bluuebunny/crossref_metadata_2025 huggingface dataset:
Legitimation of nurses’ knowledge through policies and protocols in clinical practice
Authors: Manias Elizabeth , Street Annette
Published: March 2003

Legitimation of nurses’ knowledge through policies and protocols in clinical practice

Health care professionals use policies and protocols in varying ways to guide their clinical activities and to promote quality patient care. The critical ethnographic case study upon which this paper is based, involved a research group comprising six registered nurses who worked in a critical care setting. Research methods included professional journalling, participant observation, and focus group and individual interviews. This paper examines the power relations at play between doctors and nurses, and among nurses, and the ways in which nurses used policies and protocols as a means of mediating communication. While policies and protocols provided nurses with legitimacy of their knowledge in the clinical arena, doctors tended to rely on their past experience and background to inform their knowledge and activities. For nurses to believe that they provided valued and collaborative input in patient decisions, they actively sought out written evidence through policies and protocols to confirm and support their knowledge. Policies and protocols of critical care activities provided nurses with expected standards of care, which they used to legitimize their knowledge and to communicate with doctors about ‘undesirable’ medical decisions. The doctors valued their professional authority and autonomy over policies and protocols, while nurses used these written guidelines to assert power and demonstrate resistance. Policies and protocols do not exist in isolation; they occur within a complex network of power relations that create tensions in clinical practice. In challenging these tensions, it is important that nurses and doctors establish a fine balance between using policies and protocols to provide directions for practice, and to allow sufficient latitude and flexibility in addressing the complexities of patient care.
Women’s psychosocial adjustment to diabetes
Authors: Willoughby Deborah F. , Kee Carolyn , Demi Alice
Published: March 2003

Women’s psychosocial adjustment to diabetes

Successful adjustment to a chronic illness such as diabetes mellitus is influenced by a variety of psychosocial factors. The purpose of this study was to examine the extent to which social support, personal resources, coping styles, and psychosocial adjustment to illness differ among women with diabetes living in different types of household structure and to explore the influence of social support, personal resources, coping styles, and household structure on the psychosocial adjustment of women with diabetes. Data were collected in 1995. The convenience sample included 115 diabetic women with an average age of 48 years. Mean length of time from diagnosis was 10 years. Instruments included a demographic data form, a measure of social support, a personal resource scale, the Jalowiec Coping Scale, the Psychosocial Adjustment to Illness Scale‐Self‐Report, and a self‐report item for assessing household structure. Multiple analysis of variance showed that women in various types of households differed in personal resources and coping. Higher levels of social support and more adequate personal resources were associated with more effective coping and better psychosocial adjustment. The effective use of confrontive, optimistic, supportant and self‐reliant coping was associated with better psychosocial adjustment, while evasive and emotive coping styles were associated with more adjustment problems. Multiple regression showed that 47% of the variance in adjustment was explained by personal resources and social support. Findings indicated that women in various types of households differed in the adequacy of their resources and in the ways that they cope with diabetes. Findings further indicated that greater social support, more adequate personal resources, and more effective coping are associated with better adjustment.
Grief and older people: the making or breaking of emotional bonds following partner loss in later life
Authors: Costello John , Kendrick Kevin
Published: March 2003

Grief and older people: the making or breaking of emotional bonds following partner loss in later life

The aim of this ethnographic study was to explore retrospectively the grief experiences of 12 older people whose partners had recently died in hospital, following a period of terminal illness. The rationale was based upon developing an understanding of the grief experiences of newly bereaved older people. In doing so, it is important to consider that grief is not only shaped by culture and social context but also by the nature of the relationship between the mourner and the deceased. For most of this century, the dominant conceptualization relating to grief and the social experience of bereavement has been based on the psychoanalytical school of thought. This process is said to involve the mourner passing through a number of stages or phases and forms the basis of the ‘grief work hypothesis’. Using in‐depth ethnographic interviews, the mourner’s reactions to and perceptions of the loss were explored. Tape‐recorded interview data were analysed using the inductive process of both content analysis and discourse evaluation. The findings from this study shed light on an area of conjugal bereavement that has received little attention in the past and challenges traditional models of grief. The indications are that in the first year of bereavement, the bereaved retain and modify the emotional relationship with their deceased partners, through a range of symbolic behaviours. The discussion raises issues concerning the need to consider the extent to which contemporary conceptualizations of grief explain the reactions of older people whose grief experiences are shaped by their social situation. The study also highlights important issues concerning the need to understand the complexity of grief experiences and bereavement support for older people which has a number of implications for nurses in both hospital and community settings.
Professional nurses’ perception of nursing mentally ill people in a general hospital setting
Authors: Mavundla Thandisizwe Redford
Published: March 2003

