bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and definition of the role of the operating department nurse: a review
Authors: McGarvey Helen E. , Chambers Mary G.A. , Boore Jennifer R.P.
Published: March 2003

Development and definition of the role of the operating department nurse: a review

In the current cost‐conscious National Health Service (NHS), the role of the nurse during anaesthesia and surgery is one that has interested health service managers keen to know what happens behind the closed doors of the operating department. It is clear that if nurses working within this specialized setting are to secure a future in providing care for surgical patients, then it is important to clarify and articulate exactly what it is that their role involves. The aim of this paper is to examine the role of the operating department nurse. First, it will illustrate how the role of the nurse has evolved alongside medical and technical advances in surgery, particularly in the last century. Second, it will highlight that while definition of the role has received attention in the North American literature, references in the British literature as to what it is that operating department nurses do, are scant. Finally, it will address the evolving role of the contemporary perioperative nurse highlighting the changes and challenges that nurses who work within this setting are currently facing. It is suggested here that nurses need to engage in role definition in order to be clear about their direction for the future, particularly within the fast changing, technologically driven environment of the operating department.
Waiting for coronary artery bypass surgery: a qualitative analysis
Authors: Fitzsimons Donna , Parahoo Kader , Stringer Maurice
Published: March 2003

Waiting for coronary artery bypass surgery: a qualitative analysis

Waiting lists for coronary artery bypass surgery (CABS) are common in many developed countries. Yet, there is limited information available regarding patients’ health care needs at this time. This paper reports on a prospective study which aimed to investigate the experience of waiting for CABS from a qualitative perspective. An inductive research approach was used to conduct interviews with 70 randomly selected patients at three intervals over the first year on the waiting list – referral for surgery, again after waiting 6 months (n=49), and finally after waiting for 1 year (n=28). Attrition was mainly caused by surgery having been performed (n=36), although death (n=4) and refusal to participate (n=2) also contributed. Domicilliary interviews were taped and transcribed verbatim. Thematic content analysis identified three central themes in this experience – uncertainty, chest pain and anxiety; with six secondary themes – powerless, dissatisfaction with treatment, anger/frustration, physical incapacity, reduced self‐esteem, and altered family and social relationships. The nature and meaning inherent in each theme is described using interview quotations, and a model is proposed which summarizes this data and the relationship between themes. From this analysis, uncertainty, chest pain and anxiety emerge as important indicators of a negative outcome for these patients. This report strongly suggests that patients awaiting bypass surgery require more information regarding the waiting time for such a surgery. Nurses should also offer advice regarding pain management to help improve patients’ skills and decrease the fear associated with angina. Nursing intervention and support should also be directed at reducing patients’ anxiety levels. This is the first known qualitative study which specifically examines patients’ perception of the waiting period prior to bypass surgery. It may therefore provide new evidence on which to base practice for nurses in both hospital and community, and may also stimulate further research in this area.
The critical incident technique and nursing care quality research
Authors: Kemppainen Jeanne K.
Published: March 2003

The critical incident technique and nursing care quality research

The critical incident technique, is a highly flexible qualitative research method used in solving practical problems. Although this research method has been extensively used in the service industry to evaluate consumers’ expectations and perceptions, applications to the study of health care quality are just beginning. This article describes critical incident methodology, reviews previous applications of the technique to the study of health care quality and provides illustrations from research. This practical research methodology offers the following important advantages to those interested in designing studies of care quality: identifying patients’ experiences in health care settings, exploring dimensions of nurse–patient interactions and identifying patients’ responses to illness and health care treatment.
A case study of nurse management of upper respiratory tract infections in general practice
Authors: Butler Christopher C. , Rees Mags , Kinnersley Paul , Rollnick Steven , Hood Kerenza
Published: March 2003

A case study of nurse management of upper respiratory tract infections in general practice

Background.  Nurses increasingly manage acute illness in United Kingdom (UK) general practice. Few data exist about patients routinely consulting with these nurses. There are concerns that providing this additional service will lower thresholds for consulting with an overall increase in workload. Upper respiratory tract infection (URTI) is the commonest reason for consulting. Inappropriate antibiotics promote resistant bacteria. Nurse management of URTI is an ideal opportunity to promote self‐care and nonantibiotic management.

Aims.  To describe the effects of a specially trained practice nurse managing URTI in a general practice in Cardiff, UK.

Methods.  Descriptive study.

