationale. Breast cancer is a major risk to the health of women in the United Kingdom (UK). Increasingly, research is documenting women’s needs for information and support, particularly at the time of diagnosis. However, to date there is little understanding of the information and support needs of women who have a family history of breast cancer. Contributing to the dearth of understanding of female relatives’ needs is the lack of valid and reliable instruments for use in descriptive and intervention research with this population.

Design/methods. The ISNQ and survey items documenting family history, sources of information and support for breast cancer risk, breast self‐care practices, and other variables were pilot tested for the acceptability of the measures, appropriateness of the data collection methods, initial psychometric properties of the ISNQ, and time and financial costs of administration. Data were collected from 39 women living in the North‐west of England who had primary relatives with breast cancer using mailed questionnaires and follow‐up telephone interviews.

Findings. The items on the ISNQ were reported to be clear, acceptable to women and to yield relevant data. The psychometric properties of the new measure were satisfactory with a high reliability coefficient alpha. Descriptive findings indicate that women had moderate to high needs for information and support, but reported that these needs were not well met.

Conclusions. The results of this pilot are guiding the development of a larger study in which the information and support needs of women with a family history of breast cancer are explored.
The well‐being of gays, lesbians and bisexuals in Botswana
Authors: Ehlers V.J. , Zuyderduin A. , Oosthuizen M.J.
Published: March 2003

The well‐being of gays, lesbians and bisexuals in Botswana

Aims. To investigate the level of well‐being of gays, lesbians and bisexuals (GLBs) in Botswana, how this level of well‐being could be promoted and whether their health care needs were met by health care professionals.

Rationale. It is illegal to engage in same‐sex activities in Botswana, punishable by imprisonment. Although Botswana’s citizens have one of Africa’s best health care systems, little is known about the health status, health care needs and general well‐being of Botswana’s GLBs. This survey attempted to uncover some of these potential health care needs, impacting on the GLBs’ well‐being.

Design/methods. The research framework adopted was the health and human rights approach, placing dignity before rights. A survey design, with structured questionnaires, was used. Snow‐ball sampling techniques were used.

Results. Results indicated that varying degrees of distress were experienced by 64% of the GLBs in this study. The GLBs identified a need for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) education and had concerns about their general health, discrimination against them and vulnerability to violence including sexual assaults.

Conclusions. The well‐being of the GLBs in Botswana was influenced by both positive internal acceptance of their sexual orientation and negative external acceptance by society. Health care professionals played insignificant roles in the promotion of GLBs’ well‐being, and could make greater inputs into health education efforts, and more significant contributions towards enhancing the GLBs’ levels of well‐being. Enhanced collaboration between health professionals and human rights activists are recommended to reduce violations of Botswana’s GLBs’ dignity and to improve their quality of life, including enhanced access to and utilization of health care services.
Midwives’ perceptions of the use of technology in assisting childbirth in Northern Ireland
Authors: Sinclair Marlene , Gardner John
Published: March 2003

Midwives’ perceptions of the use of technology in assisting childbirth in Northern Ireland

Aim of the paper. The aim of this paper is to report a survey of midwives’ views on the use of technology in assisting births.

Background. The research was designed to provide a deeper understanding of the integration of technology into midwives’ practice and to identify and examine aspects of training needs.

Methods. Over 400 midwives responded to a questionnaire seeking information on their experiences and perceived competence with labour ward technology, with a particular focus on the use of cardiotocograph machines (CTGs) for electronic foetal monitoring. The survey sought views on the extent to which midwives trust the technology, their perceived levels of training and competence, their awareness of policy relating to technological intervention and the issue of women’s choice in whether the progress of their delivery is technologically monitored.

Findings. The majority of midwives in this survey trust the use of technology but have concerns about issues of safety in relation to potential faults, and to their perceived lack of training in technology usage. The majority also indicated that they prefer a nontechnological birth although many point to the benefits of technological support when difficulties are encountered. The use of technology is seen as multi‐professional and there was much support among the respondents for multi‐disciplinary training in the use of technologies in future curricula.

Conclusions. If the various findings of this sample survey were to be consolidated for midwives as a whole, they suggest that provisions for continuing professional development may need to address technological awareness and competence in a more focused manner than is discernible at present.
Mothers’ evolving relationships with doctors and nurses during the chronic childhood illness trajectory
Authors: Swallow Veronica M. , Jacoby Ann
Published: March 2003

Mothers’ evolving relationships with doctors and nurses during the chronic childhood illness trajectory

Aims. In this paper the evolution of mothers’ relationships with doctors and nurses during the chronic childhood illness trajectory is explored and discussed and the implications for child health care are considered. The discussion reports one aspect of a qualitative study that sought to determine whether time of diagnosis influenced mothers’ coping across the illness trajectory.

