bluuebunny/crossref_metadata_2025 huggingface dataset:
Power and self‐perceived health in blind diabetic and nondiabetic individuals
Authors: Leksell Janeth K. , Johansson Ingrid , Wibell Lars B. , Wikblad Karin F.
Published: March 2003

Power and self‐perceived health in blind diabetic and nondiabetic individuals

Aims. The aims of this study were: (1) to explore perceptions of power in blind individuals and relate presence or absence of power to self‐perceived health and (2) to compare self‐perceived health in blind individuals with that of the general population.

Background. The theoretical framework of this study was Barrett’s Power theory, which is based on The Rogerian nursing theory. Power is defined as being aware of what one is choosing to do, feeling free to doing it, and do it intentionally.

Methods. Thirty‐nine blind subjects at three adjacent ophthalmology centres agreed to participate in the study. Of those 23 had become blind because of late complications of diabetes. Power was explored during semi‐structured interviews and self‐perceived health was measured with the Swedish health‐related quality of life questionnaire. Data on socio‐economic, rehabilitative and diabetes‐related variables were also collected.

Findings. Power was experienced by 19 of the 39 respondents and was more frequently found in nondiabetic subjects than in diabetic subjects. Those experiencing power reported a better emotional and general health compared with individuals lacking power. The perception of having power was not significantly related to any other of the studied variables. When compared with age‐ and gender‐matched controls from the general population, nondiabetic blind subjects scored higher in positive feelings and lower in physical functioning. In contrast diabetic subjects experienced poorer general health, less satisfaction with physical health and more negative feelings, but they reported that they did not experience limitation as a result of these emotions.

Conclusion. One way of improving health in diabetic blind individuals could be to increase the subject’s perception of power.
Patients with congestive heart failure and their conceptions of their sleep situation
Authors: Broström Anders , Strömberg Anna , Dahlström Ulf , Fridlund Bengt
Published: March 2003

Patients with congestive heart failure and their conceptions of their sleep situation

Aim. To describe, from a nursing perspective, how patients with CHF conceived their sleep situation.

Background. Sleep disturbances are very common in patients with congestive heart failure (CHF). Polysomnographic studies have shown that the total duration of sleep is shorter and the sleep structure disturbed, with frequent arousals and sleep stage changes.

Methods. A qualitative descriptive design inspired by a phenomenographic approach was employed. Conceptions were collected through interviews with 20 strategically chosen CHF patients.

Findings. The findings showed that the patients’ sleep was affected by their daily activities, the disease itself and cardiac symptoms. The sleep disturbances gave effects such as fatigue, listlessness, loss of concentration and loss of temper. These effects led to a need for daytime sleep, seclusion, counselling and information. Patients handled their sleep disturbances through coping mechanisms related to developed patterns of daily life and through support from their psychosocial environment.

Conclusions. Through an increased awareness of the causes of sleep disturbances in CHF patients, nurses can more effectively meet their caring needs and reduce the psychological stressors that patients develop. Information and education, both to patients and the next of kin, about the disease and the sleep situation, especially good sleeping habits, can help patients to better cope with sleep disturbances.
Changes, challenges and choices for the primary health care workforce: looking to the future
Authors: Jenkins‐Clarke Susan , Carr‐Hill Roy
Published: March 2003

Changes, challenges and choices for the primary health care workforce: looking to the future

Aims. The main aim of this paper is to draw attention to problems facing the primary health care workforce in terms of demand for treatment of minor illness over the next two decades. These predictions have implications for the community nursing workforce in particular and the flexibility of primary health care teams in general.

Background. Care delivered in the primary care sector influences, and is influenced by, the characteristics of the health care workforce. These characteristics fall into two main groups: firstly, the shape of the present medical and nursing workforce and manpower trends; and secondly, the changes in doctors’ and nurses’ workloads.

Design. This paper draws on two studies, both commissioned by the Department of Health; the first study focusing on skill mix and delegation in primary health care teams and the second addressing the implications of skill mix for medical workforce scenarios in the changing policy environment.

Findings. From the first study, general practitioners across ten general practices were prepared to delegate at least one topic from over a third of 836 consultations and a further 17% of entire consultations. This potential delegation fell mainly to practice nurses and nurse practitioners. The second study used data extracted from the National Morbidity Surveys of 1981 and 1991 predicting that minor consultations are set to increase by 11 million from the 1990s to 2020 – a minimal estimate. The authors argue that many of these extra predicted consultations will find their way onto practice nurses’ and nurse practitioners’ caseloads.

