bluuebunny/crossref_metadata_2025 huggingface dataset:
The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey
Authors: Van Teijlingen Edwin R. , Rennie Anne‐Marie , Hundley Vanora , Graham Wendy
Published: March 2003

The importance of conducting and reporting pilot studies: the example of the Scottish Births Survey

Background.  In many research papers, pilot studies are only reported as a means of justifying the methods. This justification might refer to the overall research design, or simply to the validity and reliability of the research tools. It is unusual for reports of pilot studies to include practical problems faced by the researcher(s). Pilot studies are relevant to best practice in research, but their potential for other researchers appears to be ignored.

Objective.  The primary aim of this study was to identify the most appropriate method for conducting a national survey of maternity care.

Methods.  Pilot studies were conducted in five hospitals to establish the best of four possible methods of approaching women, distributing questionnaires and encouraging the return of these questionnaires. Variations in the pilot studies included (a) whether or not the questionnaires were anonymous, (b) the staff involved in distributing the questionnaires and (c) whether questionnaires were distributed via central or local processes. For this purpose, five maternity hospitals of different sizes in Scotland were included.

Results.  Problems in contacting women as a result of changes in the Data Protection Act (1998) required us to rely heavily on service providers. However, this resulted in a number of difficulties. These included poor distribution rates in areas where distribution relied upon service providers, unauthorized changes to the study protocol and limited or inaccurate information regarding the numbers of questionnaires distributed.

Conclusions.  The pilot raised a number of fundamental issues related to the process of conducting a large‐scale survey, including the method of distributing the questionnaire, gaining access to patients, and reliance on ‘gatekeepers’. This paper highlights the lessons learned as well as the balancing act of using research methods in the most optimal way under the combined pressure of time, ethical considerations and the influences of stakeholders. Reporting the kinds of practical issues that occur during pilot studies might help others avoid similar pitfalls and mistakes.
Psychometrics of a Chinese translation of the swallowing questionnaire
Authors: Lin Li‐Chan , Chen Miao‐Yen , Chen Yi‐Ching , Portwood Michael J.
Published: March 2003

Psychometrics of a Chinese translation of the swallowing questionnaire

Aims of the study.  The purpose of this study was to determine the psychometric properties of a Chinese version of a swallowing questionnaire.

Background/Rationale.  Impaired swallowing may lead to serious complications if health care professionals do not accurately assess the problem and promptly intervene. The recognition of symptoms indicative of a swallowing problem is essential for nurses. The swallowing questionnaire could provide nurses with a valid instrument to assess patients’ impaired swallowing.

Designs/Methods.  Phase I consisted of experts doing the initial translation into Chinese and back‐translations of the questionnaire. Five experts then determined content validity of the Chinese version, and 35 bilingual subjects determined equivalence of the Chinese translation and English version. Phase II determined concurrent validity and internal consistency using 113 screened medical patients as subjects. Phase III used 105 screened long‐term care subjects to determine construct validity.

Results/Findings.
 In Phase I, rating on the appropriateness of items on the Chinese version yielding a content validity index of 0·988. The coefficient of equivalence between the Chinese and English versions of the instrument was 0·81, while per cent agreement for all items on the two versions ranged from 0·80–1·00. Phase II established internal consistency with a K‐R20 of 0·74, and concurrent validity yielded a correlation between the swallowing questionnaire and the neurological swallowing exam of 0·675 (P < 0·01). Phase III determined construct validity with significant positive correlations found between the swallowing questionnaire and stroke history and masticatory ability. Significant negative correlations were found between swallowing and cognitive status, functional status and albumin.

Conclusions.  Although useful as a tool for nursing assessment and intervention, further work on the swallowing questionnaire such as conducting video fluoroscopy and a swallowing speed test, are recommended to further validate its accuracy.
Burnout in psychiatric nursing
Authors: Kilfedder Catherine J. , Power Kevin G. , Wells Tony J.
Published: March 2003

Burnout in psychiatric nursing

Introduction.  Burnout in nursing is of both individual and organizational concern with ramifications for well‐being, job performance, absenteeism and turnover. Burnout is rarely assessed as part of a comprehensive model of occupational stress, a short‐coming which this paper attempts to redress.

Method.  A randomly selected sample of 510 psychiatric nurses from one Scottish Trust completed a questionnaire based on a psychological model of occupational stress which included the Maslach Burnout Inventory (MBI) as the dependent variable.