Professional nurses’ perception of nursing mentally ill people in a general hospital setting

The aim of this study was to explore professional nurses’ perception of nursing mentally ill patients in a tertiary hospital in Durban. An explorative, qualitative, descriptive and contextual design was followed as the basis for conducting the study. The above‐mentioned research design was achieved through field work conducted in an urban‐based general hospital. A sample of 12 professional nurses was selected from a population of 800 professional nurses employed in this setting using a purposive sampling technique. This sample size was determined by saturation of data as reflected in repeating themes. Both individual phenomenological semistructured interviews and field notes in the form of observations were used as methods of data collection. The field work was conducted without any preset theoretical framework of reference by using bracketing and intuiting. During interviews, participants were asked only one research question, namely: ‘How do you perceive nursing mentally ill patients in your unit or ward?’ Communication skills were employed to encourage participants to verbalize their perception of nursing mentally ill patients in a general hospital setting. A tape recorder was used to collect data and the data was transcribed verbatim. Data collected was analysed following the descriptive method of Giorgi (1986). Coding was carried out by the researcher and an independent expert who is a psychiatric nursing specialist and a qualitative research expert. After data analysis, the results were reflected within universal categories of the Nursing for the Whole Person Theory in order to give them structure. The four themes that emerged from the findings are: perception of self, perception of a patient, perception of feelings that hinder nursing the mentally ill, and perception of the environment. The measures for ensuring trustworthiness proposed by Guba (
Lincoln Y.S. & Guba E.G. (1985)Naturalistic Inquiry. Sage, Beverly Hills) were used as the basis for ensuring reliable and valid findings. The perception of nursing mentally ill people within a general hospital setting was negative and affected the intellectual and the affective component of the nurses’ psychological functioning within their internal environment. It was recommended that nurses’ knowledge and skills should be increased and that they should be given emotional support in terms of counselling.
Universal vs. selective services: the case of British health visiting
Authors: Elkan Ruth , Robinson Jane , Williams Debbie , Blair Mitch
Published: March 2003

Universal vs. selective services: the case of British health visiting

Aims.This paper discusses whether there should be universal or selective provision of health visiting services. The aim is to show the central relevance of the work of the late epidemiologist, Geoffery Rose, to arguments advocating the retention of a universal health visiting service.

Backround.In the United Kingdom (UK), health visiting moved, in the early years of the twentieth century, from being focused on the needs of poor families to becoming a universally provided service. Recent debates about the future of British health visiting have again raised the issue of whether health visiting remains a universal service, or should be targeted only on the most needy.

Structure.Following an exposition of Rose’s work, two kinds of problems with which health visitors are concerned, depression and child abuse, are used to illustrate the ways in which Rose’s approach can be applied to health visiting.

Central thesis.Rose argued that the bulk of problems in society arise in the many who are not at especially high risk, rather than in the few who are at high risk. This is because of a very large number of people who are not at especially high risk. Consequently, following Rose, this paper argues that in relation to such problems as depression or child abuse, to target health visiting services only on those at high risk would be to leave untouched a vast burden of health and social problems. In the context of identifying people who are at greatest risk, Rose argued that no screening instrument can ever be sufficiently precise to accurately identify those most likely to suffer problems. In corroboration of Rose’s argument, this paper illustrates the pitfalls of health visitors’ attempts to screen for families at greatest risk through the use of such instruments as checklists of risk factors.

Conclusions.It is concluded that it is neither possible to screen accurately for those at greatest risk, nor desirable to target services only on those at greatest risk. Therefore, it is advocated that health visiting should remain a universal service. However, it is recognized that within a universally provided service, some clients will require a greater intensity of input than others. In assessing the need for services, it is argued that the professional judgements of health visitors are crucial.
Video modelling to educate patients
Authors: Krouse Helene J.
Published: March 2003

Video modelling to educate patients

Background. Changes in health care delivery in the United States of America due to economic pressures have required nurses to develop innovative instructional materials for educating patients and families. Educational materials such as videotapes, specifically designed to provide information and promote active participation in treatment decisions, can be effective tools for empowering patients. A comprehensive analysis in 1988 concluded that the concept of ‘video modelling’ or ‘behavioural modelling’ offered the greatest benefit of videotaped presentations.

