bluuebunny/crossref_metadata_2025 huggingface dataset:
Grasshoppers alter jumping biomechanics to enhance escape performance under chronic risk of spider predation
Authors: Hawlena Dror , Kress Holger , Dufresne Eric R. , Schmitz Oswald J.
Published: August 2010

1. Prey can increase the probability of escaping a predator attack by adopting either behavioural tactics that provide more time or less distance to escape or by increasing their escape performances. It is assumed that the ability to improve escape performances is reserved for species that respond to chronic predation risk by substantially altering morphological traits related to locomotion. This thinking is at odds with fundamental predictions of physiological stress theory that suggest performance should be enhanced both independently of and in addition to morphological change.

2. The purpose of this study was to determine whether and how prey raised under chronic risk of predation can improve their escape performance independent of conspicuous morphological changes.

3.  We reared herbivore grasshopper in field mesocosms with and without disarmed hunting spiders and measured their outdoor jumping performance. Grasshoppers were then transferred to the laboratory where we measured the biomechanics of their jumping to elucidate mechanisms that differentiate performance between rearing treatments. We collected second generation nymphal offspring from the field mesocosms and measured their morphology and escape performances to reveal costs associated with antipredator responses.

4. Chronically scared grasshoppers made adjustments in jumping technique that enabled them to take‐off 1·2 times faster, which, in combination with additional in‐flight behavioural adjustments, led to 2·6 times longer jump distances. These improvements were independent of conspicuous morphological changes but were accompanied by attendant costs: grasshoppers reared in risky environments produced smaller and less athletic offspring than grasshoppers from risk free environments.

5. The results suggest that prey do not need to undergo conspicuous morphological changes in locomotor traits before they can improve escape performance, revealing an adaptive and possibly common aspect of physiological stress reaction to predation.
The paradox of nursing*
Authors: Chapman Christine M.
Published: August 2010

Most definitions, or descriptions of nursing emphasize that it is an interpersonal activity focusing on the understanding of the patient as an individual. In addition, such descriptions highlight not only the caring aspect of the role of nursing but also the health maintenance and rehabilitation aspects. The paper discusses the fact that despite these definitions, nursing is still task orientated, largely based on the medical model and hidebound by tradition. Suggestions are made of ways in which this approach may be altered. The use of the nursing process, the concept of the primary nurse and the developing of empathetic understanding being some of the ways in which individualized care may become a reality. The adherence to tradition highlights that nurses are the greatest hindrance to progress in nursing.
A philosophical analysis of caring in nursing
Authors: Griffin Anne P.
Published: August 2010

The concept of caring is fundamental to our understanding of human nature. A philosophical examination of the concept in a particular context by analytical and phenomenological methods, may help to characterize the responsibilities and potentialities of caring. The concept of caring as applied to nursing has both an activities and an attitudes aspect. The latter is complex in particular, involving cognitive, moral and emotional factors. Attention, perception and recognition of fundamental moral values such as respect for persons are discussed, prior to an attempt to elucidate the emotional components of caring further. Whilst it is evident that liking or affection for a patient may be contingently present in nursing care, perhaps compassion and gratitude may also be generated by the nurse‐patient relationship, where certain benefits of understanding can also accrue to the nurse. The development of such relationships implies a long‐term caring context, severely at odds with many institutional and economic pressures today.
Nurse therapist trainee variability: the implications for selection and training
Authors: Brooker C. , Wiggins R. D.
Published: August 2010

This paper examines some of the data obtained from the Joint Board of Clinical Nursing Studies Course Number 650, which ran at the Bethlem Royal and Maudsley Hospitals, London, 1978–1979. During this particular training programme, eight nurse therapist trainees treated a total of 251 patients assessed as suitable for behaviour therapy. Data were collected from patients by trainees on four separate occasions; before treatment, after treatment, and at follow‐up intervals of 1 and 6 months. It was suggested that therapists would vary systematically in terms of the assessment scores used to measure outcome. This was explored using analysis of variance techniques, where several treatment outcome measures were used as dependent variables. The analyses, which were undertaken using SPSS and GLIM computer packages, clearly demonstrated therapist variability. The results are discussed within the theoretical framework of Sudman & Brabum's (1974) interviewing model and O'Muircheartaigh & Wiggins' (1981) consideration of response errors. The implications for the selection and training of nurse therapists are presented. The final conclusion of the paper is that, although the patient's clinical outcome may be related to therapist allocation, the eight trainees allowed themselves to ‘open’ their activities to this evaluative approach – which in turn demonstrates their professionalism.
The family dynamics of childbearing and childrearing families in Finland
Authors: Hakulinen Tuovi , Paunonen Marita
Published: August 2010