Results.
 Data were collected on 132 patients consulting with the nurse. We also collected data on 234 patients consulting general practitioners (GPs) in the same practice. Patients seen by the nurse were younger and less likely to be given antibiotics at the time of their index illness than those who saw GPs (7% vs. 93%; P < 0·001). During the year following the consultation with the nurse, patients consulted slightly less often and received antibiotics for URTI less often compared with the year preceding this consultation (P=0·02). Their consultation rate for all conditions did not change. The consultation rates for URTI of the patients managed by the GPs remained constant and consultations for all conditions increased (P < 0·01).

Conclusions.  Nurse management of URTI did not lower patients’ threshold for future consulting, and patients who saw her were prescribed antibiotics less often.
The nature and effect of communication difficulties arising from interactions between district nurses and South Asian patients and their carers
Authors: Gerrish Kate
Published: March 2003

The nature and effect of communication difficulties arising from interactions between district nurses and South Asian patients and their carers

Aim. The overall aim of the study was to examine how policy directives concerning the provision of individualized care were modified in their transformation into practice and the implications this carried for the care provided to patients from different ethnic backgrounds. This paper is concerned with one aspect, namely, examining the nature and effects of communication difficulties between the nurses and South Asian patients and their carers.

Methods. An ethnographic approach was used. The study was undertaken in an English community National Health Service (NHS) Trust serving an ethnically diverse population. It comprised two stages. First, an organizational profile of the trust was undertaken in order to analyse the local policy context. Data were collected by means of in‐depth interviews with managers and a review of policy documentation and caseload profiles. Second, a participant observational study was undertaken focusing on six district nursing teams. Purposive sampling was used to identify four teams with high ethnic minority caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and fieldnotes were analysed by drawing upon the principles of dimensional analysis.

Findings. Over half of South Asian patients had little or no understanding of spoken English with women and older people the least likely to speak English. The limited use of professional interpreters and the concomitant heavy reliance on family members to translate highlighted how ethnic minority patients and carers who were not fluent in English were disadvantaged. The observed language barriers suggested that the content of advice on matters such as compliance with treatment regimes might not be fully understood. Psychological support of patients and carers was severely restricted. Moreover, the fact that follow‐up visits were on occasions made to patients for whom there was no one available to interpret constrained on‐going assessment of patients’ needs.

Conclusions. The findings raise concerns regarding the quality of care provided to patients and carers who are nonusers of English and provide evidence of inequalities in service provision. However, not speaking English should not be a barrier to appropriate and effective nursing care. District nurses need to appreciate their responsibility to provide equitable services irrespective of a patient’s linguistic background and seek to overcome the disadvantage experienced by ethnic minority patients.
Symbolic interactionism as a theoretical perspective for multiple method research
Authors: Benzies K. M. , Allen M. N.
Published: March 2003

Symbolic interactionism as a theoretical perspective for multiple method research

Rationale. Qualitative and quantitative research rely on different epistemological assumptions about the nature of knowledge. However, the majority of nurse researchers who use multiple method designs do not address the problem of differing theoretical perspectives. Traditionally, symbolic interactionism has been viewed as one perspective underpinning qualitative research, but it is also the basis for quantitative studies. Rooted in social psychology, symbolic interactionism has a rich intellectual heritage that spans more than a century. Underlying symbolic interactionism is the major assumption that individuals act on the basis of the meaning that things have for them.

Aim. The purpose of this paper is to present symbolic interactionism as a theoretical perspective for multiple method designs with the aim of expanding the dialogue about new methodologies.

Conclusion. Symbolic interactionism can serve as a theoretical perspective for conceptually clear and soundly implemented multiple method research that will expand the understanding of human health behaviour.
Comparisons of the cost‐effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients
Authors: Chiu Lian , Shyu Woei‐Cherng , Liu Yu‐Hwa
Published: March 2003

Comparisons of the cost‐effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

Aim.  This study compared the cost and effectiveness of long‐term institutional care and home care for stroke patients with severe physical disabilities.

Background.  Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult.

Methods.  From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge.

Results.  Information on family costs for caregiving, including pay for long‐term services utilized, labour costs for caregiving and out‐of‐pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals.

