bluuebunny/crossref_metadata_2025 huggingface dataset:
Open learning; the managers' and educationalists' perspective
Authors: Murphy Margaret
Published: March 2003

The development of the internal market within nurse education has led colleges of nursing to review their portfolio of course provision for consumers of health education As a result of this, education is questioning whether traditional modes of programme delivery are sufficiently versatile to meet the needs of purchasers within the changing nature of health care delivery This study uses a case study approach to explore nurse managers' and nurse educationalists' feelings and motivations towards the development of open‐learning programmes within one college of nursing The central themes emerging from the literature review of open learning mirror the philosophies underpinning humanistic education theories These themes led to the development of the theoretical framework against which the data generated from indepth interviews with managers and educationalists were analysed The data identified that both managers and educationalists valued open learning as a mode of programme delivery appropriate to their needs However, both groups confused the concepts of open and distance learning, the latter being firmly supported by nurse managers as it allows staff development without demanding time out of the clinical area Each group saw benefits in the commercialization of open‐learning packages, not purely as a cut‐throat enterprise but as a means by which nurse education can protect itself from competition
A synthesis of caring praxis and critical social theory in an emancipatory curriculum
Authors: Owen‐Mills Verna
Published: March 2003

As several schools of nursing in New Zealand are accepting the challenge to prepare nurses better in order to meet changing health care needs, onelecturer discusses the design and implementation of a new degree curriculumat Manawatu Polytechnic The author has drawn from educational, nursing and feminist literature to provide a background for the central concepts in order to explain their role in the development of the curriculum It is contended that the caring imperative is central in all student‐educator‐clinician relationships when the purpose of the curriculum is to emancipate students to become nurses who care for individuals, families and communities in a transformative way The transformative teacher is also aware of the power of open and regular dialogue when teaching caring within a critical social paradigm, and has a responsibility to ensure students understand the mandate for social action It is through such consciousness‐raising that nurses are empowered to both provide the best possible nursing care, and become agents of social change through an overhauled health care system
Comparison of the overall quality of life in 50 long‐term survivors of autologous and allogeneic bone marrow transplantation
Authors: Molassiotis Alexander , Boughton Brian J , Burgoyne Tracey , van den Akker Olga B A
Published: March 2003

Fifty long‐term survivors of bone marrow transplant (mean post‐transplant time = 42 4 months) participated in a study examining their psychosocial adjustment and quality of life Differences between patients who received an autologous marrow transplant and those who received an allogeneic marrow transplant were identified Patients with an autologous transplant had mainly psychological difficulties in their post‐transplant adaptation, whereas patients with allogeneic transplant developed more physical problems Overall, their psychosocial adjustment was similar and comparable with other medical groups of patients A quarter of both groups had failed to return to work/education and up to 9 5% had difficulty in carrying out daily tasks Twenty per cent of the patients with autologous transplant had clinical signs of anxiety and 10% clinical signs of depression, whereas there was an incidence of 10% of patients with allogeneic transplant with anxiety, but no cases with clinical depression Family relationships were found to be more integrated and lower in conflict compared with normal families Quality of life has been described as good to excellent in most of the patients Multiple regression analysis showed that physical symptomatology, vocational adjustment and depression are predictors of the degree of the patients’ quality of life
The trait and process of resilience
Authors: Jacelon Cynthia S.
Published: March 2003

Resilience is the ability of people to ‘spring back’ in the face of adversity. It is and important concept for nurses as we endeavour to assist individuals to meet the challenges of living with illness and ageing. Researchers form many disciplines in both the social and health sciences have investigated resilience of individuals throughout the life cycle in a variety of situations related to health as well as other life events. Some researchers have investigated resilience as a trait of individuals while other view resilience as a process. This article reviews the current literature on resilience from many disciplines and discusses implications for nursing practice and research.
Using patients: exploring the ethical dimension of reflective practice in nurse education
Authors: Hargreaves Janet
Published: March 2003

Within nurse education there is a growing interest in the use of reflective practice as a vehicle for professional development. Additionally, clinically reflective practice is seen as an ideal way of improving performance and patient care.

In this paper it will be argued that whilst this development is potentially valuable to both professionals and clients, there are major ethical issues which need to be addressed. The ‘how to’ literature appears to focus predominately on the practitioners subjective description and interpretation of events. It is usual for these events to include details of clients, but not usual for clients to be aware that information about them is being used in this way.