Within the context of an international comparative family dynamics project, this study had two chief goals to describe the family dynamics of childbearing and childrearing families in Finland, and to study changes in family dynamics after childbirth The sample consisted of families expecting (n= 118) and rearing (n= 94) their first or second child in Finland Two instruments were used in data collection, i e the Family Dynamics Questionnaire and the Family Dynamics Measure, both these tools have been developed in the USA According to the results, childbearing and childrearing families were thought to function quite well Pregnant mothers described their family dynamics in more positive terms than fathers, reporting greater flexibility and clearer communication Similarly, mothers reported more individuation and mutuality than their partners First‐time expectant families reported more mutuality than families expecting their second child Childrearing mothers reported more individuation, but also more role conflict than did fathers Communication in families rearing their first child was clearer than in families rearing their second child The birth of a child affected family dynamics by bringing about various changes such as role conflict, isolation and distorted communication
Breastfeeding duration: prenatal intentions and postnatal practices
Authors: Lawson Kerryann , Tulloch Marian I
Published: August 2010

A study of 78 primiparas examined the role of prenatal intent and postnatal experiences in breastfeeding duration Those fully breastfeeding 3 months after the birth of the baby had a higher level of education, timed their decision to breastfeed earlier, intended to breastfeed longer and had a more negative attitude to formula feeding Commitment and confidence scores were not related to breastfeeding duration in first‐tune mothers Breastfeeding duration was also related to the timing of the first breastfeed and extent of mother‐infant contact in the 72 hours after birth but not to the number of feeding problems
Nursing leaders’ and nurses’ view of health
Authors: Herberts Siv , Eriksson Katie
Published: August 2010

This study is part of a scientific project, ‘Multidimensional Health’, the main goal of which is to introduce a broad view on health into health care and nursing The purpose of this study is to examine the view of health among nursing leaders and members of caring staff and to compare it to that of patients (a previous study in the project) The study is based on K Eriksson's theory of caring and its view of the human being with a body, soul and spirit, and health as a dynamic process concerning all aspects of human life An inquiry form with open questions that brought to the fore various aspects and dimensions of health was filled in by 20 nursing leaders and was used in interviewing 49 nurses According to the results many aspects of life are contained in the concept ‘health’ Health is above all an experience of well‐being Ways of promoting one's health are described in terms of various ‘healthy’ living habits and preventive measures A supporting and humane attitude is hoped for in others There is unanimity that feelings affect health Belief may have a positive influence on health The meaning of life is connected with health Even suffering is part of health In interpreting the answers we assume three dimensions of health ‘Health as behaviour’ connects health with living in a healthy way ‘Health as being’ would mean a state of health and is characterized by a search for some kind of balance in one's inner state ‘Health as becoming’, growing towards health, means that a person becomes whole on a higher level of integration
How do nurses inspire and instil hope in terminally ill HIV patients?
Authors: Cutcliffe John R
Published: August 2010

In this study the researcher examined how nurses inspire and instil hope in terminally ill HIV patients The study therefore focuses on the interventions, attitudes, principles and process utilized by nurses working within a liaison psychiatry unit where in‐patient care for terminally ill HIV patients is available Using grounded theory methodology, the data were coded and analysed, producing an integrated theory of hope inspiration, comprised of four core variables reflection in action, affirmation of worth, creating a partnership, and the totality of the person The researcher postulates that hope is inspired in terminally ill HIV patients by means of nursing the totality of the person within the context of a formed partnership, underpinned by the affirmation of the individual's worth, which is assured by the nurse entering into the process of reflection in action The researcher further suggests that hope inspiration is inextricably linked to effective nursing practice, and is interwoven with the concepts of nursing, caring and helping
Feminist research: its relevance to nursing
Authors: Sigsworth Janice
Published: August 2010

It is the author's intention to explore feminist research and discover its relevance to nursing practice In order to achieve this, definitions of feminism and feminist research will be made From these it will be possible to place the feminist research process within a historical context to further understand its focus Then an analysis of feminist research will be made, examining feminist epistemology, feminist methodology and the methods used by feminist researchers At this point an examination of who should or can do feminist research will be made, followed by a discussion about the validity of feminist research
Some surprising similarities in the clinical reasoning of‘expert’ and ‘novice’ orthopaedic nurses: report of a study using verbal protocols and protocol analyses
Authors: Greenwood J , King M
Published: August 2010