Conclusions.  The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.
A method to develop a nursing intervention: the contribution of qualitative studies to the process
Authors: Gamel Claudia , Grypdonck Mieke , Hengeveld Michiel , Davis Bryn
Published: March 2003

A method to develop a nursing intervention: the contribution of qualitative studies to the process

Aim of the paper. To describe how to develop a patient‐centred nursing intervention (NI).

Background. The stimulus for scrutinizing methods and techniques to develop a NI was a research project concerning the contribution of information and support to the sexual adaptation of women with gynaecological cancer. Within this project, a NI for sexual teaching (ST) was developed because the literature review revealed no tested NI for this purpose. How patients experience and perceive received information influences the usefulness and efficacy of a teaching intervention. Qualitative methods provide insight and understanding of patients’ experience. Consequently, qualitative methods are appropriate to use when developing interventions that aim to influence patients’ situations through the provision of information.

Method. Previously reported approaches for developing an intervention did not match the goals and underlying premises identified for the intervention under development. An alternative method, consisting of a design phase and a testing phase, was developed. The goal of the design phase was to develop a working definition of the intervention and to formulate recommendations for carrying out the intervention. Written guidelines provided concrete examples of the topics to discuss and how to discuss them. During the design phase, a qualitative study was conducted to describe the lived‐experience of the phenomenon that the information should influence, namely sexuality after treatment for gynaecological cancer. In the testing phase, a different type of qualitative study took place. The patients’ experience of receiving information and the nurses’ experience of providing it were investigated in order to refine the proposed intervention, to identify the results patients hope to achieve (or achieved) and to explore the underlying theoretical explanation of the intervention. During the testing phase, the feasibility and acceptability of the modified intervention were both established.

Conclusion. Even when the starting point is advice from care‐givers, an intervention can be developed that is in harmony with the patient perspective when qualitative studies are part of the process.
Levels of compliance shown by hypertensive patients and their attitude toward their illness
Authors: Lahdenperä Tiina S. , Kyngäs Helvi A.
Published: March 2003

Levels of compliance shown by hypertensive patients and their attitude toward their illness

Aim. The aim of this paper is to describe hypertensive patients' compliance by finding out more specifically what compliance, intention, activity, responsibility and collaboration mean in the treatment of hypertensive patients. A further aim was to clarify their attitudes toward their illness.

Rationale. This study is part of a project titled `Patients' self‐motivated control of hypertension.

Method. The intervention consists of a multimedia computer program and effective lifestyle counselling. Nine male and 12 female patients from one municipality were included in an intervention programme. Data were collected through thematic interviews and analysed using content analysis.

Findings. Four levels of compliance were found: subconscious, cognitive, action and attitudinal level. Patients also had four different ways of feeling about hypertension and its treatment: some were careless, some were serious, some adjusted well and yet others felt frustrated.

Conclusion. Health care professionals should recognize each patient's way of complying with his/her treatment and his/her attitude toward the illness. Different patients need different kinds of care and support. In addition health care professionals should also recognize their own attitudes toward hypertension and the patient's position in the health care system.
Endogenous and exogenous research? Findings from a bibliometric study of UK nursing research
Authors: Traynor Michael , Rafferty Anne Marie , Lewison Grant
Published: March 2003

Endogenous and exogenous research? Findings from a bibliometric study of UK nursing research

Aims of the study. This paper uses the findings of a recent bibliometric analysis of published UK nursing research to ask whether the field is characterized by a fundamental split between two underlying areas of research interest. These can be termed `endogenous' and `exogenous'. The former term describes research which tends to be concerned with problems and issues to do with nursing as a profession; the latter is concerned with problems and issues centring around the nursing of patients.

Design/methods. Papers in the Wellcome Trust's Research Outputs Database (ROD), a database of UK biomedical research, were analysed. Nursing papers published between 1988 and 1995 numbered 1845, just less than 1% of the total papers in the ROD.

Results/findings. Analysis of the subfield identified that nursing research was atypical of biomedical research as a whole in a number of ways. One difference was that usually in biomedical research there is a general correlation between numbers of funders acknowledged on a paper, numbers of authors, and esteem of the journal in which a paper appears. In nursing there was, if anything, a tendency for highly esteemed papers to have fewer authors and be less likely to have acknowledged funding. However, the apparently endogenous and exogenous papers have quite different characteristics. This paper explores this apparent difference and possible reasons for this difference and will briefly compare nursing research with some other newly emerging social and academic groups.