Aim of the study. The purpose of this integrative literature review was to examine the concept of video modelling and its applications in clinical practice.

Methods. A computer search of the electronic databases of Medline and CINHAL between 1990 and 1999 produced a total of 40 research studies on video instruction for patients. Based on criteria for inclusion, 18 research studies involving video modelling were reviewed and three major uses were identified: (1) assisting decision making regarding treatment options; (2) reducing pre‐procedural anxiety and improving coping skills; and (3) teaching self‐care practices.

Results. The studies reviewed included a variety of research designs, clinical settings, and patient populations. Despite these differences, several benefits to the use of video modelling were found. Patients who viewed videotapes regarding treatment options had a greater understanding of the risks and benefits of those choices and were more apt to be active participants in decision making. Collective results of the studies focusing on stress and coping revealed that preparatory videotapes using video modelling could have a positive effect on reducing anxiety and physiological arousal during stressful procedures. With self‐care practices, several of the studies found that there was an increase in desired behaviours in people whose educational programmes included video modelling.

Conclusions. The use of video modelling has potential benefits for clinical practice in facilitating knowledge acquisition, reducing preparatory anxiety, and improving self‐care. Nurses must become more actively involved in evaluating various teaching approaches used with patients to enhance practice and outcomes.
An assessment of the patients’ needs in Mental Health Education
Authors: Chien Wai‐Tong , Kam Chi‐Wai , Lee Iris Fung‐Kam
Published: March 2003

An assessment of the patients’ needs in Mental Health Education

Aim of the study.  The aim of this study was to identify the specific educational needs of Chinese patients with schizophrenia using a Chinese version of the Educational Needs Questionnaire.

Background.  Patient education provides adequate clinical information to patients, increases understanding of their illness condition and encourages their health‐promoting behaviour. A full understanding and satisfaction of patient needs in relation to specific illness has played an important part in the development of an education programme for psychiatric patients. However, psychiatric patients’ perceptions of their specific educational needs and whether or not these needs are being met have seldom been explored for the purposes of optimizing the effects of patient education programmes. This study served the purpose of assessing the learning needs of Chinese patients with schizophrenia in Hong Kong.

Design.  A cross‐sectional survey was conducted in Hong Kong with 192 Chinese outpatients with schizophrenia. The principles for determining the equivalence of translated tools were applied to the development of the Chinese version of the questionnaire.

Results.  Patients gave high importance to gaining information about mental illness, strategies for improving social relationships and solving daily problems. Socioeconomic factors including education level and membership in a mutual support group correlated significantly with need importance and the unmet‐need score. Length of illness negatively correlated with need importance, indicating the adverse effect of illness on patients’ interests in fulfilling needs.

Conclusions.  Assessment of mental health consumers’ perceptions of their specific educational needs and tailoring patient educational curricula to the expressed needs appear essential. The importance of validity testing of a translated tool is also highlighted in this study.
Adults’ recollections of their experiences as young caregivers of family members with chronic physical illnesses
Authors: Lackey Nancy R. , Gates Marie F.
Published: March 2003

Adults’ recollections of their experiences as young caregivers of family members with chronic physical illnesses

Aims of the study.  The aims of this study were to describe the number, kind, and intensity of caregiving activities performed by individuals who assumed caregiving responsibilities, as youngsters, for adults with chronic physical illnesses; to explore the meaning and effects of the caregiving experience on those individuals; and to examine positive and negative effects of caregiving then and now.

Background/Rationale.  Family mobility, demographic changes, and health care system changes in the United States of America (USA) have contributed to an increasing number of youngsters under the age of 18 caring for adults with chronic physical illnesses in the home. The effects of such caregiving on youngsters and the long‐term effects on them as adults require study.