Background. The quality of relationships between mothers, who are usually the primary carers, and nursing and medical staff is central to the experience of coping with chronic childhood illness. Mothers need to develop expertise in a wide range of technical skills and knowledge of complex health care issues, while also coming to terms with the uncertainty of a condition with an unpredictable trajectory. Attempts to understand the significance of relationships between those living with chronic illness and staff have highlighted a number of factors that may influence the degree to which they are viewed as satisfactory. The way staff communicate with families has been identified as one of the mediating processes through which the quality of such is determined.

Design. Mothers of 15 children diagnosed presymptomatically and 14 children diagnosed postsymptomatically with the chronic illness Vesicoureteric Reflux (VUR) were interviewed to assess and compare coping strategies across the trajectory. Mothers’ written consent was obtained and interviews were tape‐recorded, transcribed and analysed using the ‘Framework Technique’.

Findings and Conclusion. The need to develop and sustain trusting relationships with staff was reported as a continual source of stress for mothers. The formation of satisfactory alliances, based on mutual respect and good communication early in the trajectory, in particular during the prediagnostic phase, was found to be instrumental in coping and competence development during the later chronic phase of the trajectory. Further research is needed to map prospectively the evolution of relationships between mothers and staff across the trajectory.
Experiencing a nurse identity: the meaning of identity to Swedish registered nurses 2 years after graduation
Authors: Fagerberg Ingegerd , Kihlgren Mona
Published: March 2003

Experiencing a nurse identity: the meaning of identity to Swedish registered nurses 2 years after graduation

Rationale. The professional identity and experiences of nurses have been focused upon in different studies

Aim. This is a longitudinal study whose aim was to understand how nurses experience the meaning of their identity as nurses, when they are students and nurses 2 years after graduation.

Design. Data were collected through interviews once a year during education and two years after graduation, and were analysed using a phenomenological hermeneutic method, inspired by the philosophy of Paul Ricoeur.

Findings. The analyses of the narratives resulted in four perspectives: ‘Having the patient in focus’, ‘Being a team leader’, ‘Preceptorship’ and ‘Task orientation’. The nurses did not change perspectives but the perspective showed a transition over time.

Conclusion. The nurses’ not changing perspective over time is understood as being a life paradigm, remaining throughout the years.
Meanings of good nursing care among Thai female last‐year undergraduate nursing students
Authors: Lundberg Pranee C. , Boonprasabhai Kobkul
Published: March 2003

Meanings of good nursing care among Thai female last‐year undergraduate nursing students

Aims of the study. To describe and express the meanings of good nursing care among female last‐year undergraduate nursing students of a nursing college in Bangkok, Thailand.

Background. In Thailand today, nursing educational programmes aim at producing graduates who can explore options in nursing science.

Method. Twenty nursing students were interviewed and observed using the ethnographic method.

Findings. Six categories emerged, viz., compassion (give care from heart; have sympathy; be kind and helpful; have and share feelings; be friendly and be concerned; be honest), competency (have knowledge, skill and experience; be interested to learn; have responsibility; be professional; be confident; know what to do without hesitation), comfort (assist, help and treat patient as self; attend, give patient dignity and respect; have goals and give nursing care corresponding to the patients’ needs), communication (have time to listen, talk and explain; be willing to listen and inform patients; meet patients’ needs), creation (create new knowledge; apply theory in practice; continue MSc or PhD study; do research) and courage (advocate for patient’s needs and rights, intervene for and with patient; make decisions about nursing care; face and solve patient’s problems).

Conclusions. The findings should be useful in the development and continuous improvement of nursing educational programmes, including curricula and teaching methods.
Preferences for female and male nurses: the role of age, gender and previous experience – year 2000 compared with 1984
Authors: Chur‐Hansen Anna
Published: March 2003

Preferences for female and male nurses: the role of age, gender and previous experience – year 2000 compared with 1984

Background. The situations in which patients prefer a male or female nurse are not clear, as the literature reports differing relationships between gender and preference. Furthermore, most research has focused on female preferences.

Methods. This questionnaire study investigated the preferences of both males and females for a male or female nurse, depending on four clinical situations. The role of age and previous experience with a male nurse was also taken into account. Gender, age and experience were further examined in relation to attitudes towards professional nursing practice. To determine whether preferences and attitudes have changed over time, the study was replicated in 2000, having been first conducted in 1984. Data were collected from the same general practice waiting room on each occasion.