Conclusions. Thinking of nursing research outputs in this way can provide insight into the existence of different reward systems influencing nurse researchers. However, it is impossible to draw too confident a differentiation without reading each individual paper and making judgements about whether they are `endogenous' or `exogenous', a practice generally beyond the scope of bibliometric practice.
Risk factors for citation errors in peer‐reviewed nursing journals
Authors: Lok Candy K.W. , Chan Matthew T.V. , Martinson Ida M.
Published: March 2003

Risk factors for citation errors in peer‐reviewed nursing journals

Background. Citation errors are common among nursing journals. But, there are no data regarding the factors that predispose to these errors.

Objective. To determine the risk factors that predispose to citation error in peer‐ reviewed nursing journals.

Methods. Five hundred and fifty references were selected randomly from articles published in eleven nursing journals for the year 1998. The incidences of major and minor citation errors were determined by comparing with the original articles. The relative odds of citation errors for the number of authors, collaborating institutions and the length of the reference list were calculated. The correlation between the scientific quality of the journal (by means of journal impact factor and immediacy index) and the incidence of citation error were also determined.

Results. The incidence of citation errors is comparable to those reported previously. Long reference lists in articles written by a single author predicted strongly the occurrence of minor citation errors. Journals with a high impact factor and immediacy index tend to contain fewer minor mistakes. None of these factors affect the incidence of major errors.

Conclusion. Contributors to journals should be aware of the various risk factors for citation errors. Citation accuracy may be improved by modifying these factors.
Finnish occupational health nurses’ work and expertise: the clients’ perspective
Authors: Naumanen‐Tuomela Paula
Published: March 2003

Finnish occupational health nurses’ work and expertise: the clients’ perspective

Aims. The aims of this study were to describe Finnish occupational health nurses’ functions, characteristics, prerequisites, consequences, changes, development areas and expertise from the point of view of clients.

Methods. The background literature of this study is based on public health nursing models, Finnish social and health report, arguments of special education for occupational health nurses, and earlier studies concerning occupational health nurses’ work. The data were collected from volunteer clients (n=26) by interviews.

Results. According to the qualitative content analysis, occupational health nurses’ activities include health promotion and secondary health care among workers and at workplaces. The main work characteristics are holism, client‐orientation, interaction and co‐operation. Occupational health nurses need an extensive knowledge base and practical skills, client‐orientation, courteous behaviour and a healthy and clean appearance. The outcomes of their work for clients are better health, healthier life habits and healthier working conditions. Nowadays, nurses are more client‐orientated than 20 years ago. They are expected to develop their practical and interaction skills and expand their knowledge base. The expertise of occupational health nurses consists of an extensive knowledge base with practical skills, working experience and confidence, and it appeared when advising clients and answering their questions.

Conclusions. It is important to arrange continuing education for occupational health nurses to ensure that they are always up to date in order to be able to respond to specific clients’ needs. This study provides a foundation for further investigations into, for example, occupational health nurses’ work from the point of view of employers, students of occupational health nursing and other occupational health experts and co‐operative partners.
Intentional action
Authors: Burks Kathryn J.
Published: March 2003

Intentional action

Aim. The purpose of this paper is to present a concept analysis of intentional action.

Background. Intentional action is a relevant concept for nurses because health behaviour involves action by the client of care. In addition, nurses take action when they assist their clients. Intentional action is a type of action distinguished by the presence of specific developmental skills and by intent or purpose.

Design. This concept analysis reflects a comprehensive review of the action literature.

Findings. This review revealed two views of intentional action: as social behaviour and as self‐regulated behaviour influenced by external and internal factors. Based on these findings, the antecedents and consequences of this type of action are identified and the process of action is described.

Conclusions. The concept model illustrates the relationship of intentional action with external and internal factors and demonstrates its continuous nature. Areas for further inquiry include exploration of the effect of factors such as self‐efficacy, motivation, self‐esteem, managed care and reduced health care resources on intention and subsequent action; as well as the efficacy of nursing interventions designed to influence health behaviour such as health promotion education and treatment counselling.
A study of the impact of discharge information for surgical patients
Authors: Henderson Amanda , Zernike Wendy
Published: March 2003

A study of the impact of discharge information for surgical patients

Aim of the study. To establish whether the routine information surgical patients receive about the management of pain and wound care during their hospitalization is sufficient for them to care for themselves without seeking assistance from a health professional or health care agency.