This paper reports on an Australian study of ‘expert’ and ‘novice’ orthopaedic nursing practitioners’ clinical reasoning Concurrent and retrospective verbal reports of patient assessment and care planning in real ‘everyday’ practice situations were collected from nine pairs of ‘expert’ and ‘novice’ orthopaedic nurses Verbal protocol analyses revealed that the experts used the same level of concepts as novices, that their clinical reasoning was as physically orientated as that of novices, and that the implicit constructions of nursing in the reasonings of both experts and novices were consistent with a ‘medical model’ of health care The research design, limitations and findings are discussed
Unbearable incidents: failure to endure the experience of illness
Authors: Dewar Anne L , Morse Janice M
Published: August 2010

Inherent in the illness experience are multiple assaults on one's self and one's body These assaults may be interpersonal (such as an unwitting remark made from another), or intrapersonal (such as unrelenting symptoms that are a part of illness, injury or treatments) These assaults may accumulate until the situation becomes unbearable, the person can no longer ‘take it’, and the person loses control In this paper, the authors examine the circumstances that resulted in the breakdown of endurance, and noted that while some of the factors remained unbearable, others are managed The authors suggest that the patient's response, that is‘loosing it’, may be beneficial‘Losing it’is a means of ensuring changes in care for a patient, or aids in the relinquishment of unrealistic expectations of one's self and one's future In all instances, however, the patient's plan of care should be carefully examined and, if necessary, modified
Humanism and positivism in nursing: contradictions and conflicts
Authors: Playle John F
Published: August 2010

Nursing and nurse education have been influenced by a shift towards a broadly humanistic philosophy as a basis for practice At the same time, in attempts to develop a knowledge base and credibility as a profession, the vital importance of research has been acknowledged Both these aspects of nursing are increasingly forming the basis for all nursing courses However, in this paper, it is argued that the implicit adoption of notions of science based in a positivistic paradigm gives rise to conflicts with a humanistic philosophy It is contended that nursing has inherited a ‘legacy of positivism’, which promotes objectivity and reductionism and which excludes subjective meaning and the personal from the research process In part this has been due to the powerful influence of medical hegemony, which has defined the nature of legitimate knowledge and controlled nursing research through the gatekeeping function of doctors If nursing is to make progress in the development of a knowledge base, the contradictions between humanism and positivism must be acknowledged as a barrier to an integration of the art and science of nursing This paper suggests that what is required is a paradigm shift, a redefinition of nursing science, which not only rehumanizes the nature of research, but also refutes and challenges the notion of objectivity and the objective attitude
Analysing qualitative interview data: addressing issues of validity andreliability
Authors: Appleton Jane V
Published: August 2010

Over the last 20 years qualitative research methods have increased in popularity in the field of nursing research, yet critical issues of validity and reliability are often overlooked in published research reports Thus, the aim of this paper is to describe the steps which the author followed to address issues of rigour in one qualitative research study The study was conducted to explore the health visitor's role in identifying and working with vulnerable families in the community in relation to child protection Thispaper will focus on how issues of validity and reliability were addressed in terms of qualitative interview data
Deputed power of medical control: the hidden message in the ritual of oral shift reports
Authors: Ekman Inger , Segesten Kerstin
Published: August 2010

The exchange of oral shift reports between nurses is a prominent part of the everyday routine in a hospital ward Increased awareness of the more or less explicit functions of such communication is likely to have a positive impact on the nursing profession Oral shift reports in a nursing care system based on task allocation were therefore observed and analysed Using an ethnographic approach, reports were tape‐recorded, and nurses were interviewed regarding their experiences During the shift report session, the nurses were found to receive ritually mediated deputed power of medical control from their colleague, but little attention was paid to nursing needs and measures The nurses clearly demonstrated that they were caught in a system dominated by a medical paradigm that effectively obstructed the progress of nursing as a professional discipline in its own right
Maternal behaviour during spontaneous and directed pushing in the second stage of labour
Authors: Thomson Ann M
Published: August 2010

It has become custom and practice within the midwifery and obstetric professions in the English‐speaking western world for women to be required to follow very specific instructions on how to push in the second stage of labour There is very little literature on the behaviour of women using spontaneous pushing in the second stage of labour In a pilot study of a randomized controlled trial comparing spontaneous (n= 15) with directed (n= 17) pushing, the behaviour of the women was observed and recorded The findings from the observational part of the study are reported in this paper When pushing spontaneously women do not instinctively take a deep breath, they do not start expulsive effort with the commencement of the contraction, and they use both open and closed glottis pushing In order to assist women in the second stage of labour, those caring for them should be aware of what is normal behaviour when women are using spontaneous expulsive effort
Postoperative morbidity following Caesarean delivery
Authors: Hillan Edith M
Published: August 2010