Results. Consistent with previous research, the degree of intimacy in a clinical situation was found to be predictive of same‐gender preferences. Younger females may prefer female nurses more than older females. Experience with male nurses was limited in both samples, but was not predictive of preferences or attitudes.

Conclusions. Generally speaking, results from 1984 and 2000 were not significantly different. As a quantitative study, this research contributes to an understanding of patient preferences. However, in‐depth, qualitative research is recommended to understand better the reasons for preferences and attitudes, for both male and female patients.
Using ICIDH‐2 in the classification of nursing diagnoses: results from two pilot studies
Authors: Van Achterberg Theo , Frederiks Carla , Thien Nynke , Coenen Chel , Persoon Anke
Published: March 2003

Using ICIDH‐2 in the classification of nursing diagnoses: results from two pilot studies

Background. As an International Classification of Functioning and Disability, the ICIDH‐2 is potentially relevant to the work of all health care professionals. Nurses, however, had little involvement in the development of this classification and have no tradition of using it.

Aim. Two pilot studies were designed to explore the fit between ICIDH‐2 and the nursing domain.

Methods. In the first study, experts (n=2) and nurses (n=9) were asked to identify and classify patient problems that they observed on a video taped case. In the second study, problem statements from nursing diagnoses (n=199) that had been retrieved from patient files were classified using ICIDH‐2. Each problem statement was classified by a panel of three individuals.

Results and conclusion. Results from the two studies suggest that the ICIDH‐2 is certainly relevant to the nursing discipline and allows a large majority of nursing diagnoses to be classified. It is recommended that nurses take an active role in the ongoing development of the ICIDH in order to further improve its usefulness to the nursing profession.

Limitations. The studies were small‐scale pilots performed in a single medical centre. Preliminary insight resulted from these pilots, but more research is needed.
Stresses and coping strategies of mothers living with a child with cystic fibrosis: implications for nursing professionals
Authors: Hodgkinson Rebecca , Lester Helen
Published: March 2003

Background.  Cystic fibrosis (CF) is the most common inherited disease of childhood. Caring for a child with CF is stressful and this has implications for the main carer, the parental relationship, well siblings, family functioning as well as the affected child.

Aim.  This study aimed to explore current stresses and coping strategies used by mothers and to identify roles and strategies that nursing professionals could extend or adopt to support them and families of children with CF.

Method.  Semi‐structured interviews were carried out with 17 mothers of children with CF who attended the regional cystic fibrosis hospital clinic. Interviews were analysed using the Framework method of analysis.

Findings.  The study suggests that major stresses for many mothers are feeling in the middle in terms of decision‐making particularly concerning the genetic implications of CF, the burden of responsibility for parenting a child with a chronic illness, and coming to terms with a personal change in identity. The most commonly used coping strategy was seeking support from others including nursing professionals. Relationships with health professionals in secondary care were generally positive, with nurses often the first people mothers turned to when they had concerns and also key in interpreting medical information. Relationships with primary care health professionals appeared to be more limited with a role reversal described by some mothers who felt it their responsibility to educate and inform primary care professionals about CF.

Conclusions.  This study suggests that nursing professionals in primary and secondary care need to look beyond the care of the child to the needs of the mother. It provides evidence to suggest that nursing professionals in primary and secondary care have a number of important roles to play as holders of hope, bridge builders and in providing continuity of care for such families. It also suggests strategies to strengthen nurse–patient relationship.
A controlled trial to compare the ability of foam swabs and toothbrushes to remove dental plaque
Authors: Pearson Linda Susan , Hutton Jane Luise
Published: March 2003

Aims of the study.  To measure how effective foam swabs are at removing dental plaque when compared with using a toothbrush and to quantify any difference in ability.

Background.  Few nursing studies have aimed to determine the effectiveness of different mouth care tools to remove plaque which is associated with the tooth/gingival margin and, therefore, with gingivitis and chronic inflammatory periodontal disease. Findings from a previous case study of two people that compared the ability of foam swabs and toothbrushes to remove plaque at the gum/tooth margin (gingival crevice) and plaque from between teeth (approximal plaque) suggested that the success of a toothbrush is affected by user technique and that foam swabs are not able to remove plaque from some ‘sheltered’ areas of teeth.