Background. While there has been considerable evidence suggesting cost benefits of discharge information the health care environment is constantly changing. Contemporary issues such as increased patient participation, extensive use of technology, reduction in health care expenditure, and greater awareness of consumer rights necessitate further inquiry into the appropriateness of discharge information.

Method. One hundred and fifty‐eight adult patients discharged within a week of their operation participated in the study. A written questionnaire was distributed within 24 hours prior to discharge and a telephone interview conducted 1 to 2 weeks after discharge. At the time of discharge the majority of patients had received information.

Findings. Those patients who had received information were less likely to access a health facility than those who had not received information. However, the telephone interview, revealed that there was no evidence that patients who believed they were well informed within 24 hours of discharge about the management of their wound, still felt well informed 1 to 2 weeks later.

Conclusion. Nurses need to be aware that patients who leave the hospital with little or no discharge information may not be confident in the management of their health condition and therefore may access a health facility, if even just for reassurance.
Seniors’ decision making about pain management
Authors: Ross Margaret M. , Carswell Anne , Hing Malcolm , Hollingworth Gary , Dalziel William B.
Published: March 2003

Seniors’ decision making about pain management

Background. Muscoloskeletal pain is a problem with which many seniors must contend, many on a daily basis. Little is known, however, of the self‐care decisions that seniors make regarding the management and control of this pain. These decisions can influence in a significant manner the delivery of health care to seniors and their overall health and well‐being.

Purpose. The purpose of our exploratory‐descriptive study was to investigate seniors’ decision making regarding the management and control of musculoskeletal pain by gathering data about the context of decision making, the types of decisions seniors made, their decisional conflict and the resources they used in decision making.

Methods. Focus groups and a mail‐back questionnaire were used. Data were gathered in 1997 from a convenience sample of 50 seniors in Canada who experienced musculoskeletal pain of a noteworthy nature.

Results. Findings revealed that participants made decisions within a context of ageing and the health and social consequences of advancing age. The types of decisions they made included to ignore their pain and to use distraction. They also used exercise, the application of heat and cold, and medications to manage pain. Decisional conflict was minimal and consultation with family and friends superseded that with professionals.

Conclusions. This study contributed to knowledge of decision making in later life about health matters generally, and the management and control of pain specifically. Findings point to the resourcefulness of seniors with respect to self‐care and decision making. Seniors want to make informed decisions. However, they need information about the risks and benefits of decisions.
The Data Protection Act (1998): implications for health researchers
Authors: Redsell Sarah A. , Cheater Francine M.
Published: March 2003

The Data Protection Act (1998): implications for health researchers

Aims. This paper reports on the methods used in two studies to obtain access to subjects to comply with the common law duty of confidence laid out in the Data Protection Act (1998) and discusses the researchers’ problems in interpreting the procedures.

Rationale. The amendments to the United Kingdom (UK) Data Protection Act (1998) are causing confusion within the health service and academic institutions. There is a need to balance patient confidentiality with the requirement to conduct vital, unbiased research in which health service professionals are not subject to ethical dilemmas. This paper examines the recruitment methods used in two studies in which the researchers’ attempts to adhere to the requirements lengthened the study costs and may have produced less reliable results.

Methods. The methodological difficulties in two studies are presented. In Study 1, the difficulties encountered when the Multicentre Research Ethics Committee refused permission for researchers to recruit patients directly to a multicentre randomized controlled trial are discussed. In Study 2, the method used to compile a sampling frame for a national questionnaire survey following the eight principles of the Act are described.

Findings. Our experience has shown that health care professionals are increasingly required to recruit patients to intervention trials, and that researchers are not allowed access to the names of patients or other subjects to ask them for consent to participate in a study. The requirement for researchers to use ‘intermediaries’ to obtain consent from and recruit subjects to studies increases the risk of selection bias, may expose the practitioner to ethical difficulties and may compromise the external validity of trial results. There is also a danger that research costs will soar when the Data Protection Act (1998) is fully realized.

Conclusion. The Data Protection Act (1998) is currently being interpreted in a number of different ways. We conclude there is an urgent need for consensus within the health service and academic communities.
Eating difficulties, complications and nursing interventions during a period of three months after a stroke
Authors: Westergren Albert , Ohlsson Ola , Hallberg Ingalill Rahm
Published: March 2003

Eating difficulties, complications and nursing interventions during a period of three months after a stroke

Aim. The aim of this study was to describe eating difficulties and especially swallowing in patients with dysphagia, types of nursing intervention, and the development of complications over 3 months. The aim was also to explore common characteristics of eating difficulties that influenced the ability to finish meals.