Design/Methods.  This descriptive, retrospective study had a convenience sample of 51 adults (age range 19–68 years now, 3–19 years then) who cared for their family members diagnosed with cancer, stroke, cardiovascular disease, multiple sclerosis or amyotrophic lateral sclerosis, respiratory disease, diabetes, or arthritis. Demographic data and caregiving data were analysed using descriptive statistics. The semistructured interview data were analysed using content analysis.

Results/Findings.  Of the caregiving care tasks most frequently performed, personal care was most difficult and household tasks were most time consuming. Family life, school, and time with friends were areas most likely to be affected by caregiving. Most subjects indicated they would permit their own children to assist with care as long as the youngster was not the sole caregiver. Youngsters need to be informed about the illness and caregiving tasks, have adequate support systems, and have some time to ‘still be a child’.

Conclusions.  Professional caregivers should raise questions in their practice regarding involvement in caregiving by both adults and youngsters. If youngsters participate in caregiving in the home, they need to receive adequate information regarding care and the illness trajectory. Family‐related research including the long‐term effects of such experiences on the youngsters and their families is recommended.
Whither nursing? Discourses underlying the attribution of master’s level performance in nursing
Authors: Ashworth Peter D. , Gerrish Kate , McManus Mike
Published: March 2003

Whither nursing? Discourses underlying the attribution of master’s level performance in nursing

Aim. Drawing upon the selected findings from a multidisciplinary study that sought to explore the meaning of master’s level performance in health professional practice, the characteristics which nurse educators attributed to the practice of master’s level nursing graduates are analysed to reveal underlying discourses.

Background. Although master’s level programmes for nurses have been available in the United Kingdom (UK) for the past three decades and current heath policy directives link master’s level qualifications with senior clinical nursing roles, the contribution that master’s level education might make to the future direction of nursing is unclear.

Research design and methods. In‐depth interviews were undertaken with a purposive sample of 18 nurse lecturers drawn from eight universities in the UK who were responsible for master’s level programmes in nursing. The interview agenda explored participants’ perspectives of the characteristics of master’s level performance. Drawing upon the methodology of discourse analysis, interview transcripts were interpreted in such a way as to show the implicit discourses underlying the participants’ claims regarding their graduate’s attributes of professional practice.

Findings. The characteristics attributed to master’s graduates were categorized under (a) cognitive competencies, (b) practice‐related competencies, (c) research orientation and (d) personal dynamism. However, these attributions are not empirical generalizations, developed inductively. Rather, they draw on socially available discourses regarding the future direction of the profession.

Conclusion. The nurse educators drew on the following socially available discourses: (a) a discourse in which nursing is construed as involving great competence in practice, but without radicality of thought. Associated with this is a pervasive rhetoric of pragmatism; (b) a discourse of interprofessional practice in which nursing has a role of leadership. This is associated with a view of the location and power of nursing within the structure of the National Health Service and (c) notably lacking were discourses of care‐giving, and of academic/intellectual aspiration. The implications of these discourses for the future direction of nursing are considered.
The development of reflective learning in the context of health counselling and health promotion during nurse education
Authors: Liimatainen Leena , Poskiparta Marita , Karhila Päivi , Sjögren Auli
Published: March 2003

The development of reflective learning in the context of health counselling and health promotion during nurse education

Aims and background. The purpose of this follow‐up study was to describe the development of reflective learning of 16 student nurses in the context of health counselling and promotion during clinical training of a 3‐year nursing education programme in two Finnish polytechnics. The first aim was to analyse the levels of reflectivity in the student nurses’ reflections on their videotaped counselling situations. The second aim was to explore the qualitative features of the reflective health counselling learning process in the context of health promotion. The theoretical background of the study was based on a transformative learning theory.

Methods. The data consisted of stimulated recall interviews with 16 student nurses conducted once a year between 1998 and 2000. The data were analysed using categorization and thematic analysis.

Findings. The findings of the study showed that half of the students in the research group reached the level of critical consciousness during their nursing education. The others remained at the level of consciousness. Two students who represented thoughtful action without reflection in the first study year were able to reach reflection and even critical reflection later during their education. The meaning schemas of counselling developed and were enriched when the students moved into the higher stages of reflection. There were features of an empowerment approach to health promotion only in the meaning schemas and perspectives of critical reflectors.