Conclusions. Workforce issues and questions of professional roles and boundaries, in the context of the ‘greying’ community nursing workforce, demand solutions if patient/client demand is to be met over the next two decades.
A systems approach to the reduction of medication error on the hospital ward
Authors: Anderson David J. , Webster Craig S.
Published: March 2003

A systems approach to the reduction of medication error on the hospital ward

Aims. To discuss a potentially powerful approach to safer medication administration on the hospital ward, based on principles of safety developed in other high‐risk industries, and consistent with recent national reports on safety in health care released in the United Kingdom (UK) and United States of America (USA). To discuss why punitive approaches to safety on the hospital ward and in the nursing literature do not work.

Background. Drug administration error on the hospital ward is an ever‐present problem and its occurrence is too frequent. Administering medication is probably the highest‐risk task a nurse can perform, and accidents can lead to devastating consequences for the patient and for the nurse’s career. Drug errors in nursing are often dealt with by unsystematic, punitive, and ineffective means, with little knowledge of the factors influencing error generation. Typically, individual nurses are simply blamed for their carelessness. By focusing on the individual, the complete set of contributing factors cannot be known. Instead, vain attempts will be made to change human behaviour – one of the most change‐resistant aspects of any system. A punitive, person‐centred approach therefore, severely hampers effective improvements in safety. By contrast, in other high‐risk industries, such as aviation and nuclear power, the systems‐centred approach to error reduction is routine.

Conclusions. Accidents or errors are only the tip of the incident iceberg. Through effective, nonpunitive incident reporting, which includes reports of near‐misses and system problems in addition to actual accidents, the systems‐approach allows the complete set of contributing factors underlying an accident to be understood and addressed. Feedback to participants and targeted improvement in the workplace is also important to demonstrate that incident data are being used appropriately, and to maintain high levels of on‐going reporting and enthusiasm for the scheme. Drug administration error is a serious problem, which warrants a well‐reasoned approach to its improvement.
Meeting the needs of consumers in the community: a working partnership in mental health in New Zealand
Authors: Crowe Marie , O'Malley Jane , Gordon Sarah
Published: March 2003

Meeting the needs of consumers in the community: a working partnership in mental health in New Zealand

Aim. The aim was to evaluate whether the services community mental health nurses provide are meeting the needs of consumers in the community.

Rationale. The role of the mental health nurse in the community is changing as a result of deinstitutionalization, the consumer movement and the market model of health care delivery. In this context it is important for mental health nurses to evaluate whether the service they are currently providing is meeting the needs of consumers.

Design. This was a joint project between nurses and consumers. It was a service‐specific descriptive research project utilizing qualitative methods of data collection and analysis that provides a model for working in partnership.

Findings. The results of this research identify collaboration in planning care and sharing information as two areas of concern but generally the consumers were very satisfied with the care provided by community mental health nurses. The analysis of the data suggests that consumers value nursing care because nurses provide support in their own home; they help consumers develop strategies for coping with their illness and their life; they provide practical assistance when it is required; they are vigilant about any deterioration or improvement; and they are available and accessible.

Conclusion. The results of this study have demonstrated that nurses will remain critical to the success of community‐based care because of their ability and willingness to be flexible to the demands of their own organization and the users of services.
Nursing students’ perceptions of research: usefulness, implementation and training
Authors: Ax Susanne , Kincade Eddie
Published: March 2003

Nursing students’ perceptions of research: usefulness, implementation and training

Aims. The present study explored students’ perceptions of the usefulness of research for nursing practice; beliefs about difficulties in implementing research on the wards; and finally, their satisfaction with the research training received.

Background. Anecdotal reports of nursing students’ dislike of research.

Method. Recruiting preregistration students for the present study was the first obstacle, and so the sample size remained small, consisting of 12 students. Semi‐structured interviews were conducted and later transcribed.

Results. The findings indicated that resistance, both by students and by qualified nurses, was a recurring issue. Several students disagreed with the training and expressed a need for more practical experience.

Conclusions. Overall, the present study suggests that educational and organizational improvements need to be introduced to transform nursing into a research‐active profession.
A concept analysis of malnutrition in the elderly
Authors: Chen Cheryl Chia‐Hui , Schilling Lynne S. , Lyder Courtney H.
Published: March 2003

A concept analysis of malnutrition in the elderly

Purpose. Malnutrition is a frequent and serious problem in the elderly. Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the elderly. Unfortunately, the concept of malnutrition in the elderly is poorly defined. The purpose of this paper is to clarify the meaning of malnutrition in the elderly and to develop the theoretical underpinnings, thereby facilitating communication regarding the phenomenon and enhancing research efforts.