Within a deontological ethical framework the use of people as means rather than ends is considered to be morally wrong. However, clients have probably always been used by professionals to some extent: Things such as case training and practice, and are regulated by various professional codes and committees. It would appear, however, that reflective practice is quantitatively and qualitatively different from the above, and thus may cross a moral boundary.

Reflective practice is not simply re‐examining someone's case; it involves personal interpretation and judgement. The reflector may be recording incidents, verbally or in written form, which would not otherwise be recorded, and may be controversial. This raises questions about the nature and ownership of knowledge, and continued reflection may be akin to action research and, as such, considerations of rigour, authenticity and informed consent need to be addressed.

Thus whilst reflective practice may prove to be a good thing, it cannot be seen in isolation from wider ethical concerns.
Advanced neonatal nurse practitioners in the United Kingdom: where are they and what do they do?
Authors: Dillon Ann , George Steve
Published: March 2003

The former Wessex region was the first in England to institute an advanced neonatal nurse practitioner (ANNP) course had completed the course. The role has been developed over several years in the North American health care system, where it has been shown that ANNPs have the ability to perform as competently and efficiently as junior doctors. It is a major development both in neonatal care and nursing. Following a review of the literature on ANNPs, this paper details the distribution of ANNPs in the UK, and reports on a survey undertaken by the authors, which examined the function, clinical grading and source of funding of ANNPs, as well as examining the ANNPs' view of their role and challenges they have encountered.
The impact of the commissioning agenda upon nursing practice: a proactive approach to influencing health policy
Authors: Antrobus Sue , Brown Shona
Published: March 2003

The commissioning aspect of purchasing, in the context of health care, has been heralded as an activity that will effect a shift to wards a health service. According to the Department of health (DoH), England, it will be a key factor in ensuring the ideals of the reforms; i.e. efficiency, equity and effectiveness, move from being rhetoric to reality. The importance being placed upon commissioning has implications for the functioning of each professional group. Nursing has historically been identified as relatively naïve in matters outside the immediate province of patient arena. This paper attempts to describe the impact that the current emphasis on commissioning will have on nursing practice and proposes that unless nurses understand and engage in debate around the purchasing and commissioning function in health care, nursing's capacity to influence the future development of patient services will be severely limited. A framework is outlined for addressing this, thereby ensuring that nursing can proactively inform present and future commissioning agendas.
Alcohol‐history taking by nurses and doctors — how accurate are they really?
Authors: Burns Lucinda , Adams Meredith
Published: March 2003

The aim of this study was to look at how nurses and doctors record alcohol histories on the patients under their care and the frequency and appropriateness of the way they use an alcohol withdrawal scale in the acute hospital setting. To achieve these aims patient records were audited and compared at two points in time, in 1992 and 1994. Results of the study showed that nurses and doctors took alcohol histories from patients on approximately three‐quarters of occasions and that this level of recording has not changed over time. The adequacy of alcohol‐history taking has, however, increased for both nurses and doctors since 1992. At that time, 71% of the alcohol histories taken by nurses and 74% of alcohol histories taken by doctors were judged to be adequate. By 1994, however, 79% of alcohol histories taken by nurses and 77% of histories by doctors were rated as adequate. The increase in the adequacy of history taking by nurses was significant (x2= 5. 05; d.f. = 1; P<0.05) and the increase by doctors was not significant (x2= 1.03; d.f. = 1; P > 0.05). These results are seen as being positively associated with the major governmental nursing initiative in New South Wales, Australia, the New South Wales Strategic Plan for the Nursing Management of Alcohol and Other Drugs.
A study of errors that can occur when weighing infants
Authors: Alsop‐Shields Linda , Alexander Heather
Published: March 2003

When infants are weighed at well baby or infant welfare clinics, the weight change from one visit to the next is used as a guide to the welfare of the child. Infant welfare clinic nurses are expert clinicians who use weight measurements as a rough indicator of well‐being only, as it is well known by them that these measurements are fraught with error. This paper calculates the amount of error which was found in repeated tests of weights of infants, and in the weight changes brought about by biological variation. As a result, it is recommended that babies under nine months of age be weighed at clinic visits no less than a fortnight apart, and older infants, at least one month apart. If they are weighed more often, then the weight changes detected will be less than the amount of error which affects the measurements.
Factors affecting the decision of nursing students in Taiwan to be vaccinated against Hepatitis B infection
Authors: Lin Wen‐Chuan , Ball Carol
Published: March 2003