Conclusions. These results may indicate that the empowerment approach to health promotion within the modern health promoting role of nurses requires critical reflection. Therefore, effective methods and evaluation tools of reflective learning are needed to support learning from practice via critical reflection.
Developing an evidence base for interdisciplinary learning: a systematic review
Authors: Cooper Helen , Carlisle Caroline , Gibbs Trevor , Watkins Caroline
Published: March 2003

Developing an evidence base for interdisciplinary learning: a systematic review

Aim of the study. The overall aim of the study was to explore the feasibility of introducing interdisciplinary education within undergraduate health professional programmes. This paper reports on the first stage of the study in which a systematic review was conducted to summarize the evidence for interdisciplinary education of undergraduate health professional students.

Methods. Systematic reviews integrate valid information providing a basis for rational decision making about health care which should be based on empirical and not anecdotal evidence. The accepted principles for systematic reviews were adapted in order to allow integration of the literature to produce recommendations for educational practice and guidelines for future research.

Findings. The literature on interdisciplinary education was found to be diverse, including relatively small amounts of research data and much larger amounts of evaluation literature. Methodological rating schemes were used to test for confounding influences in the research studies. The number of studies found was 141 but only 30 (21%) were included in the analysis because of lack of methodological rigour in the research and poorly developed outcome measures.

Conclusions. Student health professionals were found to benefit from interdisciplinary education with outcome effects primarily relating to changes in knowledge, skills, attitudes and beliefs. Effects upon professional practice were not discernible and educational and psychological theories were rarely used to guide the development of the educational interventions.
The team survey: a tool for health care team development
Authors: Millward Lynne J. , Jeffries Naomi
Published: March 2003

The team survey: a tool for health care team development

Aims. The aim of this study was to validate a psychometric tool, the team survey, in a health care setting with a range of teams from a Large National Health Service (NHS) Trust.

Background. The team survey was developed by Millward and Ramsay (1998) to measure the team dimensions identified in the cognitive‐motivational model of team effectiveness (Millward & Purvis 1998). The team dimensions are team potency, team identification, Shared Mental Models and team meta‐cognitions.

Design and methods. The psychometric properties of the tool as a reliable and valid predictor of team effectiveness was assessed by way of a survey of 10 teams (comprising 124 members in all) located on different premises, within a large NHS Trust. Team size ranged between 5 and 19 members, with average team size being 10 members. Two independent ratings of ‘effectiveness’ were made for each team. Factor and multiple regression analyses were employed to identify the most powerful predictors of health care team effectiveness from a cognitive and motivational perspective.

Results. The results suggest that the team survey is psychometrically robust within a health care setting.

Conclusions. It is concluded that the tool has a potentially key role in informing and evaluating team development initiatives in support of the work of practice development nurses and nursing team leaders.
Critical analysis of everyday self‐care decision making in chronic illness
Authors: Paterson Barbara L. , Russell Cynthia , Thorne Sally
Published: March 2003

Critical analysis of everyday self‐care decision making in chronic illness

Aims of the paper. The purpose of the paper is to (1) identify prevalent assumptions that underlie the traditional conceptualization of everyday self‐care decision making and (2) contrast these with the findings of relevant research.

Background/Rationale. Current understandings of self‐care decision making in chronic illness tend to be extrapolated from knowledge gained in relation to one‐time decisions, or decision making in contexts that are only superficially related to the complexity and pervasiveness of living with a chronic disease.

Findings. The authors challenge the assumptions with which current understandings represent self‐care decision making in chronic illness, using evidence from their research on what it is like to live with and manage the implications of having a chronic disease on an everyday basis.

Conclusions. The paper concludes with a call for a new conceptualization of self‐care decision making in chronic illness which sufficiently addresses the unique and complex nature of such decisions.
‘Best research practice’: in pursuit of methodological rigour
Authors: Maggs‐Rapport Frances
Published: March 2003

‘Best research practice’: in pursuit of methodological rigour

Rationale. This paper is based on the rationale that misuse of methodological notions in research publications lays research studies open to criticism and dismissal.

Aim. In search of ‘best research practice’, this paper aims to examine the different qualities of four major qualitative methodologies: ethnography, descriptive phenomenology, interpretative phenomenology/hermeneutics and critical social theory.