The current study was designed to determine the postoperative morbidity associated with Caesarean section and to compare the morbidity with the timing of the operation elective versus emergency Caesarean section, subgroups of women delivered by emergency Caesarean section, women delivered during the first stage of labour versus those delivered during the course of the second stage A retrospective review was conducted of the obstetric case record and the midwifery notes of all women delivered by Caesarean section over a 1‐year period in a university teaching hospital (n= 619) The variables used to measure postoperative morbidity included wound infection, intrauterine infection, urinary tract infection, chest infection, pyrexia, urinary catheterization and postnatal blood transfusion Only 9 5% of the women had no recorded morbidity in the postnatal period Women delivered by emergency Caesarean section experienced a greater number of postnatal problems, an increased incidence of febrile morbidity, more blood transfusions in the postnatal period and a higher proportion had a urinary catheter left in situ after surgery The incidence of wound infection, intrauterine infection and chest infection was higher in the emergency group and this resulted in an increased proportion of the women requiring antibiotic therapy in the postnatal period The study found that there was considerable postoperative morbidity associated with Caesarean delivery, particularly if the operation was carried out as an emergency procedure
Comforting: exploring the work of cancer nurses
Authors: Bottorff Joan L , Gogag Mary , Engelberg‐Lotzkar Michelle
Published: August 2010

In a study to identify and describe nurses’use of comforting strategies, techniques of qualitative ethology were used to analyse videotaped recordings of nurse‐patient interactions on an active cancer treatment ward Comforting strategies nurses were observed to use included gentle humour, physical comfort measures, emotionally supportive statements, and comforting and connecting touch In addition they increased physical proximity, provided patients with information, supported patients’active participation in decisions regarding their care, and offered opportunities for patients to engage in social exchange These strategies appeared to play a major role in helping cancer patients endure the discomforts associated with their illness and/or treatment Various combinations of comforting strategies were used in four different contexts, including helping patients put experiences into perspective, helping them stay in control, providing opportunities to function as normally as possible, and providing emotional support The findings of this study support conceptualizations of comforting that extend beyond measures related to symptom control and indicate that comforting strategies used by cancer nurses comprise a significant part of their work
Living with a venous leg ulcer: a descriptive study of patients’experiences
Authors: Walshe Catherine
Published: August 2010

This study aimed to describe the experience of living with a venous leg ulcer from the patient's perspective, to answer the question‘What is it like to live with a venous leg ulcer?’Investigating the experience of illness is important in understanding how disease processes affect people, how they understand and cope with these processes, and how care may be given most effectively Little research was identified which examined these areas with reference to people with leg ulceration A qualitative approach was taken in the following study, using phenomenological methods to describe the experience of venous leg ulceration Informal unstructured interviews were conducted with 13 informants, guided by their descriptive priorities Tape recordings were then transcribed and analysed for recurrent themes and their meanings It was found that certain symptoms of ulceration, principally pain, were the overwhelming feature of the experience These symptoms caused significant restrictions in people's lives, particularly in their ability to walk and go out Treatment was not described as being efficacious in ameliorating these symptoms, but nevertheless great confidence and trust was placed in the expertise of nurses People coped with the experience mainly by a process of normalizing its components It is concluded that if treatment is to meet the needs of those suffering venous leg ulceration, then symptom control must be the highest priority
Patient suffering: a taxonomy from the nurse's perspective
Authors: Flaming Don
Published: August 2010

Using the ethnoscientific method, a taxonomy depicting types of suffering experienced by patients was developed Nurses were asked to describe patients' suffering and, from this data, the differing types were identified The four major domains identified were ‘to bear it’, ‘to stay in control’, ‘to protect’, and ‘to strengthen’ Under these broad domains, nurses identified 24 different types of suffering, such as peaceful, meaningful, self‐absorbed, silent, stoic, flaunted, martyr‐like, ‘in limbo’, and hopeless Implications for nurses are that (a) patients expend much energy in their suffering and this should be considered when giving care, (b) nurses' personal evaluation of patient suffering should not preclude individualized care, (c) patients need personal space periodically, (d) some patients do not want their suffering alleviated, and (e) hidden reasons for patient behaviour are likely to exist
A research study exploring the patient's view of quality of life using the case study method
Authors: Dale Andrea E
Published: August 2010