Methods. Twenty‐four consecutive patients admitted because of stroke and dysphagia were included. Nursing interventions, based on assessments, were individually designed.

Results. Three subgroups could be identified: those (n=9) who were unable to complete a meal, despite assisted feeding, because of reduced alertness/energy and impaired swallowing function; those (n=5) who could complete a meal, despite suffering from reduced alertness/energy; and those (n=10) who could complete meals with minor difficulties. Patients in the first two groups developed complications such as respiratory infections and/or malnutrition. There was a tendency towards that complications in the third group were less frequent and the hospital stay was significantly shorter than in the other groups.

Conclusion. The level of alertness/energy in patients with dysphagia after stroke was important for the ability to eat and swallow and the development of complications over time, and thus of great importance for the interventions applied.
A critique of research on the use of activities with persons with Alzheimer’s disease: a systematic literature review
Authors: Marshall Melody J. , Hutchinson Sally A.
Published: March 2003

A critique of research on the use of activities with persons with Alzheimer’s disease: a systematic literature review

Topic. The topic of this paper concerns the use of therapeutic activities with persons with Alzheimer’s disease (AD).

Purpose. The purpose is to present a critique of the research on these activities, with an emphasis on methodology.

Organizing construct and scope. Nursing literature identifies a number of purposes for activities for persons with AD. Activities should be therapeutic, enhance quality of life, arrest mental decline, and generate and maintain self‐esteem. Other purposes of activities for this population are to create immediate pleasure, re‐establish dignity, provide meaningful tasks, restore roles, and enable friendships. Activities may be more important to the psychological state of well‐being of persons with dementia than the general physical and social environments in which they live.

Sources. The literature reviewed was identified with the use of computer data bases (Medline – 1991–March 2001; Cumulative Index of Nursing and Allied Health Literature (CINAHL) – 1991–March 2001; and PsychLit – 1988–March 1999). In addition, data bases of Science Citation Index and Social Science Citation Indexes as they appear in the computer base, Web of Science, were searched for 1992–2001. The time period for each search was determined by the manner in which the literature was grouped for inclusion in the particular database. Hand searches of 11 selected journals included the years 1993–2001. The search dates were selected to reflect the time period when the largest number of studies on activities and AD have appeared in the professional literature. We critique a total of 33 studies.

Conclusions. While researchers have demonstrated interest in the use of activities with persons with AD, theoretical and methodological difficulties, unclear findings and gaps exist, including a lack of emphasis on gender, ethnic, racial or cultural differences. Sampling issues involving diagnosis and staging complicate the research on individuals with AD. Case studies, single subject experimental designs, and tightly controlled quasi‐experimental and experimental designs are needed to advance knowledge in this important area.
Using a management perspective to define and measure changes in nursing technology
Authors: Alexander Judith W. , Kroposki Margaret
Published: March 2003

Using a management perspective to define and measure changes in nursing technology

Aims. The aims of this paper are to discuss the uses of the concept of technology from the medical science and the management perspectives; to propose a clear definition of nursing technology; and to present a study applying the use of the concept of nursing technology on nursing units.

Background. Nurse managers must use management terms correctly and the term technology may be misleading for some. A review of the nursing literature shows varied uses of the concept of technology. Thus a discussion of the dimensions, attributes, consequences, and definitions of nursing technology from the management perspective are given.

Design. A longitudinal study to measure the dimensions of nursing technology on nursing units 10 years apart.

Results. The findings suggest that the dimensions of nursing technology change over time and support the need for nurse managers to periodically assess nursing technology before making management changes at the level of the nursing unit.

Conclusions. This study helps health care providers understand the unique role of nurses as healthcare professionals by identifying and measuring nursing technology on the nursing unit.
Nursing the patient with severe communication impairment
Authors: Hemsley Bronwyn , Sigafoos Jeff , Balandin Susan , Forbes Ralph , Taylor Christine , Green Vanessa A. , Parmenter Trevor
Published: March 2003

Nursing the patient with severe communication impairment

Background.  Effective communication with patients is critical to effective nursing practice. Surprisingly, there is little information on nurses’ experiences in caring for patients who are unable to speak.