Compliance with Hepatitis B vaccination for nurses has been reported to be low in Taiwan. Therefore, a study of nursing students’ views was conducted in Taiwan to discover possible reasons. As complex decision‐making was involved in taking the vaccine, a four‐level utility decision model underpinned by the Multi‐Attribute Utility theory was proposed to ascertain the relative contribution of the specific components of attitude and beliefs to the final decision and experience of being vaccinated against Hepatitis B infection. Results indicated that the ‘personal value of Hepatitis B vaccination’, in particular for ‘concern about the efficacy of the Hepatitis B vaccine’, ‘fear of pain from repeated injections’, ‘time’ and ‘money’, were the main determinants in relation to the uptake of the Hepatitis B vaccination. Such results were consistent with earlier findings based on the Health Belief Model. It appears that the greater the experience gained in nursing care the lower the rate of vaccination; the important items under the concept of ‘Personal value of Hepatitis B vaccination’ varied by ‘experience in nursing care’. The overall predictive validity was 67%, based on the utility decision model. When stratified by ‘experience in nursing care’, the prediction improved, ranging from 89% to 100%. Based on these findings, a specific intervention programme should be provided to change behaviour and improve the vaccination rate.
Reflection and patterns of knowing in nursing
Authors: Heath Helen
Published: March 2003

Over the last decade nursing has progressed from a reliance on empirical theory applied to practice to a recognition that experience develops knowledge that can guide the actions of practitioners. Reflection is a means of surfacing experiental knowledge, and students may begin to use reflection as their experience of nursing accumulates. As Carper was a key figure in widening that knowledge accepted as knowing in nursing beyond the empirical, it is both justified and recommended that her work should be incorporated into reflective practice. Johns has integrated Carper's work in his model of guided reflection and this paper briefly examines this combination. The main focus is on two further patterns of knowing: unknowing and sociopolitical knowing. These patterns are examined and the contribution they could make to reflective practice is discussed.
Perceptions and practice of universal blood and body fluid precautions by registered nurses at a major Sydney teaching hospital
Authors: Knight Vickie M. , Bodsworth Neil J.
Published: March 2003

Guidelines for universal blood and body fluid precautions (UBBFP) designed to protect health care workers from occupational exposure to blood borne pathogens have been developed by the US Centers for Disease Control. These guidelines have been adopted by the New South Wales Department of Health and all major Australian hospitals. To determine the degree of understanding and utilization of UBBFP by Australian nurses, 192 nurses were asked about UBBFP, recent occupational exposures and understanding of hepatitis B transmission. Seventy‐three per cent of nurses stated they ‘used UBBFP at all times’, yet only 58% of these nurses stated they always used gloves when ‘handling blood or blood equipment’ and just 85% reported always using ‘gloves to clean up urine and faeces’. Overall 146 (76%) nurses experienced 230 occupational exposures (168 mucocutaneous, 48 percutaneous) in the previous 6 months. These were more common in men (P=0·024) and in operating theatres (95% of nurses) and high dependency units (88%). Percutaneous exposures were significantly more frequent in nurses who stated they did not wear gloves when handling blood/blood equipment (P=0·036), whereas mucocutaneous exposures were significantly more frequent among nurses who stated they do not adhere to UBBFP at all times (P=0·005). Eighty‐three per cent of nurses experiencing exposures did not report all of them. In this study knowledge and adoption of UBBFP translated directly into lower risk for an occupational exposure. It is concluded that educational strategies to improve understanding and adoption of UBBFP by nurses are required.
Specialist practice: advancing the profession?
Authors: Scott Cherill
Published: March 2003

In 1994, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) completed its framework for post‐registration education and practice. The UKCC’s strategy was based upon the two principles of compulsory re‐registration for all practising nurses and graduate‐level (or equivalent) entry to specialist practice. It may be seen as the culmination of a gradual process of professionalization, as well as a response to changes in the organization and delivery of health care in the late 20th century. This paper uses both primary and secondary sources to trace the development of the new strategy, and its wider implications for the profession.
Evaluation of a course for charge nurses on caring for people with dementia
Authors: Shanley Eamon , McDowell Joan , Wynne Trudy
Published: March 2003

