bluuebunny/crossref_metadata_2025 huggingface dataset:
Retention of nursing students with English as a second language
Authors: Jalili‐Grenier Fereshteh , Chase Mackie M.
Published: March 2003

The purposes of this study were to: (a) determine nursing students' perceptions of the learning activities which contribute the most to their knowledge and skills; (b) determine students' perceptions of their learning difficulties; (c) compare the perception of English as a second language (ESL) and non‐ESL students; (d) determine nursing faculty perceptions of ESL students' learning difficulties; (e) compare the perception of ESL students and faculty; and (f) indentify needs for educational and/or supportive programmes for faculty and students. Differences in perceptions of faculty and students regarding areas of difficulty and studetnts' needs may influence the services provided to students and therefore contribute to their lack of success and attrition.

A questionnaire was given to students in the first and second years of the University of British Columbia (UBC)/Vancouver Hospital (VH) Nursing Programme to collect data regarding their high school and post‐secondary education, date of arrival in Canada, first language, and their perceptions of helpfulness and difficulty of learning activities. A similar questionnaire was given to faculty members working with these students to collect data about their perceptions of areas of difficulty and activities that contribute the most to the learning of ESL students. Data analysis consisted of t‐test for statistical comparison of the responses of ESL and non‐ESL students, and ESL students and faculty. The results indicated statistically significant differences between the perceptions of faculty and ESL students, particularly in the areas of difficulty. The need for educational programmes for both faculty and students was identified.
Hope in nursing research: a meta‐analysis of the ontological and epistemological foundations of research on hope
Authors: Kylmä Jari , Vehviläinen‐Julkunen Katri
Published: March 2003

The purpose of this study is to describe the ontological basis of hope and the epistemological solutions adopted in research on hope by reviewing research articles concerned with the subject in the field of nursing science. The material consisted of 46 articles published between 1975 and 1993, and the examination was based on the meta‐analysis method. References to the ontology of hope were inductively clustered according to the principle of continuous comparison. For the analysis of epistemological solutions, the purpose of the study, population/respondents, and methods of data collection and analysis were identified.

The articles reviewed focus on the essence and distinctive characteristics of hope. Although rich in detail and quite vivid, there is a certain lack of precision about the descriptions. Hope may be described as an emotion, an experience or need. A distinction is made between generalized and particularized hope. There is a clear emphasis on the necessity and the dynamism of hope. As far as its dynamics are concerned, the most important dimension is the dialectic between hope and despair. An affective, functional, contextual and temporal as well as relational dimension are distinguished in the process of hope. Research on hope consists in the main part of descriptive cross‐sectional research that focuses on individuals who are unwell. The most common method of data collection is the questionnaire, while the analyses are typically based on quantitative methods.

There is need for further work to clarify the concept of hope. In the field of nursing research, there is obvious need to carry out more qualitative longitudinal research. More attention should be paid to healthy individuals and families at different stages of their life cycle.
Occupational need in severe dementia: a descriptive study
Authors: Perrin Tessa
Published: March 2003

This project represents the first phase of a large study, the whole of which is intended to demonstrate the occupational need of elderly persons, in nine dementia care units were such observed over the course of a day, using the dementia care mapping instrument. Results indicate a severe dearth of occupational provision for this client group, most of whom spent the greater part of their day unoccupied. They also highlight the conditions of minimum well‐being experienced by most residents for most of the time. The anomaly of those units whose dementia care mapping scores did not match the perceived quality of their social and physical environments is discussed. A hypothesis of an altered perception of environment in severely impaired persons ins proposed.
Subject retention in a controlled clinical trial
Authors: Good Marion , Schuler Linda
Published: March 2003

Threats to subject retention in a controlled clinical trial require strategies that encourage continued participation of subjects, with consideration of the effect of the strategies on the dependent variable. Methods to encourage retention must be based on sensitivity to the patient's changing condition and perspective. Primary considerations in the design and implementation of an intervention study are the acceptability of the intervention to particular patients and the compatibility of the intervention with other care activities. In addition, qualities of the research personnel and changes in patient conditions are important factors in retention of subjects. Vignettes illustrate the threats to retention and solutions used in a clinical trial. Threats to retention include the research nurse's approach and patient factors such as worries, control issues, visitors, symptoms of confusion and pain, and lack of cooperation. Retention strategies include supporting and educating research nurses, providing empathy and respect, including patients in decisions, negotiating with visitors, alleviating symptoms, and supporting a plan of care consistent with both the research protocol and the patient's recovery. While providing a similar approach to all groups, experimental researchers in a variable clinical environment must also provide some individualization and communication to retain valuable subjects who are ill.
The prevalence and cause of occupational back pain in Hong Kong registered nurses
Authors: French Peter , Flora Lee Fung Wah , Ping Liu Sum , Bo Luk Kar , Rita Wong Heung Yee
Published: March 2003