Findings.  The respondents reported average, low and average levels of emotional exhaustion, depersonalization and personal accomplishment, respectively. The study sample had significantly lower scores on emotional exhaustion and depersonalization than normative data but also significantly lower levels of personal accomplishment than a normative group of physicians and nurses. Only 2·0% of the study sample could be categorized as having high burnout overall (i.e. high emotional exhaustion, high depersonalization, low personal accomplishment) and they differed significantly from the rest only in terms of males being over‐represented. Hierarchical regression analysis revealed that selected explanatory variables accounted for 41·9% of emotional exhaustion, 16·4% of depersonalization and 25·6% of personal accomplishment in the study sample.

Implications.  The paper discusses the implications of the findings in terms of a comprehensive approach to intervention aimed at minimizing the risk of burnout in psychiatric nurses. Such an approach will involve interventions at the organizational and individual level.
The primary and secondary care interface: the educational needs of nursing staff for the provision of seamless care
Authors: Werrett Julie A. , Helm Ruth H. , Carnwell Ros
Published: March 2003

The primary and secondary care interface: the educational needs of nursing staff for the provision of seamless care

Aim. To identify nurses’ perceived deficits in the knowledge and skills required to provide effective seamless care, so that appropriate training could be provided.

Background. A clear understanding of nursing staff roles, skills and resources is paramount to work at the primary/secondary care interface. Nursing staff require an educational model that will provide a clear understanding of how their roles coalesce with other healthcare professionals. There is little evidence that examines the educational needs of nurses related to changing care boundaries.

Design/Methods. The study used methodological triangulation to explore these issues within current practice. Focus groups were used to generate items for inclusion in the questionnaire. Questionnaire design was based on an importance‐performance analysis. This procedure has been effective in developing health care marketing strategies. A stratified random sample of nursing staff (n=722) from the participating trusts received the questionnaire, eliciting a response rate of 172 (23·8%).

Results. Factor analysis provided a list of seven training categories in order of training need priority: information technology, awareness of roles, communications within seamless care, working across boundaries, professional issues, practice‐related issues, delivery of patient/client care issues. There were no differences in nurses’ training needs across NHS trusts. However, differences were highlighted for staff located in primary or secondary settings or working across the interface.

Conclusions. Despite there being a vast range of training issues the majority of nurses appear to have a clear idea of their training needs for the provision of seamless care. A training programme required which targets the specific needs of nursing staff working at different positions across the primary/secondary care interface.
Communication skills of nurses during interactions with simulated cancer patients
Authors: Kruijver Irma P.M. , Kerkstra Ada , Bensing Jozien M. , Van De Wiel Harry B.M.
Published: March 2003

Communication skills of nurses during interactions with simulated cancer patients

Aim.  In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated.

Rationale.
 The balance of affective and instrumental communication employed by nurses appears to be important, especially during the admission interview with cancer patients. Methods. For this purpose, admission interviews between 53 ward nurses and simulated cancer patients were videotaped and analysed using the Roter Interaction Analysis system, in which a distinction is made between instrumental and affective communication.

Results.  The results reveal that more than 60% of nurses’ utterances were of an instrumental nature. Affective communication occurred, but was more related to global affect ratings like giving agreements and paraphrases than to discussing and exploring actively patients feelings by showing empathy, showing concern and optimism.

Conclusion.  In future, nurses should be systematically provided with (continuing) training programmes, in which they learn how to communicate effectively in relation to patients’ emotions and feelings, and how to integrate emotional care with practical and medical tasks.
Are auditory warnings in the intensive care unit properly adjusted?
Authors: Solsona José F. , Altaba Carmen , Maúll Elena , Rodríguez Luisa , Bosqué Carmen , Mulero Ana
Published: March 2003

Are auditory warnings in the intensive care unit properly adjusted?

The purpose of this study was to determine whether auditory warnings in the intensive care unit (ICU) were properly adjusted. An intervention study (before‐ and‐after assessment) was conducted in a 12‐bed medical‐surgical ICU of an acute‐care teaching hospital in Barcelona, Spain. A total of 100 patients with stable haemodynamic and respiratory parameters were included. In the first 3‐month phase of the study, minimum and maximum alarm parameters of breathing rate, expired volume/min, airway pressure, SaO2, arterial blood pressure and heart rate were recorded. In the second 12‐month phase of the study, the same alarm parameters were recorded every 4 hours in the patient’s medical record. In the third 3‐month phase of the study, alarm readings were recorded again as in the first phase. The change throughout coefficient of variation (CV) and the 95% confidence interval (CI) for each alarm were calculated. Following the intervention, there was a statistically significant improvement in alarm readings for expired volume, heart rate and systolic blood pressure, so that alarms had been more properly adjusted to the patient’s real value. Nursing staff should be aware that auditory warnings in ICU stable patients are frequently set very far from suitable values. Recording of alarm parameters in the patient’s medical record as a routine daily activity was an effective intervention for improving adjustment of auditory warnings.
Cultural discovery in nursing practice with Vietnamese clients
Authors: Labun Evelyn
Published: March 2003

Cultural discovery in nursing practice with Vietnamese clients

Background. Although there is a developing body of literature dealing with cultural care issues there is a continuing need for research based knowledge of how nurses work within a multicultural population in providing culturally competent care. Nurses’ experiences with Vietnamese clients can contribute to the knowledge of how to provide cultural care.