Methods.  A time‐series, cross‐over controlled trial with 34 volunteers was used to determine the ability of foam swabs and toothbrushes to remove dental plaque which had been allowed to accumulate overnight. Plaque accumulations were scored at each approximal and crevice site for the buccal surfaces of the eight upper and eight lower teeth after each treatment of either toothbrushing or swabbing.

Results.  Plaque frequency distributions in the form of boxplots, together with results from summary statistics demonstrate that toothbrushes performed substantially better than foam swabs in the ability to remove plaque from the sites studied in this larger sample of people.

Conclusions.  The trial verified the findings from the previous study. The conclusions can be generalized to a wider population because of the magnitude and direction of the differences measured. The implications for nurse education and the development of nursing in practice settings include the need to teach effective toothbrushing skills to nurses, and to support clinical staff in developing mouthcare practice, particularly in relation to the use of assessment strategies that include the choice of effective tools.
Developing an understanding of gender sensitive care: exploring concepts and knowledge
Authors: Miers Margaret
Published: March 2003

Background.  In the United Kingdom (UK), concern about inequalities in health and health care has led to interest in gender sensitivity in health policy and practice.

Aim.  To develop an understanding of possibilities for gender sensitive care through exploring the concepts of gender and gender sensitivity and through reviewing relevant knowledge about gender and health.

Methods.  The dimensions of the concept of gender and theories explaining gender relations are explored through a review of key social science texts. A discussion of gender sensitivity draws on Bowden's analysis of gender sensitive ethics. A literature review of evidence about gender and health identifies relevant knowledge for gender sensitive care.

Findings.  Seven features of the concept of gender are identified. Gender sensitivity involves an understanding of the socio‐political context of experience and relationships. The social context also affects health. Differences in male and female mortality and morbidity rates are likely to be related to differences in economic resources, differences in men and women's position in public and private worlds, to power in social relations and to sexuality and body image. Possibilities for gender sensitive care may be supported through feminist approaches and through a postmodernist understanding of the manner in which discourses shape our understanding of gender and gender relations. Valuing care is a feature of gender sensitivity.

Conclusion.  Gender sensitive care involves recognizing the significance of research related to social influences on health and understanding nursing in its socio‐political context, and care in the context of gender relations. Experiential learning can synthesize learning across varied learning modes, bridging learning through experience and formal analysis. Exploring concepts, evidence about gender and health and personal experience will all be important in the development of gender sensitive care.
Poetry as an aesthetic expression for nursing: a review
Authors: Hunter Lauren P.
Published: March 2003

Objective.  To provide the reader with a basic understanding of the elements of poetry and to review poetry's contribution to nursing. The review will examine the poetry written by nurses, poetry's effect on the profession, and its use in education, patient care, and research.

Data sources.  Classic and current sources of poetry, which enhance the understanding of poetry and how poetry has changed over time are reviewed. The review of nursing literature was conducted in works published in the English language using the keywords: poetry, nursing, and aesthetics. The initial search included all nursing literature with the above keywords from 1960 to 2001. Articles from relevant journals and textbooks, which could contribute to the understanding of the use of poetry in the field of nursing, were included.

Conclusion.  The use of poetry in the nursing profession provides us with the opportunity to gain new meaning and understanding about the profession and the clientele served. Poetry is a rich textual medium that can assist in illuminating nursing's core belief about the uniqueness of the nurse–patient relationship, and enhance the ‘art’ of nursing and ‘ways of knowing’.
An evaluation of the role of the Clinical Placement Coordinator in student nurse support in the clinical area
Authors: Drennan Jonathan
Published: March 2003

Purpose of the study.  The purpose of this study was to evaluate the role of the Clinical Placement Coordinator (CPC) and the continued development of the role in the context of the provision of student support in the clinical area.

Background.  Following the introduction of the Registration/Diploma in Nursing Studies programme in the Republic of Ireland in 1994 the post of CPC was created to support student nurses in the clinical area. The CPC is an experienced nurse who provides dedicated support to student nurses in a variety of clinical settings however, unlike the role of mentor/preceptor they do not have a client/patient caseload. To date no major evaluation of the post has taken place. Therefore the Department of Health and Children commissioned a national evaluation of the post of which part of the findings are reported in this paper.

Methodology.  A two‐stage study is described utilizing a mixed‐methods approach. Data collection included individual and focus group interviews and questionnaires. Interviews were analysed using thematic content analysis and data collected from questionnaires were analysed utilizing descriptive and inferential statistics.

Findings.  An analysis of the data identified the responsibilities and functions of CPC were multivariate, however, core elements of the role were evident. The core elements were identified as student support and practice development. The central and most frequent finding from the data collected was the individual support students received from CPCs throughout their clinical placement.