Scope, sources used. Critical review of literature is the approach used to systematically build and develop the theoretical propositions. Conventional search engines such as Medline, PsyINFO, and CINAHL were used. The bibliography of obtained articles was also reviewed and additional articles identified. Key wards used for searching included malnutrition, geriatric nutrition, nutritional status, nutrition assessment, elderly, ageing, and weight loss.

Conclusions. The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life. Malnutrition in the elderly is a multidimensional concept encompassing physical and psychological elements. It is precipitated by loss, dependency, loneliness and chronic illness and potentially impacts morbidity, mortality and quality of life.
Power and partnership: a critical analysis of the surveillance discourses of child health nurses
Authors: Wilson Helen Vivien
Published: March 2003

Power and partnership: a critical analysis of the surveillance discourses of child health nurses

Aims. To explore surveillance discourses within New Zealand child health nursing and to identify whether surveillance practices have implications in this context for power relations.

Background. In New Zealand child health nurses are called Plunket nurses, who are employed by a voluntary organization, the Royal New Zealand Plunket Society (RNZPS). These nurses primarily work in the community with the families of new babies and preschool children. Their work is called child health surveillance and this is considered to involve routine and unproblematic practices, which are generally carried out in homes and clinics in the context of an ongoing relationship between the Plunket nurse and the mother of a baby. However, suggestions in the literature that surveillance, wherever it is practised, has implications for power relations cast doubt on official claims that this nurse–mother relationship is mediated through a partnership model of care.

Methods. Five experienced and practising Plunket nurses were each interviewed twice. The texts generated by these semi‐structured interviews were analysed using a Foucauldian approach to critical discourse analysis.

Results. In contrast with the conventional view of power as held and wielded by one party, this study revealed that, in the Plunket nursing context, power is exercised in various and unexpected ways. Although the relationship between the mother and the nurse cannot be said to operate as a partnership, it is constituted in the nurses’ discourses as a dynamic relationship in which the mother is actively engaged on her own terms. The effect of this is that it is presented by the nurses as a precarious relationship that has significant implications for the success of their work.
Students’ perceptions of the effectiveness of mentors in an undergraduate nursing programme in Hong Kong
Authors: Suen Lorna K.P. , Chow Filomena L.W.
Published: March 2003

Students’ perceptions of the effectiveness of mentors in an undergraduate nursing programme in Hong Kong

Aim of the paper. This paper reports the results of a multiple‐phase study on a mentoring scheme for nursing students in one of the universities in Hong Kong. Using a qualitative approach, students’ perceptions of the various roles of mentors were collected, and this information was used as the basis to design a tool for subsequent evaluation of the mentoring scheme.

Background. The nursing department in one of the universities in Hong Kong initiated and developed the idea of an ‘Honorary Clinical Instructors’ scheme (HCI scheme) for the supervision of the pre‐registration nurses. The scheme was examined in a local context, where the Chinese culture dominated, so that a standardized protocol that takes into account the potential cultural dimensions could be established.

Design. The mentoring roles outlined by the English National Board (ENB) for Nursing, Midwifery, Health Visiting were used as a framework to identify undergraduate nursing students’ perception of the effectiveness of mentors. Information gathered from interviews with Year 2 students (n=12) and Year 3 students (n=10) was used as the basis to design a questionnaire for subsequent programme evaluation. An evaluation questionnaire based on the interviewing results was developed for further evaluation of the mentoring scheme.

Findings. After the mentoring scheme was evaluated in semester one, a series of strategies were designed to improve the preparation of mentors and the implementation of the scheme. The strategies were identified as effective by the significant differences in the perceptions students had towards the mentoring scheme in semester one and semester two (t189=–4·80, P < 0·001), with semester two (n=81) having a mean score difference of 8·69 higher than in semester one (n=110).

Conclusions. It was concluded that the questionnaire developed in the project could be adopted as a useful instrument to evaluate the effectiveness of mentoring programmes for nursing courses, and that the results of this study may also stimulate more research interest in this area to improve the quality of clinical teaching in the pre‐registration nursing education programmes in the future.
Substitution model with central role for nurse specialist is justified in the care for stable type 2 diabetic outpatients
Authors: Vrijhoef H.J.M. , Diederiks J.P.M. , Spreeuwenberg C. , Wolffenbuttel B.H.R.
Published: March 2003

Substitution model with central role for nurse specialist is justified in the care for stable type 2 diabetic outpatients

Aim of the study. Assessment of effects on quality of care, in terms of patient outcomes, when tasks in the care for outpatients with stable type 2 diabetes are transferred from internist to nurse specialist and from outpatient clinic to general practice.

Background. For the management of chronic diseases with a high prevalence and requiring current monitoring, it is suggested that substitution of care may be an appropriate solution to safeguard high quality care.