Purpose. The purpose of this 1997 study was to investigate what North American nurses learned from their work with Vietnamese clients.

Method. A grounded theory approach was employed. A purposive sample of 27 Registered Nurses, who work with Vietnamese clients in North America, in acute care, community, and clinic settings were interviewed using a semi‐structured format. Following ethical approval, an explanation of the study, and data collection, data were analysed using dimensional analysis. Verifiability, adequacy of the findings, and empirical grounding of the theory was established through use of the constant comparative method as well as review of the research method and the study results by selected participants in the study and a nursing expert.

Findings. The action process of cultural discovery was found as the most fruitful explanation of nurses’ experiences. Properties of cultural discovery were learning to see them, seeing a common humanity, and learning to see how they see health. The condition of cultural discovery was making a connection with the consequences of learning how to provide sensitive care and a changed nurse.

Conclusions. Nurses can learn to become more culturally competent in their care for Vietnamese clients. Nurses learned to be more aware of the differences among people of different cultures as well as recognizing common elements among different groups. They learned to broaden and redevelop their concept of health and to respect the social adjustments that the Vietnamese were making.
Daughters‐in‐law in Korean caregiving families
Authors: Kim Jin‐Sun
Published: March 2003

Daughters‐in‐law in Korean caregiving families

Aim. The aim of this study was to examine the emotional and physical health and experiences of daughter‐in‐law (DIL) caregivers compared with daughter caregivers who care for cognitively and/or functionally impaired older people in Korea.

Background. In Korea, DILs are the predominant caregivers of impaired older people, but little is known about DIL caregivers. A study which explores the emotional and physical health outcomes of DIL caregivers who care for impaired parents‐in‐law in the sociocultural context of Korea is necessary.

Method. A cross‐sectional descriptive correlational study was conducted to examine the emotional and physical health of 93 DIL caregivers compared with 27 daughter caregivers who care for the cognitively and/or functionally impaired older people in Korea. This study hypothesized that DIL caregivers would have poorer emotional and physical health than daughter caregivers and that the type of relationship with the care‐recipient is an important predictor of caregivers’ health outcomes. t‐tests, chi‐square and hierarchical regression analyses were used for hypotheses testing.

Results. Contrary to expectations, this study found that caregivers’ health outcomes were very similar for DILs and daughters in Korean families. The type of relationship was not an important predictor of caregivers’ health outcomes, and neither was the quality of intergenerational relationship. However, Korean DIL and daughter caregivers reported relatively poor emotional and physical health compared to those of Western caregivers in previous studies.

Conclusions. Daughter‐in‐laws caregivers were not at greater risk group of negative health outcomes than daughter caregivers. However, DIL and daughter caregivers in Korea were a vulnerable group regardless of their relationship with the care‐recipient. The cultural norms and social expectations regarding family‐centred caregiving in Korea may cause negative health outcomes for Korean caregivers. Further family caregiving studies in the Korean context are recommended.
Critical care outreach services and early warning scoring systems: a review of the literature
Authors: McArthur‐Rouse Fiona
Published: March 2003

Critical care outreach services and early warning scoring systems: a review of the literature

Aim. The aim of this paper is to explore the literature relating to critical care outreach services and the use of early warning scoring systems to detect developing critical illness.

Background. Several studies have identified how suboptimal care may contribute to physiological deterioration of patients with major consequences on morbidity, mortality and requirement for intensive care. In a review of adult critical care services, the Department of Health (DOH) (England) recommended in 2000 that outreach services be established to avert admissions to Intensive Care, to enable discharges and to share critical care skills.

Methods. A literature search was carried out of the BIOMED and NESLI databases using the key words ‘outreach’, early warning signs/systems’ and ‘suboptimal care’. The literature review was limited to the past 10 years, and primary research articles of particular relevance were included in the review. The literature is examined within the context of recent findings relating to the provision of suboptimal care within general wards prior to cardiac arrest and/or admission to Intensive Care Units (ICU), and subsequent government initiatives.

Discussion. The discussion explores the potential contribution of critical care outreach services and early warning scoring systems to the care of patients in acute general wards, including the role that education can have in developing the knowledge base and assessment skills of ward nurses.