The provision by nurses of appropriate levels of care for people with dementia is considered to be adversely affected by the inadequate provision of post basic education. This paper reports on a study that seeks to evaluate the effectiveness of a brief educational programme for charge nurses caring for people with dementia. In addition it focuses on behavioural change resulting from the course, for example, the degree of involvement of relatives in the care of their family member. The course is seen as a model for short courses for nurses working in this area. Qualitative methodology was utilized involving questionnaires and focused group interviews. The evaluation of the course incorporated pre‐ and post‐test design. The study identified factors that enhanced the charge nurses’ educational experience. These factors included a course design incorporating andragogical teaching methods and the implementation of an action plan. The study also highlighted problems experienced by charge nurses in implementing an action plan. The action plan demonstrated that the type of involvement of relatives is more complex than presupposed and depended on such factors as the fear experienced by the relative of being left with the responsibility to care for their family member should they offer to contribute to their care in hospital. Recommendations for the design of future courses are made.
Advocacy in nursing: perceptions and attitudes of the nursing elite in the United Kingdom
Authors: Mallik Maggie
Published: March 2003

Advocacy in nursing: perceptions and attitudes of the nursing elite in the
United Kingdom¶In recent years, patient advocacy has been claimed as an integral part of the nurse’s role in health care delivery in the United Kingdom (UK). Support from the nursing leadership/elite is seen as important in the promulgation and diffusion of any ‘new’ role in nursing. This paper explores the perceptions and attitudes of nurse leaders in the UK to the adoption of the patient advocate role as an ‘innovation’ in nursing. Using a qualitative methodology, semi‐structured interviews with six of nursing’s ‘elite’ were conducted over a period of 5 months. Results revealed contradictions and paradoxes within the views of the elite. Although leaders recognized patient advocacy as a role integral to the moral value system in nursing enhanced by the nurse–patient relationship, they objected to the professionalization of the role, seeing an exclusive claim to patient advocacy as intensifying interprofessional conflicts in health care. It is argued that unless professionalized, the individual nurse will continue this potentially risky activity without adequate authority or support systems. The results overall question the role of the nursing leadership in the diffusion of innovations in nursing.
Ethical conflicts reported by registered nurse/certified diabetes educators: a replication
Authors: Redman Barbara K. , Fry Sara T.
Published: March 2003

Ethical conflicts reported by registered nurse/certified diabetes educators: a replication¶ The purpose of this study was to identify types of ethical conflicts reported by certified diabetes educators who are also registered nurses (RN/CDEs) and to examine their relationship with demographic, educational and practice setting variables. This study is a replication of an earlier pilot study. Ethical conflicts expressed by RN/CDEs in active practice in New York and Pennsylvania were analysed according to four themes. Disagreement with medical practice was by far the most dominant clinical context for the conflicts (61%), as it had been in the pilot study (75%). Participants believed that 32% of the ethical conflicts were resolved. Ethics committees and consultants were very rarely used. Of the relationships between the kinds of conflicts and their resolution, and demographic, educational and practice setting variables of the participants, only kind of position was significantly (P < 0·005) related to practice context of the ethical conflict.
A descriptive survey to identify the perceived skills and community skill requirements of mental health staff
Authors: Bugge Carol , Smith Lorraine N. , Shanley Eamon
Published: March 2003

A descriptive survey to identify the perceived skills and community skill requirements of mental health staff¶ Throughout the 1990s mental health care has shifted from a hospital to a community‐based service. Government policy indicates that staff require further education as a result of the shift to community care. However, none of the United Kingdom policy documents or mental health literature prescribes what education is required. Consequently this multidisciplinary study aimed to identify what skills, if any, were required by hospital‐based staff to move to a community‐based working environment. Study findings suggest advantages in perceiving skills as overlapping and interconnecting. Five common core skills and skill differences between professional groups are identified. It is argued that core skills are central and common to all groups and specialist skills are those that distinguish professional groups one from another and different grades of staff within professional groups. While problems of multidisciplinary education are considered, nevertheless a case is made for educating staff in core skills within a multidisciplinary environment which may be beneficial in achieving community care goals.
The language of mental health nursing reports: firing paper bullets?
Authors: Crawford Paul , Johnson Alison J. , Brown Brian J. , Nolan Peter
Published: March 2003