Design and methods. A 12‐month nonequivalent control group design was used. General practitioners (GPs) referring diabetes patients to the University Hospital Maastricht were asked to choose for the traditional model or the nurse specialist model. Informed consent was obtained from patients with stable diabetes type 2 attending these practices. All patients received care according to the model chosen by their GP. Identified outcomes were: clinical status, health status, self‐care behaviour, knowledge of diabetes, patient satisfaction, and consultation with care‐providers.

Results. In the control group (n=47) no patients were treated with oral hypoglycaemic agents (OHA) only. The control group was compared with an intervention subgroup (n=52) also without patients receiving OHA only. Clinical data were available for all patients. Patients without complete data from questionnaires had better mean concentration of HbA1c than patients with complete data (P=0·004). The traditional care model and the nurse specialist model achieved equal outcomes, while glycaemic control of patients in the nurse specialist model improved (from 8·6% to 8·3%) but deteriorated in the traditional model (from 8·6% to 8·8%; P‐value between groups=0·001).

Conclusions. The model with nurse specialists taking on roles and tasks beyond those traditionally regarded as their remit as well as new ones, is effective for the care of stable diabetic outpatients.
Nurses’ behavioural intentions towards self‐poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables
Authors: McKinlay Andy , Couston Maggie , Cowan Sue
Published: March 2003

Nurses’ behavioural intentions towards self‐poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables

Background. The incidence of self‐poisoning is on the increase. Most patients who self‐poison are dealt with initially in the general hospital. Therefore, the type and quality of care self‐poisoning patients receive will depend, in part, on how they are viewed by nursing staff within the general hospital setting. A knowledge and understanding of the attitudes held by nurses towards self‐poisoning patients is therefore important to those involved in the planning and delivery of care towards this client group. Previous studies have examined health care professionals’ attitudes towards people who self‐poison. Usually, however, these have not focused specifically on nurses’ attitudes, and they have ignored the relationship between the attitudes expressed by staff and their intentions to engage in subsequent caring behaviour of one sort or another. It is hence unclear how the findings of such studies are relevant or applicable to nursing policy and practice.

Aims. The present study aims to address these limitations using a methodology informed by the theory of reasoned action. The study aims to separate out the distinctive roles played by nurses’ own attitudes, and the social pressures represented by other people’s attitudes, in determining the types of caring behaviour in which nurses intend to engage when dealing with self‐poisoning patients.

Design/Methods. The study adopts a questionnaire‐based approach incorporating two specially designed vignettes.

Results. The results show that nurses’ own attitudes, and what they believe about the attitudes of others, predict their behavioural intentions towards self‐poisoning patients. The study also shows that nurses with a more positive orientation towards self‐poisoning patients differ in behavioural and normative beliefs from nurses who have a less positive orientation.

Conclusions. The implications for future attempts to explore the relationship between nurses’ attitudes and subsequent caring behaviour are considered, along with implications for nursing policy and practice.
Developing critical reflection for professional practice through problem‐based learning
Authors: Williams Bev
Published: March 2003

Developing critical reflection for professional practice through problem‐based learning

Aims. To explore the influence of current learning traditions in nursing on the development of reflection and critical reflection as professional practice skills and to offer suggestions for nursing education that will specifically facilitate the development of critical reflection.

Organizational constructs. Mezirow’s transformative learning theory, Barrows conceptualization of problem‐based learning (PBL).

Methods. Integrative literature review of published literature related to nursing, health science education and professional education from 1983–2000.

Findings. Professional education scholars concur that specialized knowledge is clearly essential for professional practice, however, they also suggest that self‐consciousness (reflection) and continual self‐critique (critical reflection) are crucial to continued competence. While strategies to facilitate reflection have been outlined in the literature, specific strategies to facilitate the development of critical reflection and implications for nursing education are much less clear. Advocates of reflective and critically reflective practice suggest that the development of these abilities should be inextricably linked to professional development and can be developed through active repeated guided practice. In health care, PBL based on constructivism, has been identified as one way to facilitate the development of these skills.

Conclusions. Nursing learners exposed to PBL develop the ability to be reflective and critically reflective in their learning and acquire the knowledge and skill within the discipline of nursing by encountering key professional practice situations as the stimulus and focus of their classroom learning. The learners’ ability to be both reflective and critically reflective in their learning is developed by critical questioning of the faculty tutor during situational analysis, learning need determination, application of knowledge, critique of resources and personal problem‐solving processes, and summarization of what was learned.
Reliability and validity of the nutritional form for the elderly (NUFFE)
Authors: Söderhamn Ulrika , Söderhamn Olle
Published: March 2003

Reliability and validity of the nutritional form for the elderly (NUFFE)

Aim. The aim of this study was to test the reliability and validity of the Nutritional Form for the Elderly (NUFFE).