Conclusion. The paper concludes that further study is required to evaluate the effectiveness of critical care outreach services and early warning scoring systems, and that ward staff need to be educated to identify those patients at risk of developing critical illness. Finally, it is suggested that nurses’ decision‐making in relation to calling the outreach team requires further investigation.
Starry night: using story to inform aesthetic knowing in women’s health nursing
Authors: Leight Susan B.
Published: March 2003

Starry night: using story to inform aesthetic knowing in women’s health nursing

Aim of the Paper. This paper describes the use of story as a vehicle to inform aesthetic knowing in nursing. Because health care demands that nurses know two distinct languages, the language of nursing science with its quantifiable outcomes as well as the experiential observations of health and illness, it is critical that nurses be fluent in each discourse.

Background. Nursing scholars have long voiced a commitment to two epistemological domains: scientifically derived knowledge (empirics) as well as the expressive, creative, intuitive application of knowledge (aesthetics). In recognition of the need for these interpretive paradigms for practice, nursing scholars have sought to identify the kinds of knowing which provide the nursing discipline with its unique perspective.

Discussion. Stories mould every human encounter and telling one’s story in the context of a trusting relationship allows women and nurses to journey together to uncover and discover the meanings inherent in the story. Through this mutual process of unfolding the story, nurses engage the women in deep reflection and focus on what ‘might be’ so that possibilities for the future are illuminated. This is important in all nursing, but particularly in women’s health nursing because the emergence of story suggests that contextual, phenomena‐centred knowledge has found its voice in the nursing care of women as a way of knowing that focuses on personal experience and relies on methods in which woman‐to‐woman caring facilitates the disclosure of the human health‐illness experience.

Conclusions. Storytelling is a useful strategy to inform aesthetic knowing in nursing. Stories supply a foundation for nursing scholarship because truly to hear women’s stories require nurses analyse information, formulate hypotheses, and seek to understand the causal relationships as expressed by women. Through this analysis and attention to detail, nurses are able to glimpse possibilities for the future, thus transforming the experience.
A study of skill mix issues in midwifery: a multimethod approach
Authors: McKenna Hugh , Hasson Felicity
Published: March 2003

A study of skill mix issues in midwifery: a multimethod approach

Background. While skill mix studies are quite commonplace in health care, most have focused on the most effective use of staff and skill distribution in the field of nursing; few relate specifically to the midwifery profession. In Ireland there is no recognized midwifery assistant grade.

Aims. This paper describes a study that investigated the skill mix requirements of a midwifery service based in the Republic of Ireland. The project was built on previous research, which showed that due to undertaking a number of ‘nonmidwifery duties’, midwives were unable to undertake fully the work for which they were trained.

Research methods. Data were collected using a variety of methods. These included postal questionnaires and the Delphi technique. The ‘Delphi’ was used to gain a level of consensus from hospital midwives (all grades) (n=194) and student midwives (n=79) on what are and what are not nonmidwifery duties. Analysis of secondary data (duty rotas and staff turnover data) was also undertaken.

Results. Findings indicate that the respondents spent a large proportion of their time undertaking clerical, domestic, portering and stock duties. They would welcome the introduction of midwifery assistants into the ward team and were able to identify those duties that such persons could undertake.

Conclusions. Skill mix requirements and organizational strategies to deal with the workforce changes are highlighted. Due to the current shortage of midwives in many countries and the dearth of extant research in this area, the results and recommendations have implications for midwives nationally and internationally.
Being in a fragmented and isolated world: interviews with carers working with a person with a severe autistic disorder
Authors: Hellzen Ove , Asplund Kenneth
Published: March 2003

Being in a fragmented and isolated world: interviews with carers working with a person with a severe autistic disorder

Aim. To illuminate the meaning of being a carer for a person with a severe autistic disorder.

Background. Carers working with people with severe autism are occasionally exposed to residents' self‐injurious behaviours and violent actions and at time residents appear resistant to all forms of treatment.

Design/method. A qualitative case study was conducted. Six Swedish carers enrolled nurses (ENs), working on a special ward in a nursing home were interviewed about their lived experiences when caring for an individual with a severe autistic disorder. Narrative interviews were conducted and interpreted using a phenomenological‐hermeneutic method inspired by Paul Ricoeur.

Findings. Two themes were formulated which describe the carers' reality and their dream of an ideal. This ideal described carers' experiences of being trapped in a segmented and isolated care reality and their longing to achieve a sense of wholeness. The findings were interpreted and reflected on in the light of a framework inspired by the German philosopher Karl Jaspers in order to achieve a deeper understanding of the text.