The language of mental health nursing reports: firing paper bullets?¶A great deal of the caring work of nursing is accomplished and mediated through language. This paper attempts to characterize some of this language in quantitative and stylistic terms in an attempt to characterize the genre of nursing report language. Nursing students (n = 26) and graduate nurses (n = 3) viewed a videotape of a person being interviewed by a psychiatrist and produced written reports. These showed a large proportion of words relating to the person and to feelings and needs, compared to existing databases of the English language in general. The language produced by the participants also contained many modal or modifying words and is similar to spoken rather than written English in terms of the proportion of lexical content. There was much diversity in their descriptions and the vocabulary used to refer to the client. Graduate nurses showed more scepticism of the evidence provided by the video and advocated more investigation and questioning of the client. The use of standard forms and techniques of expression suggests that these reports were assembled on a language production line. Finally, we advocate a more systematic approach to educating nursing students about the power of the language they use.
Primary nursing: a mode of care or a philosophy of nursing?
Authors: Pontin David
Published: March 2003

Primary nursing: a mode of care or a philosophy of nursing¶An examination of the literature surrounding primary nursing has shown that the term `primary nursing' is used to mean different things by different authors. This results in a confusing situation where `primary nursing' is considered by some to mean both a mode of organizing care delivery and a philosophy of nursing. In this paper I argue for a clear separation between the terms which refer to the set of ideas underpinning nursing and descriptions of modes of care. A case is made for using the term `human centred nursing' to refer to nursing beliefs and `primary nursing' to refer to the mode of nursing care delivery.
Rehabilitation, chronic illness and disability: the missing elements in nurse education
Authors: Nolan Mike , Nolan Janet
Published: March 2003

Rehabilitation, chronic illness and disability: the missing elements in nurse education¶Chronic illnesses represent one of the most significant health challenges in all developed countries and currently there is considerable debate about how to meet the rehabilitative needs of chronically ill and disabled people. The literature suggests that nursing has a potentially significant, but largely unrealized, role to play in addressing areas of current deficit. However, to fulfil this potential it is vital that the educational preparation of nurses at both qualifying and post‐qualifying levels equips them with the necessary knowledge and skills. This paper describes a study which analysed curriculum documents from an extensive range of courses in the United Kingdom (UK) in order to determine the emphasis placed on rehabilitation, chronic illness and disability. The results reveal the overall lack of attention given to these important areas and the superficial manner in which key concepts are addressed. The need to identify more clearly the nursing contribution to rehabilitation is highlighted and indicative areas of knowledge and skill required to develop an expanded role are presented.
Dedicated psychiatric care within general practice: health outcome and service providers' views
Authors: Bruce Julie , Watson Diane , Teijlingen Edwin R. van , Lawton Ken , Watson M. Stuart , Palin Alastair N.
Published: March 2003

Dedicated psychiatric care within general practice: health outcome and service providers' views

Health service reforms have led to relocation of care of the chronic mentally ill from institutions to the community, with subsequent demands on the primary health care team. Few studies have attempted to identify satisfactory models of care for this patient group. This study explores the impact of the employment of a community psychiatric nurse (CPN) by a general practice in Aberdeen city to co‐ordinate care of discharged long‐stay psychiatric patients resettled in hostels. A similar general practice with a comparable group of registered patients was selected as a control group. Patient health outcome was measured using the Health of the Nation Outcome Scales (HoNOS) and service providers' views on dedicated psychiatric care within general practice were explored using qualitative methods. Improvements in communication, liaison and drug management were reported in the intervention practice. A primary care‐based CPN service dedicated to the care of the chronic mentally ill promoted a smooth transfer of care from long‐term institutionalized care to the community setting.
On the phenomenology of empathy in nursing: empathy or sympathy?
Authors: Yegdich Tania
Published: March 2003

On the phenomenology of empathy in nursing: empathy or sympathy?