Purpose and method. This study provides descriptive information from interviews with 20 nurses who cared for patients with severe communication impairment. The interview protocol explored positive and negative experiences of nursing patients with severe communication impairment. Frequency counts and descriptive analyses were conducted to identify the major themes emerging from the interviews.

Results. The results suggest that nurse–patient communication is difficult when the patient has severe communication impairment, although some nurses discovered effective strategies to facilitate communication with such patients. Many of the difficulties could be viewed as a breakdown in understanding arising from the lack of a readily interpretable communication system that could be used by nurse and patient.

Conclusions. The results suggest a need for training nurses in the use of alternative modes of communication. Nurses also need access to a variety of simple augmentative communication devices for use with patients who are unable to speak. Finally, nurses should collaborate with speech pathologists on the development of preadmission information and bedside training for people who are admitted to hospital with severe communication impairment.
Health perceptions and health behaviours of poor urban Jordanian women
Authors: Mahasneh Sawsan Majali
Published: March 2003

Health perceptions and health behaviours of poor urban Jordanian women

Background. The economic recession and stringent economic adjustment programme that Jordan has gone through since the early 1980s have resulted in lower living standards and higher rates of poverty and unemployment. Poverty debilitates women and impairs their access to health care, proper nutrition and well‐being in general.

Rationale. Women’s health behaviours and problems need to be analysed from the perspective of women themselves. The purpose of this study was to describe the health perceptions and health behaviours of poor urban Jordanian women aged 15–45 years in the context of the family and community in which they live. The sample consisted of 267 Jordanian women aged 18–45 years, whose household income was below the poverty line.

Method. This was a community‐based study that collected data using semi‐structured interviews with women. Health perceptions were measured by asking the women to describe their health status, as they perceived it. Health behaviours were measured by asking the women about their personal hygiene, diet, activity and exercise, sleep, smoking, drinking alcohol, and safety and security.

Results. The average age of women was 33 years, 93% were or had been married, and 87·5% had received some form of education. Although the mean age at marriage was about 20 years, 13·6% were married when they were less than 16 years of age. Study women gave a lower rating of their health status than those reported in national studies. Although they reported bathing once a week, eating about three meals a day, and getting 8 hours sleep, there remain areas for improvement in their health behaviours in terms of performing regular exercise, carrying out regular health examinations, and the type and amount of food consumed.

Recommendations. Implications for nursing, with a special focus on health education and meeting the health needs of these women, are presented.
Expanding conceptualizations of culturally competent care
Authors: Canales Mary K. , Bowers Barbara J.
Published: March 2003

Expanding conceptualizations of culturally competent care

Aim. The aim of the study was to gain an understanding of cultural competence from the perspectives of non‐mainstream nurse educators, specifically those of Latin heritage.

Background/Rationale. Although the theoretical concepts of ‘cultural diversity’ and ‘culturally competent care’ have been supported and promoted by the largest professional nursing organizations, the practical application of these concepts has often created difficulties for nurse researchers, educators, and clinicians. The lack of progress in teaching and evaluating cultural competence suggested the need to ‘center the margins’ and explore cultural competence from the margins of one particular non‐mainstream nursing group, Latina nurse educators.

Design/Methods. A grounded theory research design was employed. A group of 10 doctoral, prepared, self‐identified, Latina nurse educators participated in face‐ to‐face audiotaped interviews. Data collection, analysis, and theoretical sampling decisions occurred concurrently, strengthening theory generation. Institutional review board approval was received for all steps of the study. The major limitation of the study was the omission of student voices.

Results/Findings. The analysis suggests that the Latina participants shared the common purpose of teaching students how to think about difference. The teaching practices of this group of Latina educators was based on a belief that ‘difference’ is not solely about specific cultural groups. For example, content about ‘Hmongs’ or ‘Latinos’. Rather, Latina faculty focused on teaching students how to directly connect with anyone perceived as different from oneself.