Background. The prevalence of undernutrition among older people in nursing homes and hospitals reaches high levels. Assessment of older patients’ nutritional status is an important task for nurses in clinical care. To use a simple nutritional assessment instrument for older people is one approach for nurses. Examples of such instruments are the well validated Mini Nutritional Assessment (MNA) and the newly developed NUFFE.

Methods. A total of 114 consecutively chosen, newly admitted older patients in an elder care rehabilitation ward in western Sweden were interviewed using the NUFFE and MNA. Arm and calf circumferences, body mass index (BMI), and presence of pressure sores and skin ulcers were noted as part of the MNA on admission. Weight was monitored and BMI calculated on discharge. Serum albumin levels on admission and discharge were used if these were available in the records. Reliability of the NUFFE was measured as homogeneity. Criterion related validity, concurrent validity, construct validity, and predictive validity were assessed with different statistical methods. The regional research ethics committee approved the study.

Results. The results showed that the NUFFE is a fairly reliable and valid instrument for identifying actual and potential undernutrition among older patients.

Conclusion. The NUFFE is a simple tool for nurses to use to assess older patients with the aim of detecting undernourished individuals and those at risk for undernutrition. When doing a nutritional assessment with the NUFFE, the BMI ought also to be calculated. The assessment could also be combined with food intake recording for a period of time.
Spirituality and health: towards a framework for exploring the relationship between spirituality and health
Authors: Coyle Joanne
Published: March 2003

Spirituality and health: towards a framework for exploring the relationship between spirituality and health

Background. A growing body of evidence has found that spirituality enhances health. However, spirituality is an elusive concept that defies clear definition. This inevitably presents difficulties when comparing the findings of studies. Therefore conceptual clarification is essential if practitioners are to better understand the relationship between spirituality and health.

Aims. The aim of this paper is to develop a conceptual framework, which can be used to explore the relationship between spirituality and health.

Methods. The concept‐indicator model was used to analyse spirituality in the literature. The literature was searched for empirical indicators or what are taken as essential attributes of spirituality. Similarities and differences between approaches were identified and these formed the basis of a framework.

Findings. The analysis identified three approaches (a trichotomy) to spirituality in the literature. These were termed the transcendent, the value guidance and the structuralist–behaviourist approaches. The paper shows how by clarifying the different conceptualizations of spirituality and the interrelationship between them researchers can also clarify their respective contributions to health. Thus a contribution is made towards making more explicit the ways in which key aspects of spirituality such as transcendence, meaning and purpose, connectedness, hope, and faith, work to produce health benefits in terms of prevention, recovery from illness, or coping with illness.

Conclusions. The framework (or trichotomy) will enable practitioners to understand better the connection between spirituality and health. In particular, it will show that to appreciate the benefits that patients might experience from their value or belief systems, practitioners must actively explore the content of those systems in a respectful way.
Cardiovascular health and physical activity in older adults: an integrative review of research methodology and results
Authors: Houde Susan Crocker , Melillo Karen Devereaux
Published: March 2003

Cardiovascular health and physical activity in older adults: an integrative review of research methodology and results

Purpose of the paper. The purpose of this article is to review the literature on physical activity and its relationship to cardiovascular risk factors and mortality in older adults, in an effort to clarify the specific benefits and optimal level of physical activity for cardiovascular health in the older adult population.

Background/rationale. Despite physical activity being recognized as an important factor in the quality of life of older adults, there is a lack of clarity about the optimal level of physical activity that results in positive cardiovascular health benefits.

Design/methods. An integrative review of the literature using the MEDLINE and CINAHL databases from 1990 through August 2000 was conducted identifying articles related to physical activity and cardiac risk factors, cardiovascular health, or mortality in the older adult.

Results/findings. Forty‐four research articles were reviewed. The intervention studies generally provided support for positive cardiovascular changes with exercise, but the results were inconsistent, sample sizes were small, and the outcomes, interventions, and measures of physical activity differed between studies. There was wide variation in the method of measurement of physical activity in the studies. Studies showed an increase in mortality in those who had a sedentary lifestyle compared to those who were more physically active. Results were mixed related to plasma lipids levels. Three studies showed a positive effect of physical activity on blood pressure (BP), while three studies showed no relationship. Each of the studies that evaluated the relationship between physical activity and pulse rate showed a decreased rate with increased physical activity.