A research study into the patient's perspective of quality of life is outlined This phenomenon had not been explored at the time when the study was in process However, late in 1993 towards the end of the study a paper was published by Bertero & Ek in which the findings of a similar study were discussed The findings of this study reinforced and expanded upon those of Bertero & Ek After a brief outline of the research study this paper explores validity in qualitative research, the case study method, method triangulation and the application of the hermeneutic cycle The latter two of these were strategies adopted within this study to promote validity The paper ends with a discussion of the main findings from this study and conclusions
Health promotion: a concept analysis
Authors: Maben Jill , Clark Jill Macleod
Published: August 2010

Health promotion is a concept which is frequently used, but is often ill defined Current health care trends, and the emphasis on the nurse of the future as a promoter of health suggest that it would be useful to attempt to clarify the concept This paper develops a conceptual analysis of health promotion using the process developed by Rodgers (1989) Attributes, antecedents, consequences and references are described following an examination of the ongoing debate in the literature surrounding the meaning of the concept Empirical work is also reviewed which suggests that nurses’understandings of the concept are firmly embedded in the more traditional approach rather than the more modern or new paradigm approach to health promotion A model case is described, and the analysis results in a proposed definition of health promotion which it is hoped will stimulate further discussion
Staffing levels and seclusion use
Authors: Morrison Paul , RMN Michael Lehane
Published: August 2010

In this paper the role of staffing levels as a determinant of seclusion use in one psychiatric hospital is examined A detailed review of the official records of seclusion over a 2‐year period was completed (n= 225) The staffing levels on shifts when seclusions were initiated were compared with similar shifts when seclusions were not used on the same ward Statistical analysis revealed a highly significant difference between the levels of staffing Wilcoxon matched pairs signed‐ranks test, Z=‐5 8675, two‐tailed, P= 0 001 This finding suggests that staffing levels play a crucial role in the practice of seclusion However, the overall staffing level must be considered along with other factors in the makeup of the staff group, including the ratio of female to male staff and the experience level of those staff These findings have important implications for those involved in the management and practice of seclusion as well as the patients who are secluded
Valid arguments? A consideration of the concept of validity in establishing the credibility of research findings
Authors: Avis Mark
Published: August 2010

Validity is an important concept in establishing the credibility of research findings However, the current debate about the criteria used to substantiate claims for the validity of research evidence is largely based on a set of distinctions between qualitative and quantitative methodology which are outdated and misleading This paper argues that validity is an epistemological concept, whose application depends upon some fundamental positions taken about the nature of truth, representation and scientific methodology There remain important, unresolved questions about the meaning and application of the concept of validity which have a crucial bearing on what criteria are used to establish the credibility of research evidence
A descriptive study of the work of community psychiatric nurses with elderly demented people
Authors: Adams Trevor
Published: August 2010

This study examines the work of community psychiatric nurses (CPNs) with elderly demented people A total of 14 cases, taken from the caseloads of four CPNs, were examined by direct observation of CPNs'practice and in‐depth interviews The data were analysed using a method suggested by Dey (1993) The validity of the findings was checked internally by means of respondent validation and externally by CPNs from other teams working with elderly demented people It was found that the CPNs operated two strategies one directed towards the client and the other towards the family The process underlying these strategies consisted of five overlapping phases assessment, planning, intervention, evaluation, and termination The CPNs'working process was set within a framework containing their understanding of what they understood as ‘community’, the management style within the team and the quality and availability of clinical supervision This process is integrated with existing literature on community psychiatric nursing and suggestions are made regarding possible developments within the speciality
The development of the Pain Management Inventory for patients with arthritis
Authors: Davis Gail C , Atwood Jan R
Published: August 2010

The initial development of the Pain Management Inventory (PMI), a precise clinical index of pain management methods intended for use with patients with arthritis, is reported The PMI differs from available instruments in its intent to assess specific methods that the individual is currently using for arthritis pain management and the perceived helpfulness of these methods, thus providing information to be used in combination with other clinical indicators for planning and evaluating ongoing pain self‐management Sixteen of 17 items, or methods, initially demonstrated content validity Using methods appropriate for an index of independent items, psychometric testing with a sample of 82 persons having a primary diagnosis of osteoarthritis or rheumatoid arthritis then focused on estimating the construct validity and test‐retest reliability of each item Findings assist in better understanding how various methods relate to overall pain management when it is defined as successfully taking care of or handling the pain as viewed within a cognitive‐behavioural framework Findings suggest that there are eight items that represent valid and reliable pain management methods These items should be used and evaluated with additional arthritis samples to determine whether the findings replicate
Tacit definitions of informal caregiving
Authors: Wrubel Judith , Richards T. Anne , Folkman Susan , Acree Michael C.
Published: August 2010

Tacit definitions of informal caregiving

Aims of the study: This study describes three tacit definitions of informal caregiving and explores the extent to which differences in these tacit definitions explain variation in caregivers’ negative mood over time.