In her recent phenomenological study Baillie attempted to describe the essential structure of empathy in surgical nursing. The study is important in that it utilizes a qualitative research method to investigate the phenomena of empathy, in contrast to previous quantitative studies. Although the phenomenological approach is clearly identified and ascribed to Husserl as the founder of the phenomenological movement, as well as utilizing the peculiarly Husserlian notion of bracketing, or epoché, in an attempt to describe the essence (another Husserlian objective) of the phenomenon under investigation (empathy), the research method does not reflect Husserl’s philosophy. The results reflect nurses’ subjective views on empathy, an exercise consistent with the nurse‐phenomenologists quoted, who without exception, all believe Husserlian phenomenology concerns itself with subjective experience. However, in seeking the essence of phenomena unclouded by subjective opinion, Husserl stands in contrast to nursing interpretations of phenomenology’s famous catch phrase, ‘back to the things themselves’ (zu den Sachen selbst). Nurse‐phenomenologists have misunderstood the intention of Husserlian phenomenology, and despite their opposition to traditional scientific methods, are still mired in the Kantian notion of science as a reality independent of mind. A theme consistent with the ‘things‐in‐themselves’, not the things themselves. As such, nursing’s use of the phenomenological method is questionable, and therefore the research findings on the phenomenon of empathy need to be reformulated. Interestingly, the phenomenon of empathy challenges us to question such underlying assumptions on how we view the world.
Representing nursing judgements in the electronic health record
Authors: Moen Anne , Henry Suzanne Bakken , Warren Judith J.
Published: March 2003

Representing nursing judgements in the electronic health record

The naming of nursing phenomena and representing the phenomena in a standardized manner suitable for encoding in computer‐based systems is a challenge for the nursing profession at the national and the international level. Considerable progress has been made in the development of classification systems for nursing practice. The focus of this article is on language systems developed to represent nursing judgements in computer‐based systems, in particular the electronic health record. A review of two current systems and their proposed revisions (North American Nursing Diagnosis Association, NANDA, Taxonomies I and II, and the International Classification for Nursing Practice, ICNP, Alpha and Beta versions), according to the features suggested by the Computer‐based Patient Record Institute (CPRI) for classification systems appropriate for implementation in computer‐based systems, suggests that the evolving versions extend the current versions in terms of sufficient granularity (depth and level of detail) and atomic and compositional character. However, it is not clear from the literature available to date whether the characteristics that are most closely related to definition of a formal terminology (i.e. clear and non‐redundant representation of concepts, syntax and grammar for logical constructions of compositional terms, synonyms and language independence) will be part of the evolving vocabularies. Formal terminology models and related tools have the potential to complement, extend, and refine existing nursing classification systems.
Implementing new health visiting services through action research: an analysis of process
Authors: Cowley Sarah , Billings Jennifer Ruth
Published: March 2003

Implementing new health visiting services through action research: an analysis of process

An action research project based in a single fundholding practice on the South Coast of England aimed to identify needs relevant to families with resident children, then to use the contracting system to redirect health visiting practice to meet those needs. The naïvety of this plan was well recognised, so the processes that occurred during implementation of the proposed changes were recorded throughout. An analysis of these participant observation data revealed various organisational constraints and facilitators that arose during contract negotiations. Two new full time health visiting posts were established, each with an innovative and somewhat controversial focus. One health visitor was employed to establish a community development project in an underserved area of the town, while the other was to provide a home visiting service for the families of school aged children. The processes involved in structuring decisions about ‘health needs’ and how these are best met are analysed for each of the two new posts. The analysis reveals powerful influences that affect the implementation of new health visiting services.
Planning for information technology key skills in nurse education
Authors: Sinclair Marlene , Gardner John
Published: March 2003

Planning for information technology key skills in nurse education

New recruits to courses in nursing, midwifery and health visiting come from a wide range of educational backgrounds and it is reasonable to expect that this diversity will also be reflected in the range of their experience and competence with information technology (IT). Accommodating such variety can make the planning of appropriate training to enhance and develop their IT skills difficult. In order to explore the likely extent of diversity in IT experience and skills in today’s recruits, the project reported here examined the competence, attitudes and previous IT training of two consecutive cohorts of new entrants to a higher diploma programme. The surveys add weight to the view that nurse educators do face a considerable diversity in new students’ competence and experience with IT. Further analysis has also shown that subgroups of the cohorts, characterized by their age, gender, education or previous IT training, differed significantly in a ‘knowledge of computers’ score but not in their attitudes to IT. Arising from the results, the paper argues that, in seeking to develop a consistent level of IT literacy, core IT competence should be identified and all courses should have the clear objective of raising students’ confidence in using computers.
A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice
Authors: Cowley Sarah , Bergen Ann , Young Kate , Kavanagh Ann
Published: March 2003