Conclusion.  The role of CPC was evaluated as a positive addition to the realm of student support and the clinical team. The positioning of the post in the clinical area also adds the dimension of a CPC being a link between student nurses and the various groups that provide student support, this is essential in light of the changing role of the nurse tutor following the full integration of preregistration nurse education into the third‐level sector and the development of a formal preceptorship role for clinical nurses in the Republic of Ireland.
Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers
Authors: Peerson Anita , Aitken Robyn , Manias Elizabeth , Parker Judith , Wong Kitty
Published: March 2003

Background.  Agency nursing is a poorly understood and under‐researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers.

Aim.  To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses.

Methods.  A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion.

Results.  Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments.

Conclusions.  The study was limited by the fact that the final sample was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.
Nurses' attitudes towards clients who self‐harm
Authors: McAllister Margaret , Creedy Debra , Moyle Wendy , Farrugia Charles
Published: March 2003

Background.  Deliberate self‐harm is frequently encountered by emergency department (ED) nurses. However, clients are often dissatisfied with the care provided and clinicians feel ambivalent, helpless or frustrated when working with clients who self‐harm.

Aim.  The aim of the study was to develop and test a scale to identify relevant dimensions of ED nurses' attitudes to clients who present with self‐injury.

Methods.
 Items on Attitudes Towards Deliberate Self‐Harm Questionnaire (ADSHQ) were drawn from a literature review and focus group discussions with ED nurses. The tool was piloted with 20 ED nurses not working in the target agencies. A survey of nurses working within 23 major public and 14 major private EDs in Queensland, Australia (
n  = 1008) was then undertaken.

Results.  A total of 352 questionnaires were returned (35% response). Analysis revealed four factors that reflected nurses' attitudes toward these clients. The factors related to nurses' perceived confidence in their assessment and referral skills; ability to deal effectively with clients, empathic approach; and ability to cope effectively with legal and hospital regulations that guide practice. There was a generally negative attitude towards clients who self‐harm. Correlations were found between years of ED experience and total score on the ADSHQ, and years of ED experience and an empathic approach towards clients who deliberately self‐harm.

Conclusion.  There is a need for continuing professional development activities to address negative attitudes and provide practical strategies to inform practice and clinical protocols.
Action research: politics, ethics and participation
Authors: Williamson Graham R. , Prosser Sue
Published: March 2003

Aim.  This paper contributes to an understanding of the political and ethical aspects of action research (AR).

Background.  Action research is growing in popularity in nursing and health care as a means of changing practice and generating new knowledge. As a methodology, AR relies on a close collaborative working relationship between researcher and participants, but this close relationship is also the source of political and ethical problems faced by researchers and participants.

Content.  We argue that action researchers and participants working in their own organizations should be clear about the extent to which they are engaged in a political activity, and that AR does not offer the same ethical guarantees concerning confidentiality and anonymity, informed consent, and protection from harm as other research methodologies (both quantitative and qualitative). This argument is illustrated by our experiences of participation in an AR study.

Conclusion.  We outline three areas where AR is implicitly political, and three areas where it is ethically problematic. We recommend that researchers and participants recognize, discuss and negotiate these problematic areas before starting their work.
Traditional postpartum practices among Thai women
Authors: Kaewsarn Pattaya , Moyle Wendy , Creedy Debra
Published: March 2003

Background. Culture is often related to notions of well‐being, illness, healing and health that inform individuals in their day‐to‐day activities. The postpartum period is noted for traditional practices related to rest, healing and the consumption of food and drinks, but a contemporary view of these practices is needed.

Aim. To gain an understanding of the traditional practices that Thai women follow in relation to postpartum care and the rationales underpinning such practices.

Methods. This descriptive study surveyed 500 Thai women living in Ubon Ratchathani, Thailand and attending their first postpartum hospital clinic appointment. A self‐completion questionnaire was specially developed and pilot tested, and then administered to women attending the clinic.

Data analysis. Descriptive statistics were used in relation to the incidence of particular behaviours. Chi‐square analyses were conducted to determine relationships between demographic characteristics and traditional practices.

Results. The majority of Thai women adhered to traditional postpartum practices related to the notion of regaining ‘heat’. These included ‘lying by fire’, food restrictions, taking hot baths and consuming hot drinks. Other activities involved not exposing the body to heat loss by keeping covered, not shampooing the hair, avoiding the wind and sexual abstinence. Younger, less educated, primiparous women were more likely to report traditional practices. Mothers and mothers‐in‐law were most influential in recommending these behaviours.