Conclusions. In their desperation, the carers used their empirical knowledge based on scientific knowledge, which could be understood as a substitute for their vision of a consolating wholeness. This paper shows that searching for a substitute to consolation seems to be an important aspect of the meaning of being a carer for a person with a severe autistic disorder.
The meaning of mobility for residents and staff in long‐term care facilities
Authors: Bourret E.M. , Bernick L.G. , Cott C.A. , Kontos P.C.
Published: March 2003

The meaning of mobility for residents and staff in long‐term care facilities

Background. Although the physical and psychological effects of decreased mobility have been documented, little is known about what it means to be mobile from the institutionalized elders' perspective. Even less is known about nurses' perceptions regarding institutionalized elders' mobility and about mobility enhancing strategies.

Aim. The purpose of this study was to generate knowledge about the phenomenon of mobility from both the nurses' and institutionalized elders' perspective.

Design. An exploratory qualitative design was used. Focus groups with residents and nursing staff were conducted in three long‐term care facilities in a large metropolitan city in 1998. Ethical approval was received from the ethics committees in all three facilities prior to study implementation. Twenty long‐term care facility residents and 15 nursing staff participated in the study.

Methods. A trained facilitator used an interview guide to moderate discussions in which residents' and nurses' opinions and feelings about mobility were solicited. The group responses were tape recorded, transcribed and coded. The codes reflected major concepts or abstractions of the data and emerged from the participants' verbal responses to the research questions.

Findings. Both groups identified mobility as being pivotal to the residents' quality of life and well‐being. The residents viewed mobility as a means of freedom, choice and independence, and they made great efforts to maintain their mobility. The nurses also valued the importance of mobility and assisted the residents through preparatory care, environmental modifications and encouragement. Factors that related to the residents' willingness to be mobile, environmental barriers and the impact of waiting were compared between the two groups.

Conclusion. Mobility involves more than the movement from one point to another. The nature of the assistive nurse‐client relationship and the resident's subjective perspective must become central to understanding the meaning of mobility for residents in a long‐term care facility.
Assessing the skills for family planning nurse prescribing: development of a psychometrically sound training needs analysis instrument
Authors: Hicks Carolyn , Tyler Claire
Published: March 2003

Assessing the skills for family planning nurse prescribing: development of a psychometrically sound training needs analysis instrument

Rationale and aims. Family planning nurses have been identified for early development for prescribing authority in the United Kingdom (UK). Currently, no psychometrically founded training needs analysis instrument exists that can reliably assess the nature and extent of the specific educational provision required for this role. This paper is concerned with the development of an instrument capable of defining the development needs for family planning nurse prescribing.

Methods. A national survey was conducted with 388 family planning nurses, using a modified training needs analysis instrument. Respondents were required to assess the importance of 40 tasks, firstly for the role of the family planning nurse (FPN), and again for the role of the family planning nurse prescriber (FPNP). The data from each set of ratings were separately factor analysed using orthogonal Varimax rotations and Cronbach’s α was computed for each factor.

Results. Six factors emerged from the family planning nurse ratings (‘professional development’, ‘managing patient consultations’, ‘critical appraisal’, ‘clinical information giving and professional accountability’, ‘collaborative working and current National Health Service (NHS) issues’ and ‘dispensing of drugs’) and nine factors emerged from the FPNP ratings (‘research and practice development’, ‘prescribing and professional accountability’, ‘management/leadership’, ‘clinical decision making and risk assessment’, ‘advanced health assessment’, ‘critical appraisal’, ‘referral processes’, ‘core nursing skills’ and ‘dispensing of drugs’. This suggests that the role of the FPNP is more extended and, moreover, that the two roles are configured very differently but in a way that makes logical and coherent sense within existing research and government policy. This indicates that the instrument is valid. Moreover, all but two of the factors had a Cronbach’s α score of >0·7 and so can be considered reliable.

Conclusions. The results indicate that the modified instrument is valid and reliable and therefore can be used with confidence to assess the training needs of FPNPs. In addition, the factors have outlined a cogent definition of the role of the FPNP, which can be used both to inform educational programmes and to assess their efficacy.
Aspects of curriculum policy in preregistration nursing education in the Republic of Ireland: issues and reflections
Authors: Fealy Gerard M.
Published: March 2003

Aspects of curriculum policy in preregistration nursing education in the Republic of Ireland: issues and reflections

Aims. This paper sets out to examine critically aspects of curriculum policy related to preregistration nursing education in the Republic of Ireland.