It is well known that many patient‐oriented tasks contribute to occupational back pain in nurses and this is borne out by previous studies. In order to know whether the incidence of back pain and the contributing factors are the same in Hong Kong, a descriptive study was adopted to investigate the situation locally. This study explored the prevalence and perceived contributing factors of back pain, utilizing a non‐experimental survey approach. Baseline data for this study were gathered by means of a questionnaire. The questionnaire elicited characteristics of the subjects' history and contributing factors to back pain. Of 47 nursing staff at an acute care hospital, the reported occurrence of some form of back pain during their career was found to be 80.9%. Approximately one‐third of nurses with back pain experienced pain at least once a month. The top two dynamic factors contributing to back pain were lifting patients and transferring patients. Meanwhile, stooping was identified as the most common static factor contributing to back pain. In addition of those who had experienced some form of back pain, 92.1% stated that they have never reported their back pain to their employers. Contributing factors such as transferring patients from bed to chair and lifting patients within bed without assistance indicate poor practice which should be eliminated by the existence of continuing in‐service education.
Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries?
Authors: Coyne Imelda T.
Published: March 2003

Sampling is a very complex issue in qualitative research as there are many variations of qualitative sampling described in the literature and much confusion and overlapping of types of sampling, particularly in the case of purposeful and theoretical sampling. The terms purposeful and theoretical are viewed synonomously and used interchangeably in the literature. Many of the most frequent misinterpretations relate to the disparate meanings and usage of the terminology. It is important that the terminology is examined so that underlying assumptions be made more explicit. Lack of shared meanings and terminology in the nursing discourse creates confusion for the neophyte researcher and increases the production of studies with weak methodologies. This paper analyses critically purposeful and theoretical sampling and offers clarification on the use of theoretical sampling for nursing research. The aim is not to make prescriptive statements on sampling; rather, to enhance understanding of the differences between purposeful and theoretical sampling for nursing research.
Can health care assistants replace student nurses?
Authors: Chang Anne M. , Lam Lina
Published: March 2003

With the implementation of Project 2000 in the UK the traditional student nurse workforce has largely been replaced by health care assistants (HCAs). This study was carried out in Hong Kong at a time when university‐based nurse education is gradually being introduced. Evaluation of a HCA pilot programme in an acute care hospital in Hong Kong provided the opportunity to examine the work of HCAs and hospital‐based student nurses during the gradual introduction of university‐based nurse education. The data used in this paper were drawn from a larger study evaluating the use of HCAs. The observational data collected at two phases after the introduction of HCAs were analysed using Kruskal‐Wallis one way analysis of variance. No significant differences were found in the total amount of all types of activity performed by SNs and HCAs. However in the direct care type of work HCAs performed significantly more basic care and less technical activity than any level of student at phase 1 (P<0·001) and phase 2 (P<0·001). These differences in the work undertaken suggest that qualified staff do not perceive SNs and HCAs as equally unqualified. Thus the replacement of SNs with HCAs alone is likely to lead to a notable change in the role of qualified staff in terms of their direct and indirect care activities and in the amount of time spent delegating and supervising unqualified staff.
An ethnographic study of the process of medication discharge education (MDE)
Authors: Martens Karen H.
Published: March 2003

Medication discharge education (MDE) is an essential component of the hospital discharge process. It is especially important for older persons with heart disease because they are among the highest users of hospital care. Accurate management of medications is believed to be one strategy to prevent or delay hospitalization. Despite its accepted importance, there is little documented research about patient education in general, or MDE in particular. This ethnographic study collected interview, observational, and document data from older persons with heart disease, family members, nurses and medical records in order to describe the process of MDE. MDE was found to be both structured and unstructured, uncoordinated, and driven by accreditation guidelines. Older patients and their family members valued MDE, especially when information was personalized, provided orally and reinforced in writing. Suggestions for improving the effectiveness of MDE are offered.
Self‐efficacy as a predictor of academic performance in science
Authors: Andrew Sharon
Published: March 2003