A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice

The role and expectations of community nurses in carrying out needs assessments changed when an internal quasi‐market was introduced to the British health service under the National Health Service (NHS) & Community Care Act 1990. This paper reports on a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment in the context of this legislation. A multiple case study design was utilized and four cases identified, incorporating the geographical variation in England. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (n=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. Participants were interviewed after the observation period (n=33 practitioners), to determine the extent of formality they attached to each assessment, and to elicit information about aspects which may be embedded in everyday practice. Single and multiple case analyses across the four cases used an iterative process of pattern‐matching, replication logic and explanation building. The preliminary analysis yielded a descriptive ‘taxonomy’ which could serve as a basis for classifying the variants of needs assessment and help to clarify the whole phenomenon. When applied further to the data, this revealed the complex interactions between the different ideals (relating to policy, nursing and ascribed worth), the various types (purpose, formality/specificity and complexity) and timing (in relation to client, service and practice issues) within needs assessment.
Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care
Authors: Ellis Judith
Published: March 2003

Sharing the evidence: clinical practice benchmarking to improve continuously the quality of care

It is unacceptable for health care professionals to acquiesce quietly to inconsistencies in the quality of health care received by patients. In the United Kingdom, the introduction of clinical governance has formalized the expectation that professionals’ practice will meet recognized standards of care consistently. It is being stated that all available evidence is being used to identify national standards of excellence. This will inform professionals not only of expected outcomes but of also the structures and processes that need to be in place to support the attainment of such outcomes. Clinical practice benchmarking is one continuous quality improvement approach, which is being used by paediatric units in 27 National Health Service Trusts in the north‐west of England to promote the utilization of available evidence in to practice. The evidence base for benchmarks of best practice is considered continuously using a hierarchy of evidence. This clarifies the different evidence available, upon which benchmarks or standards of excellence can be based, but reinforces the kudos awarded quantitative research evidence within health care. Once benchmarks have been agreed, benchmarking activity supports practitioners in a continuous cycle of comparison and sharing that is aimed at ensuring that children and their families receive evidence‐based care, wherever they are admitted in the north‐west of England.
Effects of infant and caregiving conditions on an infant’s focused exploration of toys
Authors: Pridham Karen , Becker Patricia , Brown Roger
Published: March 2003

Effects of infant and caregiving conditions on an infant’s focused exploration of toys

An infant’s exploration of toys, in the context of the mother’s regulating actions, is a setting for cognitive and social development. The aim of this study was to examine the contribution of infant and caregiving conditions to the quantity of focused exploration of toys for 8‐month‐old infants. Infant biological conditions were gender and birth weight, including a range of both prematurely and term‐born infants. The infant behavioural condition was responsiveness to care. Caregiving conditions included mother’s education, the supportive, stimulating and sustaining quality of the home environment, and the attention‐directing and ‐supporting behaviour of the mother during play. The direct and indirect effects of these conditions on focused toy exploration were modelled using multiple regression. The sample of 79 mother–infant dyads included 43 full‐term infants and 36 premature infants. The mother’s attention‐directing behaviour was a significant negative predictor of focused toy exploration. Infant birth weight did not have a significant direct effect on focused toy exploration. Birth weight did not interact significantly with responsiveness to care or with any of the caregiving environment conditions to affect focused toy exploration. Further study of infant responses to the mother’s attention‐regulating and emotion‐regulating behaviour during play is recommended to better understand how the caregiving environment supports or thwarts focused toy exploration.
A comparison between the ethics of justice and the ethics of care
Authors: Botes Annatjie
Published: March 2003

A comparison between the ethics of justice and the ethics of care

The parameters of the problem within which the principal aim of the present article will be addressed can be described as follows. When making ethical decisions there are different perspectives that health care professionals may use. This may lead to conflict and insufficient co‐operation between the members of the health team. Two of these perspectives are the ethics of justice and the ethics of care. The ethics of justice constitutes an ethical perspective in terms of which ethical decisions are made on the basis of universal principles and rules, and in an impartial and verifiable manner with a view to ensuring the fair and equitable treatment of all people. The ethics of care, on the other hand, constitutes an ethical approach in terms of which involvement, harmonious relations and the needs of others play an important part in ethical decision‐making in each ethical situation. To seek some sort of way of avoiding conflict and promoting a mutual understanding about ethical decisions in the health team, there is a need to examine the ethics of justice and ethics of care. In order to understand the ethics of justice and ethics of care, the purpose of this article is to compare the two ethical perspectives. It is argued that the ethics of justice and the ethics of care represent opposite poles. If the members of the health team were to use only one of these two perspectives in their ethical decision‐making, certain ethical dilemmas would almost certainly remain unresolved. Both the fair and equitable treatment of all people (from the ethics of justice) and the holistic, contextual and need‐centred nature of such treatment (from the ethics of care), ought therefore to be retained in the integrated application of the ethics of justice and the ethics of care.
Dementia care mapping: an approach to quality audit of services for people with dementia in two health districts
Authors: Younger Dennis , Martin Geoffrey W.
Published: March 2003