Conclusions. The quantity and type of physical activity that should be recommended to bring about positive effects on cardiovascular health and mortality is unclear. There is support, however, that an active lifestyle decreases mortality. There is conflicting evidence to support positive effects of physical activity on cardiac risk factors. Further research is needed with larger sample sizes, better control of extraneous variables, and using measurements of physical activity that have undergone adequate psychometric testing.
A framework for the role of Registered Nurses in the specialty practice of rehabilitation nursing in Australia
Authors: Julie Pryor BA MN RN CM MRCNA  , Smith Clair
Published: March 2003

Aim of the study.  This study sought to explore systematically the role of Registered Nurses working in rehabilitation in Australia.

Background.  Rehabilitation has been identified as an important aspect of health care. However, evidence of a comprehensive investigation of the nurses' role in rehabilitation cannot be found. From Australia, in particular, no research has been published in this area.

Methods.  This study used a qualitative approach by engaging 13 nurses in one‐to‐one interviews and a further 21 in focus group discussions. Thematic analysis was conducted on the interview and focus group data.

Findings.  Seven domains of practice were identified and are suggested as a framework for the specialty practice of rehabilitation nursing. They capture the ‘how’ and ‘what’ of rehabilitation nursing practice. Central to this practice is a rehabilitative approach to patient care, teaching and coaching, and continual assessment. The nurses explained in detail how these aspects of rehabilitation nursing differentiate their practice from that of their acute care colleagues.

Conclusion.  The rehabilitative approach is one of a variety of approaches to nursing care, but should not be seen as the exclusive domain of rehabilitation nurses. Rehabilitation belongs in every nurse's toolkit.
The nursing contribution to qualitative research in palliative care 1990–1999: a critical evaluation
Authors: Bailey Chris , Froggatt Katherine , Field David , Krishnasamy Meinir
Published: March 2003

Background. Qualitative research plays an important part in providing evidence for practice in nursing, and is gaining greater acceptance within medicine. However, questions remain about what criteria are most appropriate for evaluating qualitative research. To date, little systematic evaluation of qualitative research in palliative care has been conducted.

Aims. This paper is based on a larger study in which we conducted a critical review of qualitative research in palliative care from nursing, medicine, specialist palliative care, sociology, death studies, medical anthropology, and gerontology journals published between 1990 and 1999. The aim of this paper is to present an account of the strengths and weaknesses of qualitative palliative care research in nursing, using data from this review.

Methods. In the larger study, 138 papers from 50 journals were reviewed critically using a tool developed to assess both content and quality; in one part of this tool reviewers recorded open‐ended comments on the strengths and weaknesses of each paper. In this paper, we present a thematic analysis of reviewers' comments on a subgroup of 67 nursing papers from the main review, together with an analysis of comments on 29 papers from a comparison group of death studies, medical anthropology, and sociology journals. Patterns of positive and negative evaluation are identified and used to generate an account of strengths and weaknesses in qualitative palliative care research in nursing.

Findings. Over 40% of the subgroup of papers from nursing journals received positive comments on topic and quality of writing; around 30% received positive comments on contribution to understanding, practical value, and conceptual or theoretical issues. Less than 20% received positive comments on other critical dimensions. Over 40% of nursing papers received negative comments on the link between data, analysis, and findings, other aspects of method and theoretical and conceptual issues. A higher proportion of papers in the comparison group received positive comments on conceptual and theoretical issues and contribution to understanding.

Conclusions. Nearly half the nursing papers reviewed were judged to be well written or to have a well‐chosen topic. However, more than 40% of papers drew negative comments about key methods‐related issues. Arguably therefore efforts to improve the quality of research evidence should focus on this area.
Issues concerning the on‐going care of patients with comorbidities in acute care and post‐discharge in Australia: a literature review
Authors: Williams Allison , Botti Mari
Published: March 2003

Issues concerning the on‐going care of patients with comorbidities in acute care and post‐discharge in Australia: a literature review

Background.  Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most western countries. This has resulted in an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of younger people experience more than one chronic illness. Large numbers of these may require repeated admissions to hospital for acute or episodic care that is superimposed upon the needs of their chronic conditions.

Aim.  To explore the issues that circumscribe the complexities of caring for people with concurrent chronic illnesses, or comorbidities, in the acute care setting and postdischarge.

Methods.  A literature review to examine the issues that impact upon the provision of comprehensive care to patients with comorbidities in the acute care setting and postdischarge.

Findings.  Few studies have investigated this subject. From an Australian perspective, it is evident that the structure of the current health care environment has made it difficult to meet the needs of patients with comorbidities in the acute care setting and postdischarge. This is of major concern for nurses attempting to provide comprehensive care to an increasingly prevalent group of chronically ill people.