Nursing students have traditionally experienced difficulties with the science subjects in nursing curricula, and irrespective of the institution conducting a nursing programme, this trend appears to be continuing. A satisfactory means of predicting academic performance in these subjects will facilitate the development of educational strategies designed to assist students overcome their difficulties. In this study, an instrument called the Self‐Efficacy for Science (SEFS) was developed and tested. The SEFS was designed to predict academic performance in the science areas of a first‐year undergraduate nursing course. A cohort of first‐year students enrolled in a bachelor of nursing course were surveyed by questionnaire. Students’ academic scores for two first‐year science subjects were obtained and used as the criterion measure for the study. Principal component factor analysis revealed the SEFS contained six instead of the hypothesized four factors. These six factors could explain 70% of students’ self‐efficacy for science. Cronbach alpha of the SEFS was 0·9. The SEFS could predict 24% of the cohort’s academic performance in a physical science subject and 18·5% for a bioscience subject. Studying science in the final year at high school was not statistically significantly related to the SEFS. Implications for students and future research are discussed.
Synthesis in nursing knowledge: an analysis of two approaches
Authors: Copnell Beverley
Published: March 2003

The need for synthesis in nursing knowledge development has been attested to by many authors. It is consistent with nursing’s holistic focus and is the mark of a mature discipline. This paper examines two approaches to synthesis: the use of multiple paradigms and the possible emergence of a new paradigm based on chaos theory. It argues that in their current form both approaches have flaws and neither achieves synthesis as it is here defined. However, both may make significant contributions to the development of nursing knowledge.
Misinterpretive phenomenology: Heidegger, ontology and nursing research
Authors: Paley John
Published: March 2003

This paper argues that Heidegger’s phenomenology does not have the methodological implications usually ascribed to it in nursing literature. The Heidegger of Being and Time is not in any sense antagonistic to science, nor does he think that everydayness is more authentic, more genuine, than scientific enquiry or theoretical cognition. It is true that social science must rest on interpretive foundations, acknowledging the self‐interpreting nature of human beings, but it does not follow from this that hermeneutics exhausts all the possibilities. Positivist approaches to social science are certainly inconsistent with Heidegger’s ontology, but realist approaches are not and structuration theory, in particular, can be seen as a sociological translation of his ideas. Social enquiry in nursing is not therefore confined to studies of lived experience. Indeed, lived experience research constitutes not a realization, but rather a betrayal, of Heidegger’s phenomenology, being thoroughly Cartesian in spirit.
The effects of aftercare on chronic patients and frail elderly patients when discharged from hospital: a systematic review
Authors: Bours Gerrie J.J.W. , Ketelaars Corry A.J. , Frederiks Carla M.A. , Abu‐Saad Huda Huyer , Wouters Emiel F.M.
Published: March 2003

The purpose of this systematic review was an assessment of the efficacy of aftercare in chronic patients and the frail elderly when discharged from hospital, as regards quality of life, compliance, costs, medical consumption and quality of care. In pursuit of this goal, 17 publications on the effects of aftercare after discharge from hospital were examined. A systematic assessment of methodological quality by two blinded independent reviewers resulted in a consensus score (0–100 points), based on four categories: the study population, description of the interventions, measurement of the outcome and the analysis and presentation of the data. Only three of the 17 studies scored more than 50 points, indicating that most of the studies were of poor methodological quality. The most prevalent methodological problems were that co‐interventions were not avoided, a placebo group was lacking, the assessment was not blinded and the analysis was not made on the basis of the intention‐to‐treat principle. The majority of the studies did not report clear beneficial effects in favour of the intervention group. The positive effects reported were limited to costs and quality of care.
Ministering to madness: the narratives of people who have left religious orders to work in the caring professions
Authors: Crawford Paul , Nolan Peter W. , Brown Brian
Published: March 2003

This paper examines the life stories of 14 men and women who spent time in religious communities and who subsequently took up work in the caring professions. Their accounts reflect the alignment between the ethics of care and those of religious life, the centrality of contemplation and self‐examination to both Christianity and psychotherapy. There are further correspondences between their narratives and recent academic interest in the spiritual aspects of health care. They also describe profound changes and moments of uncertainty which parallel other transitional experiences like grieving or unemployment. For many respondents also, caring for others is part of caring for oneself. Disappointment with the religious life and isolation on leaving it appear to have brought the respondents into a close relationship with those who suffer mental illness. It is almost as if they seek to heal the distress in their own lives by proxy.
Lecturer practitioner: a concept analysis
Authors: Elcock Karen
Published: March 2003