Dementia care mapping: an approach to quality audit of services for people with dementia in two health districts

The audit reported in this paper and submitted to the Psychiatry of Old Age Management group, assessed six units within each of two health districts in the UK. Using a nonparticipatory observation method in the units selected, the aim was to measure quality and the environment of care. Dependency levels of the clients/residents were also estimated to give a clearer picture of the setting and the care requirements. This was intended to establish a baseline for the units mapped and to enable care developments to be focussed upon intended outcomes. Results led to a number of observations related to the levels of interaction between staff and clients/residents, the need for a wider range of activities to promote person–centred care, and a suggested route to the improvement in quality of life for this vulnerable group of people. Assessment of dependency levels linked to the results of the mapping showed that high dependency does not lead automatically to a lower quality of person centred care.
Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice
Authors: Clancy John , McVicar Andrew , Bird David
Published: March 2003

Getting it right? An exploration of issues relating to the biological sciences in nurse education and nursing practice

Concerns have been expressed that bioscience education is not meeting the needs of nursing students in the UK. This paper explores the situation further by comparing student perceptions with those of experienced practitioners (Part One of the study) and also evaluates the confidence of staff nurses in explaining the rationale for care applied to a common but specific disorder (influenza; Part Two). Questionnaires were used. Responses were elicited from DipHE Nursing (Project 2000) adult/child branch students (n=153) from two universities and from adult/child care staff from their local clinical placements (n=171 in Part One of study; n=266 in Part Two). The questions asked followed two themes: (1) confidence in understanding biological science and (2) issues of teaching and learning. Most questions utilized a rating scale from 1 to 10; this scale provides no central value and a vertical line was drawn to encourage respondents to identify which half of the scale their responses came under (basically, a negative or positive viewpoint). The significance of the data distribution either side of the midline was analysed statistically (simple sign test), as were any differences in distribution between the groups (chi‐square test). Median values were also determined. The data do not provide support for views that the biosciences are being significantly diminished by modern curricula, but also show no evidence for a great improvement in the bioscience knowledge base in recent years. What was surprising was the lack of confidence expressed by staff nurses: one illuminating finding was the lack of confidence in articulating their knowledge to patients and, even less so, to other health professionals. The paper reiterates a need for a national teaching and learning strategy for pre‐ and postregistration education in the biosciences. In particular, a means to raise the level of understanding of staff nurses must be identified urgently so that the mentoring of students in these subjects is improved.
Delayed clarification: information, clarification and ethical decisions in critical care in Norway
Authors: Bunch Eli Haugen
Published: March 2003

Delayed clarification: information, clarification and ethical decisions in critical care in Norway

Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision‐making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision‐making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants.
Storytelling and the interpretation of meaning in qualitative research
Authors: Bailey Patricia Hill , Tilley Stephen
Published: March 2003

Aim. This paper reviews literature on narrative analysis and illustrates the meaning‐making function of stories of chronic illness through analysis and discussion of two case studies from a study of acute episodes of chronic obstructive pulmonary disease (COPD).

Background. Individuals living with COPD experience acute exacerbations characterized by extreme dyspnea, but there has been little research to provide understanding of these events from the perspectives of individuals with COPD, family caregivers, and nurses. Narrative analysis – considered in the context of the aims of qualitative research – illuminates how these people make sense of acute exacerbation events by telling stories.

Design and methods. In an ethnographic study, 10 patient–family nurse units in two Canadian general hospitals participated in interviews concerning acute episodes of COPD. Narrative analysis enabled identification of several story forms and their functions.

Results. Examples were found of a story told twice with different meanings, and of a patient's ‘death story’ used to communicate distrust of the nurse's ability to recognize the seriousness of distress and implications for its potential course. These examples are presented, and interpreted with respect to issues of meaning.

Conclusions. The analysis indicates that stories told by patients in the context of nurse–client interactions inform understanding of the individual's acute exacerbation events beyond the biophysical.