Conclusions. Traditional postpartum practices are still dominant in contemporary Thai culture and are perpetuated by close female family relatives. Health professionals need to be aware of clients' culture and consider the extent to which professional care complements the mothers' traditional beliefs. Nurses need to educate women about the benefits of contemporary postpartum care and to provide strategies to help them to integrate their beliefs and the practices recommended in contemporary health care practice.
Nurses who left the British NHS for private complementary medical practice: why did they leave? Would they return?
Authors: Andrews Gavin J.
Published: March 2003

Background. Although the successful retention of National Health Service (NHS) nursing staff is a policy concern, evidence suggests that substantial numbers of registered nurses continue to leave the profession, and some to own and run small caring‐related business. At the same time, private complementary medicine has undergone a rapid expansion in recent years, and initial impressionistic evidence suggests that many therapists are former nurses.

Aims. The paper investigates the motivations and experiences of nurses who have either left nursing altogether, or substantially reduced their involvement, and who now practise complementary medicine in the private sector. It also investigates the issue of whether they would consider returning to practise complementary medicine within the NHS.

Methods. A combined questionnaire (n  = 63) and semi‐structured interview (n  = 11) survey was used to collect detailed attitudinal data from respondents. The analytical approach to the interview data used a form of constant comparative analysis which was derived from the principles of grounded theory. In particular, the interviews were developed and refined from each other as they progressed.

Results. The majority of therapists operate independently, either from their own homes or from small rented premises. They were originally motivated by a disillusionment with the health service and particular aspects of their former jobs. However, equally they were attracted by the therapies themselves, the conceptual paradigms which underpin them and the different experiences of practice. Despite stating a disillusionment with the NHS, most respondents expressed a cautious willingness to potentially re‐enter the NHS to practise complementary medicine.

Conclusion. Many practising complementary therapists are registered nurses who may be willing to re‐enter the formal health service. It is therefore argued that a greater synergy between orthodox and complementary medicine may be one way of addressing shortages of nursing labour, and in particular this form of drop‐out, whilst meeting evolving consumer health care demands.
Evaluating health promotion: a model for nursing practice
Authors: Whitehead Dean
Published: March 2003

whitehead d. (2003) Journal of Advanced Nursing 41(5), 490–498

 Evaluating health promotion: a model for nursing practice

Aims. To investigate the place and validity of effective process in evaluating health promotion practice in nursing and, in doing so, develop a specific model for this purpose.

Background/rationale. The failure of many nurses to provide successful health promotional programmes is underpinned by a distinct lack of evaluation research activity. Without this type of activity, health‐related nursing practice remains limited in its scope and nature. This article seeks to redress this situation by proposing a specific evaluation model that assists the nurse in their attempts to include evaluative research activity in future health promotion practice.

Method. This article draws on existing literature to develop an evolving theoretical perspective for health promotion practice in nursing. The proposed model was developed from this perspective.

Conclusion. Evaluation is an essential activity for any health promotion programme. Failure to include it in practice ensures that attempts to conduct health promotion are usually rendered ineffective and unsuccessful. Evaluation models are valuable tools that nurses can incorporate routinely into existing frameworks of practice, alongside other models of health education/health promotion, such as planning models. The development of this model is intended to enable nurses to review their current practice and offer a further framework for those who wish to extend their current health promotion repertoire.
Nursing care of dead bodies: a discursive analysis of last offices
Authors: Quested Beverleigh , Rudge Trudy
Published: March 2003

Background. Nurses care for patients before they are born, after they have died and during the lifetime in between. This paper explores nursing care of the patient after they have died including the actions by nurses in preparation of the body, the covering with a shroud, and the transfer to the mortuary.

Aims. The analysis of a procedure manual excerpt Last Offices, which directs care of the dead patient aims to explore nursing care practices in regard to dead patients, as well as the impact of the health care institution and society at large on these care practices.

Method. An acute care teaching hospital located in a major Australian city was approached and permission was granted to access their procedure and policy manuals. The Last Offices excerpt of the procedure manual was discursively analysed.

Findings. It is the contention of this paper that, through their care, nurses enact the transition between life and death, and from person to corpse. Furthermore, nurses mediate the move from embodied person to becoming dead, and in so doing traverse the cultural, ontological and epistemological breaks that death entails.
Pain and anxiety management in the postoperative gastro‐surgical setting
Authors: Manias Elizabeth
Published: March 2003

Background. Despite increasing knowledge and technological advances, patients continue to experience pain and anxiety in the postoperative setting.