Lecturer practitioner: a concept analysis¶ The concept of the lecturer practitioner arose in one health authority in Britain in the late 1980s. Since its inception there, the concept has been widely adopted across the country suggesting that there is a perceived need for this role. However, there is much confusion over what a lecturer practitioner is, since each post is multifaceted, complex and unique. Rodgers’ (1993) evolutionary concept analysis is used in an attempt to clarify and to identify those elements that are common to this concept. Through a review of all the available literature on this concept, the attributes, antecedents and consequences are identified and their implications discussed. Rodgers’ evolutionary method is described and critiqued throughout the paper and is shown to be a suitable method for clarifying a complex concept.
Clinical supervision: insider reports of a private world
Authors: White Edward , Butterworth Tony , Bishop Veronica , Carson Jerome , Jeacock Julie , Clements April
Published: March 2003

An exploratory study, funded by the Department of Health, London and the Scottish Home and Health Department, Edinburgh, was conducted over an 18‐month period to provide an informed view on possible assessment tools that could be used to assess the impact of clinical supervision (CS) in nursing and to report on the CS activities in 23 selected sites in England and Scotland. The study not only examined the utility of several standardized research instruments, to be reported separately, but also explored the experience of a small sub‐sample of nurses (n=34) engaged in CS, as supervisors and supervisees. Interviews were undertaken to help better understand some of the issues involved around the domains of structure, process and outcome. Respondents reported an enthusiasm for the opportunity to talk meaningfully to a trusted colleague about their personal circumstances at work. Such opportunities were particularly welcomed by nurses who wished to reflect upon their own practice with patients, especially when dealing with their clinical conditions which were upsetting, or otherwise challenging, and sometimes harrowing. Substantive and methodological areas of interest for future research are suggested.
Nurse–patient relationships: the context of nurse prescribing
Authors: Luker  , Austin  , Hogg  , Ferguson  , Smith
Published: March 2003

Nurse prescribing was initiated in the United Kingdom in October 1994 in eight demonstration sites. The evaluation of this extension to the community nurses’ role explored both economic and qualitative benefits to patients, carers, nurses and other health care professionals. In this paper the impact of nurse prescribing on patients is explored. Benefits experienced by patients are described along with the difficulties encountered. The patients’ views regarding nurses as prescribers are also explored.

 Data were collected by means of interviews with patients/carers, the focus of which was to evaluate changes associated with nurse prescribing. Patients raised a number of issues associated with their relationship with nurses. Patients valued nurses for both their accessibility and approachability, which led them to discuss health issues which would not otherwise have been brought to the attention of the general practitioner. The arguments which support the incorporation of these qualities into an expanded nursing role are presented.
The application of decision making concepts by nurse practitioners in general practice
Authors: Offredy Maxine
Published: March 2003

The application of decision making concepts by nurse practitioners in general practice¶This paper is concerned with the conceptual frameworks which could be applied to nurse practitioners in general practice in reaching decisions during patient consultations. Four strategies of decision making are explained within a practice context: hypothetico‐deductive method, decision analysis, pattern recognition and intuition. The study uses retrospective verbalization and observation of 20 nurse practitioners working alongside general practitioners to explore decision making issues. The results of the study show that important factors relating to decision making include: the ability to recognize patterns in clinical situations to fit with patterns previously seen; an appreciation of the consequences of inappropriate action; and the ability to concentrate simultaneously on complex and sometimes masked patient cues as well as multiple treatment options.
A perspective on clinical evaluation in nursing education
Authors: Star Mahara M.
Published: March 2003

A perspective on clinical evaluation in nursing education¶Clinical evaluation in nursing education is an important activity with potentially serious implications for students, teachers, and the recipients of nursing care. The evaluation of student learning in the clinical area has been the focus of much effort and energy as educators struggle with issues arising from the subjective nature of clinical evaluation and the role of clinical instructors as both teachers and evaluators. In this paper, the objectivity‐subjectivity debate is reviewed and the limits of evaluation practices based solely in positivism are discussed. The teacher‐evaluator and formative‐summative distinction is viewed as a false dichotomy which enforces power differentials and impoverishes student learning. A case is built for clinical evaluation as a form of inquiry, the purpose being the discovery and verification of the process and product of the teaching and learning of nursing practice. Fourth generation evaluation is proposed as a basis for evaluation practices that address the unique and context‐dependent nature of clinical practice, are capable of producing credible and dependable clinical evaluations, and are supportive of empowering teacher‐student relationships.
Episodes of lucidity in people with severe dementia as narrated by formal carers
Authors: Normann  , Asplund  , Norberg
Published: March 2003