Design. The study presents a critical overview of methodological decision‐making, illustrating the sorts of issues researchers must consider in order to justify to the readership and to themselves the employment of a particular methodology. This is presented alongside a general overview of qualitative research and a précis of each of the major qualitative methodologies. The paper describes the methodologies, salient features, and examines methodological similarities and differences. The paper concludes by examining the need for methodological rigour within the framework of the National Health Service (NHS) Executive’s drive for evidence‐based practice in health care.

Recommendations. It is hoped that the paper will stimulate a deeper exploration of methodological rigour in future research publications.
Components of a proper hospital discharge for elders
Authors: Bull Margaret J. , Roberts Julia
Published: March 2003

Components of a proper hospital discharge for elders

Significance. Effective discharge planning is a vital link in continuity of care for elders. Previous studies identify problems with planning for elders’ discharge from the hospital and problems elders encounter managing care post‐discharge. However, little attention has been given to identifying effective discharge planning processes. Explicating the components of effective discharge planning is critical to replicate the process in other health care settings and predict post‐discharge outcomes.

Purpose. The purpose of this study was to identify the components of effective discharge planning for elders and factors that impede planning.

Methods. Ethical approvals were obtained from the University and National Health Service (NHS) Trust. Qualitative methods were used and data were collected from two wards in a 78‐bed geriatric rehabilitation hospital that was part of a National Health Service Trust serving Southwest London. Data included semi‐structured interviews and documents related to discharge planning, care delivery, and community resources. A total of 24 semi‐structured interviews were conducted with health care professionals who were part of the hospital’s multidisciplinary team, those affiliated with the Community Trust that provided aftercare, elders, and family carers.

Results. Participants consistently used the term ‘proper discharge’ when referring to effective discharge planning. The multidisciplinary team comprised a vital context for a proper discharge. The findings indicated that three circles of communication were central in a four stage discharge process. Different circles of communication were key at different stages.

Conclusions. The findings provide insights for educating nurses about effective planning practices and examining the global significance of impediments to a proper hospital discharge.
Action research from the inside: issues and challenges in doing action research in your own hospital
Authors: Coghlan David , Casey Mary
Published: March 2003

Action research from the inside: issues and challenges in doing action research in your own hospital

Background and rationale. Nurses are increasingly engaging in action research projects to improve aspects of nursing practice, education and management and contribute to the development of the profession. Action research involves opportunistic planned interventions in real time situations and a study of those interventions as they occur, which in turn informs further interventions. Insider action research has its own dynamics which distinguish it from an external action researcher approach. The nurse‐researchers are normally already immersed in the organization and have a pre‐understanding from being an actor in the processes being studied. There is a paucity of literature on the challenges that face nurse action researchers on doing action research in their own hospital.

Aim. The aim of this article is to address this paucity by exploring the nature of the challenges which face nurse action researchers. Challenges facing such nurse‐researchers are that they frequently need to combine their action research role with their regular organizational roles and this role duality can create the potential for role ambiguity and conflict. They need to manage the political dynamics which involve balancing the hospital’s formal justification of what it wants in the project with their own tactical personal justification for the project.

Main issues. Nurse‐researchers’ pre‐understanding, organizational role and ability to manage hospital politics play an important role in the political process of framing and selecting their action research project. In order that the action research project contribute to the organization’s learning, nurse action researchers engages in interlevel processes engaging individuals, teams, the interdepartmental group and the organization in processes of learning and change.

Conclusions. Consideration of these challenges enables nurse‐action researchers to grasp the opportunities such research projects afford for personal learning, organizational learning and contribution to knowledge.
The relationships between health beliefs and utilization of free health examinations in older people living in a community setting in Taiwan
Authors: Hsu Hsiu‐Yueh , Gallinagh Róisín
Published: March 2003

The relationships between health beliefs and utilization of free health examinations in older people living in a community setting in Taiwan

Objective. To examine the influence of demographics and the health beliefs of older people on uptake of a free annual health examination administered by the Twu‐Tyan Bureau of Sanitation (TTBS), Pingtung, Taiwan.

Background. The free health examination is a preventive intervention with potential to detect illness. This programme for older people aged 65 years and over, has been available free in some areas since 1980.

Method. A stratified random systematic sample of 200 men and women over 65 years was selected and consisted of 100 individuals who had undertaken the free health examination and 100 who had not. A 17‐item Health Belief Scale (HBS) was used to glean information on their health beliefs and uptake of a free health examination.