Background. Following a period of industrial unrest concerned with pay, promotional opportunities and conditions of employment amongst nurses and midwives in the Republic of Ireland, a Commission on Nursing was established in March 1997. Along with a series on recommendations pertaining to the role and the professional development of nurses and midwives, the final report of the Commission on Nursing contained recommendations on the educational preparation of nurses. Specifically, the Commission recommended that the future framework for preregistration nursing education in the Republic of Ireland be based on a 4‐year degree programme, fully integrated into higher education. As a means of giving effect to this recommendation, the Commission also recommended the establishment of a Nursing Education Forum, whose task it was to develop a strategic framework for the introduction of the proposed preregistration nursing degree programme. The Forum published its final report in October 2000 and this report constituted the most explicit statement of official policy on the nursing curriculum in the Republic of Ireland.

Design. The paper constitutes a critical analysis of selected aspects of the report of the Nursing Education Forum, in the light of scholarly literature on curriculum philosophy and curriculum policy.

Summary of content. The paper considers some of the implications for curriculum development and design arising out of the recommendations of the Nursing Education Forum. Among a list of core principles underpinning curriculum regulation and design, the report included the principle of ‘eclecticism’. The paper considers this principle with reference to nursing epistemology, pedagogical practice and curriculum policy, and seeks to challenge some of the assumptions underlying this principle.

Conclusions. The epistemological identity and the structural integrity of primary forms of knowledge in the preregistration curriculum need to be maintained if students are to develop their knowledge and understanding of nursing science.
The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service
Authors: Brooks Ian , Brown Reva Berman
Published: March 2003

The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service

Background. One of the ways in which it is possible to achieve successful organizational change is through the elimination of those ceremonies that reinforce or preserve the negative aspects of professional and work group autonomy, thus maintaining the barriers between subcultures. Conversely, the encouraging of ceremonies which reinforce positive aspects is likely to achieve more flexible, team‐orientated changes.

Aim. The paper considers those ceremonies, which perpetuate barriers in a National Health Service (NHS) Trust, and explores new ceremonies which may question, weaken or eliminate current dysfunctional practices.

Design. Our research approach was mainly phenomenological, as we wished to elicit the symbolic significance of organizational routines. The primary source of data was spoken language. The findings are based on purposive sampling of informants by means of semi‐structured interview and observation. Other types of information were also collected, including business plans, reports and brochures. Informants included the Chief Executive and four Board members, three consultants, the director of nursing and midwifery, 10 middle managers and eight junior, nonmedical and nonmanagerial employees.

Findings. Two broad bands of ceremonies have been identified – those which preserve the existing norms and autonomy of professional and worker groups, which we have named Ceremonies of Preservation, and those which encourage change, which we have called Ceremonies of Change. Considerable data are provided to help to `tell the story'.

Conclusion. The paper argues that attention to ceremonial in the wider change process may facilitate the desired, specific change or changes in practice. It suggests that changes which confront unnecessary demarcation, but which do not undermine professional integrity, can create real benefits for NHS hospitals.
Benner's remnants: culture, tradition and everyday understanding
Authors: Paley John
Published: March 2003

Background. Benner's account of meaning and embodiment in nursing depends on a theory which she has never fully articulated, although she makes numerous allusions to it. Behind the background of shared meanings hovers something called ‘culture’, which provides each individual with meaning, determines what counts as real for her, and actively hands down interpretation‐laden practices. This view is based, Benner claims, on the Heideggerian assumption that the meaning and organization of a culture precedes individual meaning‐giving activity.

Aim. I explore Benner's implicit view of culture, drawing on her published work over 15 years, and offer an appraisal of it. In doing so, I attempt to make sense of some rather strange remarks Benner has recently made about ‘remnants’ of Cartesian and Kantian thinking being found in the everyday understandings of people with asthma.

Methods. The concept of culture is developed with reference to both Benner's own work and that of the anthropologist, Clifford Geertz, whose work she frequently cites. Having identified the principal tenets of what we might conveniently call the Benner–Geertz theory, I proceed to interrogate the theory, using the recent anthropological literature – and, in particular, materialist attacks on the idea of culture as a system of meanings – in order to cast doubt on it. I also review, very briefly, an alternative way of understanding ‘culture’, which is not vulnerable to the same criticisms.

Conclusions. Benner's implicit theory of culture is revealed, somewhat ironically, as an inverted form of Cartesian dualism. Its intellectual provenance is not Heidegger, who appears to reject it, but the sort of American sociology associated with Talcott Parsons. As a corollary, it is suggested that Benner's ‘remnants’ analogy cannot be justified, and that the idea of Cartesian and Kantian concepts permeating Western culture, infecting both the providers and receivers of health care, is a myth.
Staff nurses' perceptions of supernumerary status compared with rostered service for Diploma in Nursing students
Authors: Hyde Abbey , Brady Dympna
Published: March 2003

Background/rationale.  In the Republic of Ireland, the amount of clinical teaching expected of staff nurses has increased substantially in the wake of the transfer of nursing education to universities, and the advent of supernumerary status for students. A modicum of previous research noted that staff nurses are unclear about their role in relation to facilitating the clinical learning of supernumerary students.