Episodes of lucidity in people with severe dementia as narrated by formal carers¶ Twenty formal carers employed in three nursing homes narrated 92 episodes of lucidity (ELs) in people with severe dementia. Sixty‐two episodes concerned speech, nine concerned actions and 21 episodes concerned both speech and actions. Most ELs were said to occur spontaneously when the patients were acting closely together with a carer who did not make demands on them and regarded them as valuable human beings whose behaviour was a meaningful expression of their experiences. The narrations showed characteristics that indicated trustworthiness and the episodes described in three separate nursing homes were very similar and resembled descriptions given in previous research reports as well as in relatives’ reports. Further research seems necessary and the assumption that severe dementia implies the destruction of the self or personhood must be questioned.
Analysing qualitative data: computerized and other approaches
Authors: Webb Christine
Published: March 2003

Analysis of qualitative data: computerized and other approaches¶ Analysis of qualitative data can be done `manually' using a variety of techniques such as `cut and paste' and use of coloured pens to categorize data and develop theoretical explanations. More recently a number of computer software packages have been developed to mechanize this `coding' process as well as to search and retrieve data. This article reviews the background to and advantages and disadvantages of computerized approaches, and compares these with manual techniques used in a number of recent nursing PhD studies. It is concluded that beginning researchers conducting small‐scale studies would be best recommended to use a manual approach in order to gain insight into the intuitive aspects of analysis which are the essential basis of any method of analysis, including computerized forms.
Abused women and child custody: the ongoing exposure to abusive ex‐partners
Authors: Shalansky Catriona , Ericksen Janet , Henderson Angela
Published: March 2003

Abused women and child custody: the ongoing exposure to abusive ex‐partners¶Abuse of women in domestic relationships has become an epidemic. Research studies have documented that abuse does not end when a woman with children leaves the abuser but, in fact, the danger increases. A father's legal right to custody of and access to his children and the children's bond with their father prevent a woman from truly breaking free of her abuser. Theoretical literature has addressed how custody and access can serve as a means for an abuser to continue his abuse and expose his children to ongoing abuse and discord. Research on how custody and access issues are affecting abused women is limited. Key details about this phenomenon are not known. Hence, a research study using the qualitative methodology of phenomenology was conducted on abused women's experiences with custody and access and the ongoing exposure to abusive ex‐partners. Six single mothers who had left abusive relationships and were at the time sharing custody of and/or access to their children with their abusive ex‐partners participated in the study. Unstructured, non‐directive interviews were conducted. Direction for analysis was taken from the specific steps outlined by Giorgi. Data analysis revealed that all of the women were living in great fear for their safety and that of their children. The ongoing danger and stress of living with the restrictions of the law took its toll on the women and ultimately affected their physical health and psychological well‐being. The women described their experiences as having four components: (1) safety — living with ongoing danger; (2) stress — living with the restrictions of the law and the legal system; (3) coping — social support systems; and (4) to heal and move forward in life.
Family health in everyday life: a qualitative study on well‐being in families with children
Authors: Åstedt‐Kurki Päivi , Hopia Hanna , Vuori Anne
Published: March 2003

Family health in everyday life: a qualitative study on well‐being in families with children¶This article describes the subjective health views of young Finnish families with children. The data were collected in unstructured focused interviews with 19 families, most of whom were interviewed twice. Set within a phenomenological‐hermeneutic framework, the study applies a qualitative method in order to uncover the meanings attached by the families to different facets of their everyday life. Health is an integral part of the everyday life of families with children, comprising various dimensions of experienced well‐being and unwell‐being, security and different life‐habits. Social networks are crucial to family health: they can either strengthen or undermine experienced health. Professionals working with families in the health care system need to have at least a basic knowledge of the different dimensions of family health: this helps to identify and understand the individual ways in which families work to promote their health and well‐being. This knowledge of family health is also important for research purposes. Health care professionals also need to know more about how families cope with their everyday problems and about how client families can be supported. More research is needed on the concepts of family health and on how those concepts are applied to practice in different health care sectors and in education.
Resources revisited: salutogenesis from a lay perspective
Authors: Cowley Sarah , Billings Jennifer Ruth
Published: March 2003