Findings. It was found that those with higher education and higher economic status had a greater uptake. Family support was also found to influence take‐up. A statistically significant difference was found between the health beliefs of users and nonusers. Users perceived a higher level of seriousness and susceptibility to ill health than nonusers.

Conclusions. A number of practical pointers are given that might help clinicians increase uptake rates in such health promotion programmes. These encompass understanding the influence of key demographical and social factors, perceived susceptibility, severity and benefits of the intervention, barriers to attendance and self‐efficacy.
The maternity information concerns of Somali women in the United Kingdom
Authors: Davies Myfanwy M. , Bath Peter A.
Published: March 2003

The maternity information concerns of Somali women in the United Kingdom

Aims. The aims of the study were to explore the maternity information concerns of a group of Somali women in a Northern English city and to investigate the relationships of these women with maternity health professionals.

Background. The Somali community is one of the most established ethnic minorities in the United Kingdom (UK). The health needs of this group and in particular, the information needs of Somali women with respect to pregnancy, childbirth and post‐natal care are poorly understood. To facilitate information provision to birthing mothers and to support maternal decision‐making among minority ethnic women, research is required to understand and identify their information needs.

Methods. A user‐centred study utilizing a focus group and semi‐structured interviews with English‐speaking and non‐English speaking Somali women was conducted in a large English city. Discussions were audiotaped, translated, transcribed and then analysed using a variation of the constant comparative method. Themes and categories were identified across transcripts during data collection and analysis and appropriate quotations are used to illustrate all themes.

Findings. Major findings that emerged from the analysis related to contact with health professionals, language support and information and satisfaction with health professionals. The findings indicate key maternity information concerns of Somali women with regard to maternity issues and have a number of implications for midwifery and nursing practice.

Conclusions. Poor communication between the non‐English speaking Somali women and health workers was perceived as an underlying problem in seeking information. Fears about misinterpretation and confidentiality, limit the usefulness of interpreters. The Somali women perceived that they were denied information due to punitive attitudes and prejudiced views among health professionals.
A critique of cultural education in nursing
Authors: Duffy Mary E.
Published: March 2003

A critique of cultural education in nursing

Aim(s) of the paper. This paper critiques cultural education in nursing. Current approaches to cultural education, embedded in traditional anthropology, are obsolete and fail to acknowledge the global environment that impacts even the most remote and isolated cultures. The argument is made that new, tranformative approaches to cultural education are needed.

Background. Cultural awareness of theotheris the foundation of existing strategies to teach cultural education. Students are encouraged to learn about each culture, often described as a monolith, by learning the unique characteristics of a group with a common race, ethnicity, or other distinguishing feature. Despite the increased emphasis on cultural education in nursing worldwide, culturally based problems persist. Nurse and health care researchers continue to report disparities in health, an unequal distribution of health care, and the lack of knowledge and sensitivity when caring for clients from another culture.

Discussion. Globalization contributes to differences within cultures that may equal or exceed differences between cultures. Evidence is presented that current nursing education emphasizes cultural distinctions that do not persist in the postmodern world. Problems adherent to the continued use of cultural monoliths as the foundation of cultural education are discussed and expanded perspectives on culture and cultural education are presented.

Conclusion. The principles of transformative education are offered as an alternative to the current approaches to cultural education. Students are encouraged to be vulnerable to personal change when interacting with people from other cultures because transformative education is as much about personal growth as it is about enhanced care of others. This modernized approach to cultural education transcends the standard adaptation of care from the dominant culture of the health care delivery system to the culture of the client/patient.
Relationship between nurses’ pain knowledge and pain management outcomes for their postoperative cardiac patients
Authors: Watt‐Watson Judy , Stevens Bonnie , Garfinkel Paul , Streiner David , Gallop Ruth
Published: March 2003

Relationship between nurses’ pain knowledge and pain management outcomes for their postoperative cardiac patients

Nurses’ knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses’ stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university‐affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse–patient combinations. Nurses’ knowledge scores were not significantly related to their patients’ pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients’ perceptions of their nurses as resources with their pain were not positive. Nurses’ knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses’ stated pain knowledge was not associated with their assigned patients’ pain ratings or the amount of analgesia they received.
Problem behaviour, caregiver reactions, and impact among caregivers of persons with Alzheimer’s disease
Authors: Robinson Karen M. , Adkisson Pam , Weinrich Sally
Published: March 2003

Problem behaviour, caregiver reactions, and impact among caregivers of persons with Alzheimer’s disease

Background. Problem behaviours that occur during Alzheimer’s disease (AD) can have major impact on caregivers. How caregivers react to these behaviours may determine the total impact experienced from caregiving.