Background/Rationale: There is a growing need to understand the sources of stress and gratification for informal caregivers. Tacit definitions of informal caregiving refer to caregivers’ understanding of what caregiving entails. These definitions are tacit because they arise from caregivers’ taken‐for‐granted understanding rather than formally articulated positions concerning caregiving.

Design/Methods: A random sample of 60 men, all of whom were caregiving partners of men with acquired immunodeficiency syndrome (AIDS), was drawn from a larger cohort of 253 participants in the University of California San Francisco (UCSF) Coping Project (1990–1997). The caregivers were assessed bimonthly for 2 years with procedures that included a semi‐structured interview focusing on a recent stressful event involving caregiving, and quantitative measures of well‐being.

Results/Findings: Interpretive phenomenological case studies of the narrative accounts of the 60 caregivers produced three tacit definitions of caregiving – engagement, conflict and distance. These three tacit definitions were distinguished by differences in learning about caregiving, involvement in health care decisions, caregiving activities and reported sources of stress. The three groups differed on measures of dyadic adjustment, depression, anger and anxiety.

Conclusions: Better understanding of caregivers’ tacit definitions can facilitate and enhance effective support and interventions for caregivers.
Stressors, coping and depression in haemodialysis patients
Authors: Welch Janet L. , Austin Joan K.
Published: August 2010

Stressors, coping and depression in haemodialysis patients

Background: Depression is common in persons receiving outpatient haemodialysis, but little work has been done to explore the variables associated with depression.

Aims: The primary purposes of this study were to (i) examine relationships among stressors, coping and depression and (ii) test the mediating role of coping.

Design/Methods: Data were collected at two points in time, three months apart in 1995/1996. The final convenience sample at Time 2 was 86 participants from two United States midwestern, inner‐city dialysis units. Structured interviews were conducted using the Centre for Epidemiologic Studies Depression Scale, the haemodialysis stressor scale (HSS) and the coping strategy indicator.

Results: At Time 1 more psychosocial stressors were associated with greater use of problem‐solving, social‐support and avoidance coping. Both avoidance coping and more psychosocial stressors at Time 1 were related to depression at Time 2. Finally, avoidance coping was found to explain much of the relationship between psychosocial stressors and depression.

Conclusions: Research is now needed that explicates the causal relationships among stress, coping and depression in haemodialysis patients.
Rethinking ethnography: reconstructing nursing relationships
Authors: Manias Elizabeth , Street Annette
Published: August 2010

Rethinking ethnography: reconstructing nursing relationships

Aims of the study. Critical ethnography is being adopted increasingly by nurses as a legitimate form of research methodology. This paper explores the research practices and dilemmas that emerge from this methodology using a recently completed ethnographic study of nurse–nurse and nurse–doctor interactions in a critical care hospital setting.

Background. Critical ethnography provides a useful methodology that facilitates mutual dialogue among participants. It may be limited, however, by the central role of researchers and by a tendency to negotiate participants’ realities according to a particular ‘truth’. These concerns have been strongly critiqued by poststructuralists using concepts such as discourse, subjectivity and power. By incorporating the notion of a poststructural analysis into critical ethnography, researchers are in a position to examine critically the tensions in their own practices, and their struggles with documenting and analysing ethnographic accounts.

Design. Six registered nurses comprised the participants of the research group. Through the method of professional journalling, the first author of this paper explored her professional interactions with doctors and other nurses in her role as a nurse in the critical care setting under investigation. Other methods included participant observation, and individual and focus group interviews with nurse participants.

Issues of methodological concern. This paper considers three issues of methodological concern: researcher/participant subjectivity; the movement from empowerment to reflexivity and the construction of one form of ethnographic ‘truth’. These issues are discussed in reference to the research relationships with the nurse participants and the process of analysing ethnographic accounts.

Conclusions. In working with critical ethnography using a poststructural analysis, we were able to generate valuable insights about previously hidden areas of relationships among nurse participants in a research group during all stages of the research process. It also provided a means of informing the analysis of ethnographic texts.
Monitoring treatment fidelity in a randomized controlled trial of a complex intervention
Authors: Spillane Valerie , Byrne Mary C. , Byrne Molly , Leathem Claire S. , O’Malley Mary , Cupples Margaret E.
Published: August 2010

Title. Monitoring treatment fidelity in a randomized controlled trial of a complex intervention

Aim. This paper is a report of a study to describe how treatment fidelity is being enhanced and monitored, using a model from the National Institutes of Health Behavior Change Consortium.