Resources revisited: salutogenesis from a lay perspective¶Health visitors are being pressured to move away from their traditional role in health promotion and public health to focus more closely on people with established clinical disorders. This is partly because of a paucity of theoretical explanations against which to assess interventions directed explicitly at promoting health rather than only preventing disease. However, there are growing public health concerns about increasing inequalities and rising numbers of disadvantaged groups in the UK as well. This paper revisits a grounded theory study that revealed how, in the absence of a need for clinical intervention, health visitors appear to assess needs by treating health as a process fuelled by the accumulation and use of `resources for health'. Wider theories about salutogenesis (`health creation') and research showing the importance of health and social capital demonstrate the potential of this idea, and were combined with the health visiting study to create a theoretical framework for analytical purposes. Semi‐structured interviews with the main carer in 50 families with resident children were analysed using this framework, to provide a lay perspective on how people consider they maintain their health. The analysis demonstrated the usefulness of treating health as a process and of focusing on the development of health‐related resources rather than only on presenting problems. The processes of developing capacity were shown to be more important than the presence or absence of specific resources. Links with personal empowerment were apparent; cultural patterns that evolved across generations and neighbourhoods revealed possible pathways to social cohesion. Practice approaches that enhance or inhibit the development of these health‐creating resources were identified, and considered in the light of emerging public health needs.
Nurses' cognitive structural models of work‐based stress
Authors: Taylor Shirley , White Bob , Muncer Steven
Published: March 2003

Nurses' cognitive structural models of work‐based stress¶ This study examined the causes of stress experienced by National Health Service nurses in England over the course of a single week with the aim of generating a cognitive structural model. Qualitative data served as the foundation of a network study which employed inductive eliminative analysis. These data were also analysed using conventional qualitative methods and by content analysis.

The results were consistent with previous studies that identified a number of primary sources of stress. However, the network study indicated that two systems of causation were operating. The first centres on inadequate staffing levels, which were seen as leading to poor attitudes and abilities among colleagues, multiple work roles and lack of support. Lack of support also contributed to powerlessness and poor attitudes and abilities. The behaviour of managers was strongly endorsed as a direct cause of stress, but the strongest explanatory link was through staffing levels and powerlessness. The second system of causation related patients' suffering to stress. The qualitative data validated the network study results through elaborating the understanding of the respondents' nominated causes. Discussion focused on the pressure and frustration experienced by nurses because of organizational factors and interaction effects with the caring nature of nursing work. It is suggested that nursing discourse is subordinated to managerial and biomedical discourse reflecting the relative powerlessness of nurses. The extent to which such powerlessness is primarily a result of the failure of nurses to assert themselves or intrinsic organizational factors is not clear. The consequences of a stressed and demoralized nursing workforce on the quality of patient care and risk profile are identified as the focus for future research.
Mastectomy, body image and therapeutic massage: a qualitative study of women's experience
Authors: Bredin Mary
Published: March 2003

Mastectomy, body image and therapeutic massage: a qualitative study of women's experience

Despite the wealth of literature concerning the impact of breast loss on a woman's body image, sexual and psychological adjustment, there have been few studies within the medical and nursing literature directly quoting a woman's private perspective; how in her words she experiences her changed body. Furthermore, there is a lack of evidence‐based interventions for addressing the problem of altered body image (ABI); healthcare professionals often feel at a loss in knowing how to help women cope ( Hopwood & Maguire 1988). In this study in‐depth interviews were undertaken to explore three women's experiences of breast loss with particular focus on body image issues; a second phase piloted a massage intervention as a means of helping them adjust to living with their changed body image. Listening to their experience, in combination with the therapeutic massage, allowed deep access and insight into the nature of the women's trauma. The experiences of the three women in this study suggest there may be a group of women whose needs are overlooked and who, despite their prosthesis and reassurances that they are disease‐free, opt to conceal the problems they have in living with a changed image. The availability of a body‐centred therapy might help with certain aspects of adjustment as revealed by this study.
The meaning of suicidal psychiatric in‐patients' experiences of being cared for by mental health nurses
Authors: Talseth  , Lindseth  , Jacobsson  , Norberg
Published: March 2003

The meaning of suicidal psychiatric in‐patients' experiences of being cared for by mental health nurses

Twenty‐one psychiatric in‐patients who had thought about, expressed the wish or even attempted to commit suicide narrated their experiences of receiving care from mental health nurses. The interview texts were transcribed and interpreted using a phenomenological–hermeneutic method, inspired by Ricoeur's philosophy. Two main themes with subthemes were found:Confirming: attending to patients' basic needs; seeing patient; having time for patient; being with patient; listening to patient without prejudice; being open to patient; accepting patient's feelings; communicating hope to patient; andLack of confirming: overlooking patient's basic needs; not seeing patient; not having time for patient; leaving patient to herself or himself; listening to patient with prejudice; not being open to patient; denying patient her or his feelings; communicating hopelessness to patient. These findings were interpreted in the light of Hegel's philosophy of mutual recognition and confirmation. When relating episodes of good or bad nursing care suicidal patients emphasized their need for confirmation during their interaction with nurses when in hospital after suicide attempts.
A framework for the study of coping, illness behaviour and outcomes
Authors: Shaw Chris
Published: March 2003