Conclusion.  Further research is necessary to explore how episodic care is integrated into the on‐going management of patients with comorbidities and how nurse clinicians can better use an episode of acute illness as an opportunity to review their overall management.
Community perspective on a model to reduce teenage pregnancy
Authors: Tabi Marian M.
Published: March 2003

Design. Qualitative methodology was used to validate elements of an educational career youth developmental model (ECYDM) to reduce teenage pregnancy among African American teens in two inner city urban communities. The specific aims of the study were to gain understanding of the factors contributing to teenage pregnancy and to identify a pregnancy prevention programme relevant to the needs of African American youth.

Methods. Data were collected from a convenience purposive sample of 43 African American teens and adults. Teen participants included males and non‐pregnant, pregnant, and parent females. Adult participants included parents, school staff, and community clergies. Data were collected using demographic questionnaires, structured individual and focus group interviews. Approval from the Institutional Review Board was obtained before conducting the study.

Findings. Findings supported elements of the ECYDM as a pregnancy prevention programme for African American teens in inner city urban communities. Participants identified an educational‐career motivational programme that utilizes mentoring to teach, counsel, and provide information to improve youths' health, education, career, and social outcomes as the pregnancy prevention programme for youth in urban communities.

Conclusions. These findings have important implications for future programme design and research. Teenage pregnancy must be addressed within the context of the individual, family, and community. Community partnership and collaboration of resources is necessary to reduce teenage pregnancy. Educational‐career programmes are needed to provide information and knowledge to young men and women to make sound informed decisions. Continued qualitative research is also needed to gain understanding of pregnancy prevention programmes.
Northern nursing practice in a primary health care setting
Authors: Vukic Adele , Keddy Barbara
Published: March 2003

Background.  This paper explicates the nature of outpost nursing work, and/or the day‐to‐day realities of northern nursing practice in a primary health care setting in Canada. The study was carried out to systematically explore the work of nurses in an indigenous setting. Institutional ethnography, pioneered by Dorothy Smith was the methodology used to guide this research. The theoretical perspective of this methodology does not seek causes or links but intends to explicate visible practices.

Aim.  It is intended to explicate the social organization of specific discourses that inform work processes of nurses working in remote indigenous communities.

Methodology.  The data originated from various sources including spending 2 weeks in a northern remote community shadowing experienced nurses, taking field notes and audio taping interviews with these nurses. One of the two researchers was a northern practice nurse for many years and has had taught in an outpost nursing programme. As part of the process, texts were obtained from the site as data to be incorporated in the analysis. The lived experiences have added to the analytical understanding of the work of nurses in remote areas. Data uncovered documentary practices inherent to the work setting which were then analysed along with the transcribed interviews and field notes derived from the on‐site visit. Identifying disjuncture in the discourse of northern nursing and the lived experience of the nurses in this study was central to the research process.

Results.  The results indicated that the social organization of northern community nursing work required a broad generalist knowledge base for decision making to work effectively within this primary health care setting. The nurse as ‘other’ and the invisibility of nurses' work of building a trusting relationship with the community is not reflected in the discourse of northern nursing. Trust cannot be quantified or measured yet it is fundamental to working effectively with the community.

Conclusion.  The nurses in this study saw building trust to promote health and well‐being in communities as very important, yet very difficult to achieve. The difficulty in part stems from the constraining, structural, administrative, historical, cultural and political contextual realities that have shaped northern community nursing.
A lived experience of dualism between the natural and human science paradigms in nursing
Authors: Chan Engle Angela
Published: March 2003

Aim.  To describe the use of narrative as both phenomenon and method to illuminate college nurse educators' nursing knowledge development through their day‐to‐day stories on the institutional landscape, which shape and are shaped by health‐care and nursing education changes.

Background.  The Ontario health‐care reform in Canada and a shift in nursing curriculum have brought to light a different dimension of a theory–practice issue. The traditional predominant natural science approach in nursing is now no longer considered responsive to the unique characteristics of patients' health‐care needs. Emerging from current nursing education is an emphasis on a human science paradigm. However, as many college nurse educators moved back and forth between their classrooms to clinical settings, they experienced tremendous tensions in living between the new caring paradigm and the old culture of biomedical science ideology. Compounding this challenge is a lack of understanding by the policymakers and administrators of the importance of nurses' contribution vis‐à‐vis an ailing health‐care system. This growing complexity demands that nursing, as a practice discipline, should articulate its unique body of knowledge for advancing contributions in health care.

Methods.  My stories of experience and those of my participants were analysed narratively to determine the knowledge and understanding developed from living the complex and interwoven changes in nursing education and practice.