Background. The objective of treatment fidelity is to minimize errors in interpreting research trial outcomes, and to ascribe those outcomes directly to the intervention at hand. Treatment fidelity procedures are included in trials of complex interventions to account for inferences made from study outcomes. Monitoring treatment fidelity can help improve study design, maximize reliability of results, increase statistical power, determine whether theory‐based interventions are responsible for observed changes, and inform the research dissemination process.

Methods. Treatment fidelity recommendations from the Behavior Change Consortium were applied to the SPHERE study (Secondary Prevention of Heart DiseasE in GeneRal PracticE), a randomized controlled trial of a complex intervention. Procedures to enhance and monitor intervention implementation included standardizing training sessions, observing intervention consultations, structuring patient recall systems, and using written practice and patient care plans. The research nurse plays an important role in monitoring intervention implementation.

Findings. Several methods of applying treatment fidelity procedures to monitoring interventions are possible. The procedure used may be determined by availability of appropriate personnel, fiscal constraints, or time limits. Complex interventions are not straightforward and necessitate a monitoring process at trial stage.

Conclusion. The Behavior Change Consortium’s model of treatment fidelity is useful for structuring a system to monitor the implementation of a complex intervention, and helps to increase the reliability and validity of evaluation findings.
The Work‐Related Quality of Life scale for healthcare workers
Authors: Van Laar Darren , Edwards Julian A. , Easton Simon
Published: August 2010

Title.  The Work‐Related Quality of Life scale for healthcare workers

Aim.  This paper is a report of a study to develop and test the psychometric properties of the Work‐Related Quality of Life scale for healthcare workers.

Background.  As problems associated with stress and job satisfaction are evident for healthcare workers and nurses, a reliable tool to assess employees’ quality of working life is required. However, previous research has produced inconsistent factor structures and inadequate psychometric properties for a range of quality of working life measures. This new scale expands the concept of quality of working life by incorporating a broad six‐factor structure derived from a theoretical review of the field.

Method.  We used data from a 2003 survey of 953 healthcare workers. Eighty‐six per cent of the sample is female and 36% had been employed by the organization for 1–5 years. Approximately 50% of workers were employed full‐time.

Findings.  Both exploratory and confirmatory factor analysis using split‐half data sets produced a good fit and a reliable 23‐item, six‐factor measurement model of Work‐Related Quality of Life. The factors generated were labelled: Job and Career Satisfaction, General Well‐Being, Home–Work Interface, Stress at Work, Control at Work and Working Conditions.

Conclusion.  The Work‐Related Quality of Life measure is one of the most succinct yet psychometrically valid and reliable Quality of Working Life scales in the literature. We propose that it can appropriately be used in healthcare organizations to assess quality of working life. Further research is required to refine the instrument and assess its applicability to other areas.
Families’ lived experience one year after a child was diagnosed with type 1 diabetes
Authors: Wennick Anne , Hallström Inger
Published: August 2010

Title.  Families’ lived experience one year after a child was diagnosed with type 1 diabetes

Aim.  This paper is a report of a study to elucidate families’ lived experience of diabetes one year after a child was diagnosed with type 1 diabetes.

Background.  The incidence of type 1 diabetes is rapidly increasing worldwide, with a shift towards younger age groups. This illness is treated by means of an intensive management regimen that often disrupts the child’s usual activities and requires disease‐focused behaviours from the child and his or her family. However, research elucidating families’ lived experience from the perspective of all its members is sparse.

Method.  A hermeneutic phenomenological study was carried out in 2004, based on interviews one year after diagnosis with 11 consecutively chosen Swedish‐speaking family members with children aged between 9 and 14 years.

Findings.  The families described their one year of lived experience as living an ordinary yet different life. They experienced their lives to be neither particularly difficult nor as easy as they had been before the child was diagnosed with diabetes. Related themes were ‘feeling acceptance yet frustration’, ‘being healthy yet invisibly ill’, ‘feeling independent yet supervised’ and ‘feeling confident yet insecure’.

Conclusion.  It may be helpful if healthcare professionals make use of the knowledge and experience of families living with the illness to meet their specific needs, especially when the affected child is experiencing fluctuating blood sugar levels. Thus, health‐promoting collaboration should be tailor‐made for every individual and proceed from each family’s everyday life.
Opportunities and barriers to successful learning transfer: impact of critical care skills training
Authors: Meyer Edgar , Lees Amanda , Humphris Debra , Connell N.A.D
Published: August 2010

Title.  Opportunities and barriers to successful learning transfer: impact of critical care skills training

Aim.  This paper is a report of a study to assess the impact on nursing practice of critical care skills training for ward‐based nurses.