A framework for the study of coping, illness behaviour and outcomes

This paper presents a theoretical framework for the study of coping, illness attribution, health behaviour and outcomes. It is based upon models developed within health psychology and aims to provide a theoretical basis for nurse researchers to utilize psychosocial variables. It is an interactionist model which views outcomes as dependent upon both situation and person variables. The situation is viewed as the health threat or illness symptoms as well as the psychosocial context within which the person is operating. This context includes socio‐economic factors, social support, social norms, and external factors such as the mass media. The experience of health threat is dependent upon individual appraisal, and the framework incorporates Folkman and Lazarus' transactional model of stress, as well as Leventhal's illness representation model. Behaviour and the perception of threat are also dependent upon outcome expectancies and the appraisal of one's own coping resources, and so the concepts of locus of control and self‐efficacy are also incorporated. This framework allows one to identify determinants of behaviour and outcome, and will aid nurses in identifying areas for psycho‐social intervention.
The new public management and the new nursing: related by rhetoric? Some reflections on the policy process and nursing
Authors: Hewison Alistair
Published: March 2003

The new public management and the new nursing: related by rhetoric? Some reflections on the policy process and nursing

The importance of health policy in terms of its effects on nursing is now recognized as an issue of concern for nurses; however, the essentially dynamic character of policy requires that consideration of its nature and consequences is continuous. This paper addresses the parallel development of the New Public Management (NPM) and the New Nursing as a means of demonstrating the perceived disjunction between events in nursing and the wider policy arena. The nature of policy is discussed and the relationship between the NPM and the New Nursing is explored. An examination of the unintended consequences of policy implementation and the role of rhetoric in the development of the NPM and the New Nursing demonstrates that these contrasting ideologies have emerged from a similar set of circumstances and have developed along a broadly similar timescale. The final effects of this process, however, are not yet clear. It is suggested that although the processes of policy formation and implementation are inherently complex there is an opportunity for nurses to exert some influence over them. Finally it is argued that if nurses become skilled in the art of rhetoric and combine this with a thorough understanding of the policy process they may be able to shape policy directly when and where it is implemented.
Menorrhagia: women’s perceptions of this condition and its treatment
Authors: Chapple Alison
Published: March 2003

Menorrhagia: women’s perceptions of this condition and its treatment

This paper reports a qualitative study of women’s perceptions and experience of menorrhagia. Having obtained ethics committee approval, and informed written consent, interviews were conducted with 30 women who reported that they were suffering from menorrhagia. The sample included 13 women of South Asian descent. Some of those interviewed did not want medical treatment for menorrhagia. Other women were quite satisfied with the treatment they received when they consulted their doctors. However, it appears that some general practitioners failed to recognize women’s need for treatment and were slow to comply with requests for referral to a gynaecologist. Although in the past there has been justifiable concern about women who undergo unnecessary treatment for perceived menorrhagia, this study suggests that health care professionals should be aware that some women may experience menorrhagia for long periods of time without receiving effective health care. It is possible that those who volunteered for the study were those most likely to have experienced problems with their treatment. However, the results of this study have implications for nurses, who may be in a position to give help and advice to women who want information about possible alternative treatments and sources of help for menorrhagia.
The moral metaphors of nursing
Authors: Wurzbach Mary Ellen
Published: March 2003

The moral metaphors of nursing

The essence of metaphor is understanding and experiencing one thing in terms of another. Metaphorical concepts structure and reflect what we perceive, how we act, and how we relate to other people. In nursing ethics, several metaphors have emerged which have had a great impact on nursing practice. These metaphors include the military metaphor which exemplified nursing during the 1800s, the advocacy and academic metaphors which became a philosophical basis for nursing during the 1960s, and the individualist and community as caring metaphors which have emerged more recently. Although beneficial in some ways, these metaphors may be obscuring the complex moral reality of nursing practice. This article defines a moral metaphor, critiques nursing’s moral metaphors, and provides an historical overview of their development with examples of how they have and do affect nursing practice.
Passivity vs. militancy: a Q methodological study of nurses’ industrial relations on Merseyside (England)
Authors: McKeown Mick , Stowell‐Smith Mark , Foley Bernard
Published: March 2003

Passivity versus militancy: a Q methodological study of nurses’ industrial relations on Merseyside (England)