Aim of the study. The aim of this study was to examine how nurses managed patients' pain and anxiety within the gastro‐surgical hospital setting.

Methods. An observational design was selected to examine nurses' management of postoperative patients' pain and anxiety. Six nurses who were involved in direct patient care in one of two gastro‐surgical wards in a public teaching hospital in Melbourne, Australia, were randomly selected to participate. The observation period comprised a fixed 2‐hour segment, and each nurse was observed on three different occasions.

Findings. Patient assessment was a major concern for participants, which was influenced by the modes of assessment used, patients' medical condition and operation procedure, and their self‐reports of pain or anxiety. Communication with health care professionals and policy and protocol concerns also affected nurses' pain and anxiety management decisions. Formal communication through the multidisciplinary ward round tended to be somewhat fragmented, as the medical consultant did not seek out the bedside nurse. Nurses had good knowledge of unit policies and protocols and, while attempting to enforce them, spent considerable time encouraging medical colleagues to abide by these guidelines. Finally, nurses made complex clinical judgements which extended beyond the administration of analgesics or antianxiety drugs.

Study limitations. It is possible that nurses demonstrated a raised awareness of how they managed patients' pain and anxiety during observation periods.

Conclusions. The study confirmed the importance of examining the complexities of the clinical context in determining how nurses manage pain and anxiety in the postoperative setting.
The effect of neighbours on the mortality of harvester ant colonies
Authors: Gordon Deborah M. , Kulig Alan
Published: March 2003

1.  This study investigates how the density and size of conspecific neighbours affected the mortality of established colonies. Data were from a population of 250–300 colonies of the red harvester ant [Pogonomyrmex barbatus (F. Smith)], on a 10‐ha site, from 1988 to 1995.

2.  Colonies are more likely to die as they grow older.

3.  Small neighbours tend to lower the probability of dying.

4.  The probability of dying varied significantly from year to year.

5.  There was little effect of crowding on mortality.

6.  There appeared to be no spatial effects, on the scale of 25. m, on the probability of dying.

7.  Previous work shows effects of density on the founding of new colonies and on the reproductive output of established ones. The results presented here indicate that competition with neighbours rarely causes the death of established colonies.
Metapopulations of moths on islands: a test of two contrasting models
Authors: Nieminen Marko , Hanski Ilkka
Published: March 2003

1.  We describe a generalized mainland‐island metapopulation model which includes migration among the island populations. We test model predictions with quantitative data on more than 200 species of moths in two contrasting networks of small islands. The data include a direct measure of migration rate, based on trapping of moths on rocky skerries with no local populations of the vast majority of species.

2.  We predicted that moths which are strong fliers but uncommon on the islands have a higher incidence on scattered islands than on islands in a group, because the latter ‘compete’ for immigrants from the mainland. In contrast, we predicted that weakly flying species with potentially large local populations on the islands occur more frequently on islands in a group due to enhanced colonization rate.

3.  Both predicted patterns were observed. Island occupancy increased significantly with the number of individuals caught on the rocky skerries, which is our measure of migration rate from the mainland, supporting the basic assumption that the species occur on the islands in a balance between colonizations and extinctions.

4.  These results demonstrate that the moth metapopulations on islands represent a mixture of Levins’s and mainland‐island metapopulations, and that the mixture is different for different species in the same landscape.
Population regulation in adult, but not juvenile, resident trout (Salmo trutta) in a Lake District stream
Authors: Elliott  , Hurley
Published: March 2003

1.  Unlike a neighbouring sea‐trout population that showed strong density‐dependent survival, a resident trout population (Salmo trutta L.) showed simple proportionate survival in the early life‐stages. However, this persistent population fluctuated within narrow limits. Mature adults, especially during spawning, were the only possible life‐stage left in which regulation might occur.2.  An October census, just prior to spawning, was made at five sites (total area 300  m2) from 1965 to 1983. Gravel nests (redds) associated with females of known size were excavated outside these sites to obtain a power‐function relationship between egg density per redd and female length (range 181–280  mm, n  =  26). This relationship and the census data for females (range 186–284  mm) were used to estimate egg densities in each year‐class.3.  The census data for the early life‐stages (0+, 1+, 2+ trout) confirmed proportionate survival with no evidence for density‐dependent regulation. In contrast, the number of spawning females produced in each year‐class was strongly density dependent on the initial number of females that laid eggs at the start of the year‐class. Similarly, total egg production in each year‐class was density dependent on initial egg density.4  Both relationships were well described by the Ricker and Beverton‐Holt stock‐recruitment models (P  <  0.001) and the goodness‐of‐fit was similar for both models. This study is probably the first to provide clear evidence for fish population regulation in the adult, rather than the juvenile, stage.
The effect of age at first breeding on Ural owl lifetime reproductive success and fitness under cyclic food conditions
Authors: BROMMER JON E. , PIETIÄINEN HANNU , KOLUNEN HEIKKI
Published: March 2003