Background.  Following a government review in the UK of adult critical care provision, new ways of working were advocated to ensure that critical care services depended on the needs of the patient, not their location in the hospital. A re‐conceptualization beyond service provision in high dependency units and intensive care units was required in order to deliver an integrated service. This has ramifications for training requirements.

Methods.  Semi‐structured interviews were used to explore perceived learning and learning transfer from a range of courses. The data were collected from course attendees (n = 47) and line‐managers (n = 19) across two sites between 2005 and 2006.

Findings.  Learning was closely associated with the clinical application of new skills and knowledge. Commonly, course attendees and line‐managers quoted increased knowledge and confidence, better assessment skills and improved interprofessional working. Time with competency assessors, availability of expanding roles, and supernumerary time were key factors for successful learning transfer. Barriers were financial pressures on hospitals, lack of perceived relevance of the course to staff or nursing practice, and lack of time to practice skills or work with clinical skills facilitators.

Conclusion.  Course design should be a collaborative activity between education providers and commissioners to ensure the impact of training on practice. Relevance of material, time to practise skills and new learning, and organizational, rather than merely individual, support are essential for successful training interventions.
Patient knowledge of atrial fibrillation: 3‐month follow‐up after an emergency room visit
Authors: Koponen Leena , Rekola Leena , Ruotsalainen Taru , Lehto Mika , Leino‐Kilpi Helena , Voipio‐Pulkki Liisa‐Maria
Published: August 2010

Title.  Patient knowledge of atrial fibrillation: 3‐month follow‐up after an emergency room visit

Aim.  This paper is a report of a study to assess patient knowledge about atrial fibrillation, its determinants and evolution during 3 months after a visit to the emergency room.

Background.  Atrial fibrillation is one of the most common single diagnoses in the emergency room, and care often results in treatment modifications after which most patients are discharged home.

Method.  A knowledge test was developed to measure patients’ knowledge of atrial fibrillation. Patient data from 200 patients were assessed by examining quartiles and medians. The statistical significance of changes was tested with the Sign test. A logistic regression model was built to identify variables possibly related to patient knowledge. The data were collected in 2003 in three emergency rooms in Finland.

Results.  Patients had only moderate knowledge about atrial fibrillation in the emergency room, and their knowledge showed only limited improvement 3 months after the visit. They had best knowledge of the symptoms of atrial fibrillation and its effects on everyday life. There were gaps in their knowledge about this disease and how it is treated, including anticoagulation, detection of symptoms and when to seek treatment, both during the emergency room visit and 3 months thereafter. Male gender, previous atrial fibrillation diagnosis and sense of good coping with the disease were statistically significantly associated with better knowledge.

Conclusion.  Informational support should be available for patients with atrial fibrillation during and after the emergency room visit. The knowledge test introduced in this paper could be developed to evaluate the educational needs of individual patients.
Evaluation of a pregnancy prevention programme using the Contraceptive Behavior Change model
Authors: Chung‐Park Min S.
Published: August 2010

Title.  Evaluation of a pregnancy prevention programme using the Contraceptive Behavior Change model

Aim.  This paper is a report of the findings of a study to examine the effects of application of the Contraceptive Behavior Change model on knowledge, attitudes, perceived benefits and barriers, self‐efficacy (SE), stages of change (SOC) and contraceptive behaviours.

Background.  Unintended pregnancy is a global issue; it is also a concern for the military, as it impacts on mission readiness. Effective sexuality education programmes are needed but, to date, an evaluation of existing programmes using a conceptual model is lacking in the health literature.

Method.  A sample of 198 single, junior enlisted females was randomly recruited from United States of America Navy ships. An experimental design was adopted. The experimental group received two class sessions, 2 months apart, while the control group received none. The variables measured were: knowledge, attitudes, perceived benefits and barriers, SE, SOC and contraceptive behaviours. Data were collected on three separate occasions at 2‐month intervals over a 4‐month period in 2004–2005.

Results.  Initially, a striking lack of knowledge was evident among study participants. The experimental groups’ knowledge increased statistically significantly with repeated interventions, while the control group’s knowledge did not change over the same period. Both groups started with no pregnancies, and at the end of the study, the pregnancy rate between the two groups was statistically significant: experimental group 0%, and control group 14%.

Conclusions.  The intervention led to increased knowledge, which in turn led to avoidance of pregnancy. The proposed model was appropriate for the evaluation and consequently can be considered as an effective tool to use for development or refinement of existing programmes.