This paper describes a Q methodological study of accounts of nurses’ industrial relations expressed by a sample of nurses (n = 60) drawn from the geographical area of Merseyside, United Kingdom (UK). The participants completed a 65‐item Q sort made up of statements which could be ranked in terms of their relevance to an understanding of their industrial relations situation. Of interest was the importance of the narrative accounts which nurses draw upon in making sense of their employment relations, having the potential to underpin or delimit their actions. The notion of industrial action was an important focus of this research. Q methodology was chosen to allow the meaningful investigation of such subjectivity, with interesting tensions between differing notions of professionalism and militancy apparent from the analysis. Six accounts of industrial relations, which are available to be drawn on by nurses, are described and interpreted within a social constructionist framework. Some implications for the conduct of nurses’ industrial relations in the UK are contemplated.
Meal procedures in institutions for elderly people: a theoretical interpretation
Authors: Sidenvall Birgitta
Published: March 2003

Meal procedures in institutions for elderly people: a theoretical interpretation

In a study of mealtimes in institutions for elderly people the organization of meals was found to be task‐oriented rather than patient‐oriented in ways which failed to meet the needs of patients. The aim of the current paper is to examine and explain the institutional organization of meals, drawing on Goffmans’ theory of institutionalized culture, Elias’ theory of civilization, Douglas’ theory of purity and order, and Bourdieus’ key‐concept ‘habitus’. The method entails a secondary analysis of previous research carried out in a rehabilitation and long‐term hospital. This second analysis indicates that elderly patients coming to the ward with their individual meal customs were met by caregivers with an institutionalized culture. Meals in the ward were organized in line with the organization of family meals in society, and both the elderly people and the nurses strove towards civilized manners, purity and order. The demands implicit in these cultural practices kept the elderly patients silent. By failing into line, they suffered from their loss of habitus. In contrast nurses’ habitus was accomplished by carrying out procedures automatically. Consequently, the combination of patients’ lost habitus and nurses’ working habitus resulted in defective nursing, where the purpose of nursing is the fulfilment of patients’ social, personal and material needs.
The relationship between diabetes knowledge and compliance among Chinese with non‐insulin dependent diabetes mellitus in Hong Kong
Authors: Chan  , Molassiotis
Published: March 2003

The relationship between diabetes knowledge and compliance among Chinese with non‐insulin dependent diabetes mellitus in Hong Kong

This study examines the relationship between diabetes knowledge and compliance among Chinese with non‐insulin dependent diabetes mellitus (NIDDM) in Hong Kong. A cross‐sectional design was used to collect data through structured self‐report interviews based on validated scales assessing diabetes knowledge, compliance behaviours and demographic data. The Diabetes Knowledge Scale was used to sample knowledge in the major areas of basic physiology of diabetes and general principles of diabetes care. Compliance level was assessed by using the Compliance Behaviour Questionnaire, inspection of patients’ feet and the value of HbA1c. A convenience sample of 52 Chinese with NIDDM receiving out‐patient diabetes care participated in the study on a voluntary basis. Descriptive and correlational statistical analyses were used to analyse the data. The findings indicated that there was no association between diabetes knowledge and compliance. There was a gap between what the patients were taught and what they were actually doing. Most of the patients gained higher marks on factual knowledge on diabetes but lost marks on the application of knowledge to their real life situations. Strategies are suggested to close the ‘knowledge–action gap’ and increase patients’ motivation and ability to comply with the health regimen.
Good characteristics of a clinical supervisor: a community mental health nurse perspective
Authors: Sloan Graham
Published: March 2003

Good characteristics of a clinical supervisor: a community mental health nurse perspective

A qualitative methodology was adopted using a questionnaire and focus group to identify characteristics of a good supervisor from a supervisee perspective (staff nurses working in a mental health setting). Findings from the questionnaire and focus group were used as a basis for the nominal group technique to establish a prioritization of those characteristics identified. Thematic content analysis of the focus group generated five major categories: who provides clinical supervision; what happens during supervision; factors affecting the choice of supervisor; characteristics of a good clinical supervisor; and limitations caused as a result of how supervision is conducted. The ability to form supportive relationships, having relevant knowledge/clinical skills, expressing a commitment to providing supervision, and having good listening skills were perceived by the staff nurses as important characteristics of their supervisor. Supervisees viewed their supervisor as a role model, someone who they felt inspired them, whom they looked up to and had a high regard for their clinical practice and knowledge base. Nonetheless, limitations to the supervisory process were identified. Having their clinical supervisor allocated to them, their supervisor also being their manager, and having supervision sessions documented and stored by this manager threatened the full utility of the clinical supervision. In this paper three categories will be discussed: what happens during clinical supervision; good qualities of a clinical supervisor; and limitations caused as a result of how clinical supervision is conducted. In light of the study’s findings, recommendations are offered to develop the provision of clinical supervision.