Findings.  Through living, telling, retelling and reliving our stories, my participants and I recognized a false dualism between the seemingly polarized biomedical and human science paradigms.

Conclusion.  The meaning of certainty–uncertainty inherent in nursing teaching and practice demands that nurse educators rethink how stories of experience play out in their understanding of teaching future graduates the interrelationships between these two approaches.
Portfolios and assessment of competence: a review of the literature
Authors: McMullan Mirjam , Endacott Ruth , Gray Morag A. , Jasper Melanie , Miller Carolyn M.L. , Scholes Julie , Webb Christine
Published: March 2003

Background.  The literature review presented here was conducted as part of an English National Board for Nursing, Midwifery and Health Visiting funded project to evaluate the use of portfolios in the assessment of learning and competence. Initial consideration of the topic revealed the need to clarify the terminology and approaches used to assess competence using portfolios, and therefore the literature review was conducted to inform the study.

Aims.  To clarify definitions, theoretical bases and approaches to competence and the use of portfolios in the assessment of learning and competence in nursing education.

Methods.  A comprehensive literature review was conducted using the CINAHL and MEDLINE databases and the keywords competenc*, portfolios and nursing. Articles published in the period 1989–2001 in English were obtained and their reference lists scrutinized to identify additional references. Twenty articles were found using a combination of the keywords competenc* and portfolios, and 52 using the combination portfolios and nurse education. Articles were included in the review if they focused on the use of portfolios in nursing, and those concerned with professional or transitional portfolios were excluded. This article will analyse definitions of and approaches to competence and its measurement and to portfolios and their use as discussed in the articles identified.

Results.  Three approaches to competence were identified, each with its appropriate forms of assessment. With regard to portfolios, a number of definitions were again found, but there was a consensus that the theoretical basis of their use is theories of adult learning. A number of reasons for and advantages and disadvantages of their use were found, as well as varying ideas about what a portfolios should consist of and how it should be assessed.

Conclusions.  A holistic approach to competence seems to be compatible with the use of portfolios to assess competence in nursing students, but the concept and its implementation is still evolving. A variety of assessment methods are needed for assessment and portfolios appear to have the potential to integrate these. Reflection is an essential component of a portfolio, as are the student–teacher relationship and explicit guidelines for constructing the portfolio. Issues of rigour in assessment of portfolios need to be addressed, but the assessor's professional judgement will inevitably enter into this assessment.
Exploring nursing outcomes for patients with advanced cancer following intervention by Macmillan specialist palliative care nurses
Authors: Corner Jessica , Halliday Debbie , Haviland Jo , Douglas Hannah‐Rose , Bath Peter , Clark David , Normand Charles , Beech Nicola , Hughes Philippa , Marples Rachael , Seymour Jane , Skilbeck Julie , Webb Tom
Published: March 2003

Background. Little information exists about the outcomes from nursing interventions, and few studies report new approaches to evaluating the complex web of effects that may result from specialist nursing care.

Aims. The aim of this study was to explore nursing outcomes for patients with advanced cancer that may be identified as resulting from the care of a Macmillan specialist palliative care nurse.

Methods/instruments. Seventy‐six patients referred to 12 United Kingdom Macmillan specialist palliative care nursing services participated in a longitudinal study of their care over 28 days. Patients were interviewed and completed the European Organization for Research on Treatment of Cancer Quality of Life Scale and the Palliative Care Outcomes Scale at referral, and 3, 7 and 28 days following referral to a Macmillan specialist palliative care nursing service. A nominated carer was interviewed at baseline and 28 days. Notes recorded by Macmillan specialist palliative care nurses in relation to each patient case were analysed.

Findings. Significant improvements in emotional (P = 0·03) and cognitive functioning (P = 0·03) were identified in changes in patients' European Organization for Research on Treatment of Cancer Quality of Life Scale scores, and in Palliative Care Outcomes Scale patient anxiety scores (P = 0·003), from baseline to day 7. Analysis of case study data indicated that overall positive outcomes of care from Macmillan specialist palliative care nursing intervention were achieved in 42 (55%) cases.

Study limitations. Sample attrition due to patients' deteriorating condition limited the value of data from the quality of life measures. The method developed for evaluating nursing outcomes using data from patient and carer interviews and nursing records was limited by a lack of focus on outcomes of care in these data sources.

Conclusions. A method was developed for evaluating outcomes of nursing care in complex situations such as care of people who are dying. Positive outcomes of care for patients that were directly attributable to the care provided by Macmillan specialist palliative care nurses were found for the majority of patients. For a small number of patients, negative outcomes of care were identified.