Purpose. This study examined the relationships between problematic behaviours and caregiving impact in 30 primary caregivers of persons with AD. The first question explored the relationship between frequency of problem behaviour and impact; the second explored the relationship between caregiver reactions to problem behaviours and impact from caregiving.

Methods. The frequency of problem behaviour and the caregiver reaction was measured using The Revised Memory and Behaviour Problem Checklist (Teri et al. 1992). The impact from caregiving was operationalized using the Cost of Care Index developed by Kosberg and Cairl (1986).

Results. Significant associations were found for 11 of the 20 subscales that measured the association between the frequency of problem behaviour in the client and the impact from caregiving experienced by the caregiver. In comparison, the association between caregiver’s reaction to problem behaviours and impact from caregiving was even more significant in value with 15 subscales of 20 being significant. Female caregivers experienced a greater reaction to disruptive and depressive behaviour when compared with male caregivers even though both genders reported similar frequencies of problem behaviours. In regard to findings about the impact from caregiving, four of the six indicators were higher for women than for men.

Conclusions. Caregiver reaction to problem behaviours was more highly associated with impact from caregiving than the actual frequency of the behaviours. These findings have great implications for intervention programs. Caregivers, especially females, need to receive individualized, specific education/training on how to understand and manage disruptive and depressive behaviour in persons with AD.
Parent involvement in children’s pain care: views of parents and nurses
Authors: Simons Joan , Franck Linda , Roberson Elaine
Published: March 2003

Parent involvement in children’s pain care: views of parents and nurses

Aim of the study. This study investigated the views of parents and nurses about the involvement of parents in the management of their child’s pain during the first 48 hours after surgery.

Background. Children’s pain management has been found to be problematic and in need of improvement. Nurses are the key health care professionals with responsibility for managing children’s pain. Parents can make important contributions to assessment and management of their child’s pain.

Methods. Using a phenomenological approach, nurses and parents were interviewed about their perceptions of parent involvement in pain management.

Findings. The findings indicated that parental involvement in their child’s pain management is superficial and limited in nature. Parents described a passive role in relation to their child’s pain care and conveyed feelings of frustration. Only a minority of parents expressed satisfaction with their child’s pain care. Nurses perceived that there was adequate involvement of parents and adequate pain management for children.

Conclusions. These findings may be somewhat explained by differing views and a lack of effective communication between parents and nurses. There is a clear need for nurses to discuss parent involvement with parents and negotiate roles in relation to pain management.
‘Your ears become your eyes’: managing the absence of visibility in NHS Direct
Authors: Pettinari Catherine Johnson , Jessopp Lynda
Published: March 2003

‘Your ears become your eyes’: managing the absence of visibility in NHS Direct

Aims. To identify and describe nurses’ perceptions of interactional practices they use to manage the absence of visual cues in telephone consultations with callers at an NHS Direct site.

Background. A routine activity in telephone consultations is visualizing the patient and the situation from which the call is made, that is, ‘building a picture of the patient’. Little is known about interactional practices between nurse and caller that contribute to shaping a conception of the caller, or other activities that nurses do to manage the absence of visibility in the consultation.

Methods. Qualitative analysis of semi‐structured interviews conducted with nurses new to NHS Direct telephone consultations, the first immediately prior to the NHS Direct site’s opening, and the second 6 months later.

Findings. The activity of visualizing patients and their environment is closely linked to interactional practices carried out between nurse and caller. Nurses described a range of interactional activities that they perceive help callers to describe with more precision what the nurse cannot see. Nurses also tailor interaction to a nonvisual environment in order to manage the more emotional aspects of telephone consultations, such as delivering information, advice, reassurance, and building trust and rapport.

Conclusions. Nurses developed skills to manage interaction with callers in order to compensate for the absence of visibility. Skills were based on their professional backgrounds and experience and developed in an ad hoc way. Further research could examine the efficacy of these strategies, and be a prerequisite to adding them to training programmes.