Aims of the paper.  To explore staff nurses' perceptions of their role in the facilitation of learning for university‐educated diploma students in the clinical area and their attitudes towards these students.

Design/methods.  Sixteen staff nurses were interviewed in depth using semi‐structured interviews. Data were analysed qualitatively, using content analysis, with the help of the software package NUD*IST.

Findings.  Among the central themes to emerge, upon which this article is focused, was participants' perceptions of supernumerary status compared with rostered service for diploma students. Data suggested that the rostered status of students was generally favoured by staff nurses over and above supernumerary status because, unlike supernumerary students, rostered students did not disrupt the existing social structure within the clinical setting. Both structuration theory and role theory are drawn upon to explain the reproduction of the prevailing social structure, where the concentration is on getting through nursing work with little emphasis on the supervised learning of supernumerary students.

Study limitations.  This study is constrained by eliciting only the views of staff nurses. Further studies are required of student nurses' experiences of rostered service and supernumerary status.

Conclusions.  Because staff nurses are part of the system within which they work, they need to modify their role to include active student teaching as a legitimate component of that role.
In the spirit of creativity: the learning and teaching of ethics in nursing
Authors: Doane Gweneth Hartrick
Published: March 2003

Aim. This paper discusses the development of a pedagogy that nurtures not only the caring and the critical, but also the creative spirit of nursing. To explore the idea of creative pedagogy the learning/teaching of ethics in nursing is considered.

Background. Based on the understanding of ethics as a deeply personal process that is lived in the complexity and ambiguity of everyday nursing work I describe a pedagogy that seeks to support students to ‘become’ moral agents – to see ethics as something they are, not merely as something they follow, and to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous, and shifting terrain of ethical nursing practice. An example of one student's experience is used to illustrate how a pedagogy of creativity can promote the development of students' creative capacity in their everyday ethical practice.
Men living with fibromyalgia‐type pain: experiences as patients in the Swedish health care system
Authors: Paulson Margareta , Norberg Astrid , Danielson Ella
Published: March 2003

Background. Individuals with fibromyalgia (FM) frequently use health care services and experience only short‐term improvements. They often feel that health care staff do not take them seriously. This increases the burden of living with the illness.

Aim. To describe how men living with fibromyalgia‐type pain experienced being patients in the Swedish health care system.

Method. Narrative interviews with 14 men who fulfilled the American College of Rheumatology criteria for classification of fibromyalgia. Content analysis was used when analysing the data.

Results. The results are described using five themes. Theme I ‘Feeling afraid of being looked upon as being a whiner’ highlights how the men endured a lot of pain before they sought health care, and how difficult it was to find a receptive listener. Theme 2 ‘Feeling like a guinea pig’ shows that the men's feelings were twofold; they wanted examinations, even if these made them feel that they were being exposed to numerous treatments without any cure. Theme 3 ‘Feeling hopeful’ describes the hope for a cure after having been referred to a specialist clinic. Theme 4 ‘Feeling neglected’ illustrates being looked upon as an uninteresting patient and theme 5 ‘Feeling no recovery’ illustrates the pain relief they gained, but not the actual cure.

Conclusion. Men with FM type pain experienced a long wait before treatment at a specialist clinic as well as no continuity and follow‐ups in primary care and general hospitals. Encounters with engaged and skilful staff promoted the men's well‐being despite the fact that no cure was available. Not being respected led to a feeling of being neglected despite the care received. Thus, the men had to accept the fact that they would never recover.
Living with newly diagnosed breast cancer: a qualitative study of 10 women with newly diagnosed breast cancer
Authors: Landmark Bjorg T. , Wahl Astrid
Published: March 2003

Aim. The aim of this qualitative study was to describe from the perspective of 10 women (aged 39–69 years), their experience of living with breast cancer.

Background. Although there is increasing research into a variety of aspects associated with breast cancer, there is a continuing need for research to increase nurses' understanding of how women experience living with newly diagnosed breast cancer.

Design/methods. Following ethical approval, open‐ended interviews were analysed, using methods influenced by Grounded Theory. Verifiability and empirical grounding of the theory was established through use of the constant comparative method.

Findings. Existential issues arose as an important aspect of living with newly diagnosed breast cancer. The will to live emerged as the central theme. All energy was channelled into a tenacious fight for life. Furthermore, results revealed other aspects in the women's awareness of living with breast cancer, such as their experiences in relation to emotional reactions, bodily physical changes, their female identity, meaningful activities and their social network.