Conclusions: Latina faculty did not distinguish between competent care and culturally competent care; for them, competence necessarily includes cultural competence. They conceptualize the provision of competent care to all persons who are perceived as different, rather than focusing only on those who are perceived as ‘culturally’ different. These conceptualizations have the potential to shed new light on how nurses and nurse educators think about, develop, and integrate cultural competence into nursing education, practice, and research.
Obesity in adults and children: a call for action
Authors: Holm Karyn , Li Suling , Spector Nancy , Hicks Frank , Carlson Elizabeth , Lanuza Dorothy
Published: March 2003

Obesity in adults and children: a call for action

Obesity/overweight in adults and children is a worldwide health problem associated with substantial economic burden as measured by paid sick leave, life and disability insurance rates, and obesity‐related physician visits and hospital stays. Overweight/obese people experience hypertension, elevated cholesterol, and type 2 diabetes and suffer more joint and mobility problems than people within the normal weight for height range. While there is need to understand individual behaviors that can be modified to promote weight loss and weight maintenance, there is as great a need to consider contextual factors at the societal level that can impede or even sabotage weight control efforts. In every country with improved living standards people will continue to eat too much and engage in too little physical activity. The call for action is for all modernized societies to alter environments and attitudes to support, rather than hinder, healthy dietary intake and being physically active.
Research information in nurses’ clinical decision‐making: what is useful?
Authors: Thompson Carl , McCaughan Dorothy , Cullum Nicky , Sheldon Trevor A. , Mulhall Anne , Thompson David R.
Published: March 2003

Research information in nurses’ clinical decision‐making: what is useful?

Aim. To examine those sources of information which nurses find useful for reducing the uncertainty associated with their clinical decisions.

Background. Nursing research has concentrated almost exclusively on the concept of research implementation. Few, if any, papers examine the use of research knowledge in the context of clinical decision‐making. There is a need to establish how useful nurses perceive information sources are, for reducing the uncertainties they face when making clinical decisions.

Design. Cross‐case analysis involving qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England, United Kingdom. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 hours and 122 nurses were involved in the Q modelling exercise.

Results. Text‐based and electronic sources of research‐based information yielded only small amounts of utility for practising clinicians. Despite isolating four significantly different perspectives on what sources were useful for clinical decision‐making, it was human sources of information for practice that were overwhelmingly perceived as the most useful in reducing the clinical uncertainties of nurse decision‐makers.

Conclusions. It is not research knowledge per se that carries little weight in the clinical decisions of nurses, but rather the medium through which it is delivered. Specifically, text‐based and electronic resources are not viewed as useful by nurses engaged in making decisions in real time, in real practice, but those individuals who represent a trusted and clinically credible source are. More research needs to be carried out on the qualities of people regarded as clinically important information agents (specifically, those in clinical nurse specialist and associated roles) whose messages for practice appear so useful for clinicians.
Socio‐psychological stressors as risk factors for low back pain in Chinese middle‐aged women
Authors: Yip Yin‐bing , Ho Suzanne C. , Chan Sieu‐gaen
Published: March 2003

Socio‐psychological stressors as risk factors for low back pain in Chinese middle‐aged women

Aim(s) of the study. This study aims to explore the relationship between socio‐psychological stress and low back pain (LBP) prevalence among Chinese middle‐aged women.

Background. Women in mid‐life experience increasing socio‐psychological stress because of midlife transitions, stressful life events and housework or work factors. Encountering socio‐psychological stress itself may result in the manifestation of LBP.

Design. A case–control study of Hong Kong community‐based middle‐aged women was conducted. The study subjects were either from the University Family Medicine Clinic or from a previous population‐based cross‐sectional study of middle‐aged women conducted by Department of Community and Family Medicine. Among the 928 potential eligible subjects from both sources, a total of 182 cases and 235 controls participated in this study. Data were collected from face‐to‐face interviews and included demographic factors, menopausal status, socio‐psychological stress and occurrence of LBP. Socio‐psychological stress covered social factors, self‐reported nature of housework/work, housework/work stress and stressful life events.

Results. Among the 182 cases who entered this study, 83 women (45·6%) had experienced 1–<14 days of LBP, and 99 women (54·4%) had at least 14 days of LBP in the previous 12 months. Those who reported that ‘their family members, relatives or friends were very sick, died, needed her to take care of them or who they worried about in the past 12 months’ had an increased risk of LBP of 67% (95% confidence interval (CI) 1·09–2·55). In addition women with a bad or ordinary relationship with cohabitants had an increased risk of LBP of 70% (95% CI 1·00–3·04). Lastly, women with a high housework or work stress had an increased risk of suffering both types of LBP of nearly two‐ and half‐fold (95% CI 1·61–3·85).

Conclusions. The results indicate that an association exists between high socio‐psychological stress and LBP prevalence. Alleviating the impact of housework or work related factors would, however, involve improving both the work and home environment.