1.  Individuals are expected to balance the costs and benefits underlying the trade‐off between current and future reproduction. If starting to breed does not seriously lower future reproductive output, individuals that start breeding early in their life should have a higher fitness than individuals that postpone their breeding career. We studied how the fluctuations in food supply interacted with Ural owl’s age at first breeding, lifetime reproductive success (LRS) and fitness.

2.  During the period 1977–95, 126 Ural owl females started and ended their breeding career in a study area in southern Finland. Voles, the owls’ main food source, showeda 3‐year cycle of low, increase and peak population numbers. We recorded when the females started to breed and how many fledglings they produced. For 57 females the age at first breeding was known.

3.  LRS of female Ural owls varied from 0 to 33 fledglings (mean 6.7±0.52 SE). The variance in LRS was explained by variation in the components: breeding lifespan (97%); nest success (23%); and average clutch size (15%).

4.  Survival of breeding females was low (62%) after a peak year, when the vole population crashed. In other phases the survival was 85–95%. Females that started breeding in a peak year had half the LRS of females that started in an increase year.

5.  There was a strong interaction between the vole cycle and age at first breeding. 1‐year‐olds started in a peak and 2‐year‐olds in an increase year.

6.  There was no effect of age at first breeding on LRS for females that started breeding in the same phase of the vole cycle.

7.  Females that started breeding at age 1–3 years had equal fitness, whereas females that started at age ≥4 had a lower fitness. Females that postponed first breeding as a two‐year‐old in an increase year had a lower fitness than females that did not do so. Females that postponed first breeding as a 1‐year‐old in a peak year had equal fitness to females that did not do so.

8.  Cyclic fluctuation in food supply clearly constrains the option as to during what phase and at what age to start breeding. In terms of fitness, the optimal age to start breeding depends on the phase of the vole cycle at hatching.
Patch exploitation by the parasitoids Cotesia rubecula and Cotesia glomerata in multi‐patch environments with different host distributions
Authors: Vos Matthijs , Hemerik Lia , Vet Louise E. M.
Published: March 2003

1. We analysed the foraging behaviour of two closely related parasitoid species (Cotesia rubecula and Cotesia glomerata) with respect to leaving tendencies from patches in different environments. We investigated how intrapatch experiences like contact with feeding damage and encounters with hosts influence patch leaving decisions. We also estimated the effect of experiences in previously visited patches on leaving decisions in the present patch.

2. For this analysis we applied the proportional hazards model (Cox 1972) to data collected in three versions of a multiple patch set‐up. These set‐ups consisted of different host species or combinations of host species: (1) Pieris rapae, (2) Pieris brassicae and (3) both P. rapae and P. brassicae. The larvae of these hosts differ in their spatial distribution on plants: P. brassicae occur in clusters and the distribution of larvae is heterogeneous; P. rapae larvae feed solitarily.

3. The specialist parasitoid C. rubecula used a simple strategy: highest leaving tendency on empty leaves, lower leaving tendency on leaves infested with the non‐preferred host P. brassicae, lowest leaving tendency on leaves infested with the preferred host, P. rapae. In the environment with both host species, the leaving tendency only decreased on leaves infested with P. rapae.

4. The generalist C. glomerata used a more complex set of rules. (a) Multiple ovipositions on the present patch decreased the leaving tendency on leaves containing the gregarious host. (b) Once the parasitoid had encountered two or more hosts, it had a lower leaving tendency during subsequent patch visits. (c) The leaving tendency increased with the number of visits on infested leaves. In environments where the less preferred host P. rapae was present, C. glomerata switched to the same simple type of rule as used by C. rubecula.

5. Neither of the two Cotesia species used a count‐down rule, in which ovipositions increase the leaving tendency. We discuss how patch exploitation by both Cotesia species compares to the patch exploitation mechanisms as proposed by Waage (1979) and Driessen et al. (1995).

6. We formulate an ‘adjustable termination rate’ model for patch exploitation in both Cotesia species in multi‐patch environments.