Conclusions. An understanding of how women experience their new and changed life situation is important to the support nurses give in the process of healing. Nurses need this knowledge to be better able to assist women and their families in their development of coping strategies.
Pain management problems in patients' terminal phase as assessed by nurses in Finland
Authors: Kuuppelomäki Merja
Published: March 2003

Background.  This study is part of a larger questionnaire survey concerned with the views of nursing staff on physical, emotional and spiritual support for terminally ill patients and decision making on the transition to the terminal phase of treatment.

Aim.  This article discusses the results concerning the prevalence of physical pain in patients and with problems in pain management.

Methods.  A total of 328 nurses working on the inpatient wards of 32 municipal health centres in finland took part. Data were collected with multiple‐choice items and one open‐ended question, which were part of a larger structured questionnaire. The data were analysed by means of the SPSS statistical software and content analysis.

Findings.  Dying patients often suffered from pain, which was most commonly because of cancer. Intractable pain was common. The problems of pain management concerned attitudes and qualifications related to treating pain, the assessment of the pain, pain management per se and the organization of pain management.

Conclusion.  The study highlights the need to increase pain education, discussion and agreement on the principles of pain management in municipal health centres in Finland.
Exploring childhood immunization uptake with First Nations mothers in north‐western Ontario, Canada
Authors: Tarrant Marie , Gregory David
Published: March 2003

Background. Childhood immunization is an important component of preventive health care for young children. Successful control of vaccine‐preventable diseases depends on high levels of immunization coverage. Immunization statistics show that on‐reserve First Nations (Native Indian) children have lower vaccination coverage than children in the general Canadian population. There has been little research, however, conducted with First Nations populations on this topic.

Aim of the study. This study explored First Nations parents' beliefs about childhood immunizations and examined factors influencing immunization uptake.

Methods. This study used a qualitative descriptive design to explore the issue of childhood immunization uptake. Twenty‐eight mothers from two First Nations communities in north‐western Ontario, Canada, were interviewed about their perceptions of childhood immunizations and vaccine‐preventable diseases. The interviews were transcribed and content analysis was used to examine the data.

Findings. Data analysis revealed the following six themes: (1) the fear of disease; (2) the efficacy of immunizations; (3) the immunization experience; (4) the consequences of immunization; (5) interactions with health professionals; and (6) barriers to immunizations. Participants were motivated to seek immunizations for their children by a fear of vaccine preventable diseases. A small proportion of mothers, however, questioned the effectiveness of vaccines in preventing disease. Traumatic immunization experiences, vaccine side‐effects and sequelae, negative interactions with health professionals, and barriers such as time constraints and childhood illnesses all served as deterrents to immunization.

Conclusions. The research outcomes highlight the varied beliefs of First Nations parents about childhood immunizations and the numerous factors that both positively and negatively influence immunization uptake. Further research is needed to explore the issue of childhood immunizations in First Nations communities and to determine strategies to improve uptake.
Personal improvement project in nursing education: learning methods and tools for continuous quality improvement in nursing practice
Authors: Kyrkjebø Jane Mikkelsen , Hanestad Berit Rokne
Published: March 2003

Background.  All health care providers, including nurses, need to learn how to improve the care they give. Continuous quality improvement (CQI) is a theory and method used in health care to guide improvement. The question is how best to teach it, particularly to nursing students. It was conjectured that a systematic approach to improve study habits and lifestyle would increase nursing students' awareness of how they handled their studies and, at the same time, became acquainted with improvement knowledge methodology. Using the starting point that ‘quality is personal’, students worked on personal change and improvement. The purpose was to learn methods and tools for improvement in their personal life and enable them to transfer and use this knowledge in their professional work.

Aims.  To describe the use of a personal improvement project (PIP) by nursing students and the resulting increased knowledge, skills, and enthusiasm to continue working with CQI.

Methods.  Forty‐four nursing students worked on a PIP, which they felt was important, and presented their projects to fellow students. The students answered a questionnaire, and their presentations documented the results of their work.

Results.  All 44 students followed the instructions in a workbook describing PIPs over an 8‐week period and answered a questionnaire. Forty‐five per cent felt they had made an improvement in their study habits or lifestyle. Eighty‐nine per cent reported that this project helped them to start learning CQI, and 75% reported that they could see the benefit of this kind of knowledge in their future clinical practice.

Conclusions.  Personal improvement projects seem to be an effective way of introducing CQI knowledge to nursing students. Even those who did not succeed in achieving personal improvement felt they had a positive learning outcome from the project.