bluuebunny/crossref_metadata_2025 huggingface dataset:
The clinical role of nurse teachers within a project 2000 course framework
Authors: Carlisle Caroline , Kirk Susan , Luker Karen A.
Published: March 2003

This paper reports on part of a national study that was conducted over a 3‐year period (1991–1994). The overall aim of the study was to explore the changing role of the nurse teacher. Multiple methods of data collection were used, including a modified Delphi survey, a case study and telephone interviews. The sample included a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). Findings in relation to the clinical role of the nurse teacher within a project 2000 course framework are presented. This includes the nature of the clinical role, views on linking theory and practice, and potential barriers to the nurse teacher's clinical role. The future role of nurse teachers within the clinical area is discussed and this includes suggestions for the ways in which a nurse teacher's clinical commitment could be facilitated. Issues relating to the role of lecturer/practitioner are also highlighted.
Nursing ideology: identification and legitimation
Authors: Taylor Julie S.
Published: March 2003

Nursing is undergoing radical change and with this has come the emergence of a‘new’nursing. However, in struggling to define ourselves, it is imperative that we identify a nursing ideology. Whilst ideology can begin to be clarified within a historical context, the threads of beliefs, values, power, and politics must also be respected. In attempting to explore the ideology of nursing, this paper considers the pluralistic nature of nursing and the modes of operation utilised in legitimizing its ideology. In particular, a uniquely nursing strategy has been identified — that of patientization. Nursing has more than one ideology and whilst all may be criticized, self‐knowledge is seen as imperative in enhancing any future this occupation might have.
Gynaecological nursing
Authors: McQueen Anne
Published: March 2003

This paper shows how gynaecological nursing is perceived by nurses working in this specialism. To gain an emic perspective a qualitative study was conducted with 12 qualified nurses working in a gynaecological unit. Data were obtained by means of in‐depth interviews and the use of paradigmatic cases. Analysis showed the nurses to identify many aspects to their work that could be shared with nursing in general. However, the specific nature of gynaecological nursing indicated a special focus on interpersonal work related to the private and sensitive nature of gynaecological disorders, with social, psychological and emotional implications for sexuality, reproduction, future life and relationships.
The experience of spouses whose partners have suffered a myocardial infarction: a phenomenological study
Authors: Theobald Karen
Published: March 2003

This phenomenological study describes the lived experience of spouses whose partners have suffered a myocardial infarction. In‐depth interviews were conducted with three participants (two females and one male) about their experiences. The findings from the participants were analysed using Giorgi's method (1985). Informants' experiences were captured within five major themes: (i) crushing uncertainty, (ii) overwhelming emotional turmoil, (iii) the need for support, (iv) the lack of information heightened anxiety and (v) the acceptance of lifestyle changes. The implications from this study suggest that health care workers need to: embellish their skills in managing spouses' emotions; communicate with community health professionals regarding support systems; provide families with information concerning the emotional issues associated with MI; provide advice in terms of financial aid; and identify community support groups if these are required. The in‐depth knowledge gained from the study will enable nurses to understand how family members feel when a spouse/partner has suffered an MI. It will also provide a framework with which practitioners and families can understand their reactions and assist in the overall rehabilitation of clients.
Women and midwives in partnership: a problematic relationship?
Authors: Fleming Valerie E.M.
Published: March 2003

Midwives in New Zealand have been practising independently of medicine and nursing since 1990 using the concept of partnership as a basis for their practice. This article shows, however, that the beliefs which underpin the practice of the midwives are not always the same as those of their clients. Supporting evidence is provided in the form of verbatim data provided by participants. Three major areas in which contradictions were found were in the work of midwives, the knowledge for practice and reflections on the experience. It is recommended that midwives become more visible by removing themselves from hegemonic structures, valuing alternative forms of knowledge and respecting the knowledge of their clients.
Absorption of nursing students: new immigrants in the general academic nursing programme in Israel
Authors: Ehrenfeld  , Shmueli  , Henig
Published: March 2003

Two years after upgrading its nursing programme to university level, Israel experienced a massive wave of immigration from the former Soviet Union. Previous studies have shown that Russian immigrants in general, and in nursing in particular, have several unique characteristics that need to be taken into consideration in planning curricula and absorption programmes. The aim of the present work was to update these data, focusing on the reasons new immigrants choose nursing as a career, their image of the profession and their satisfaction with it. The study population consisted of 302 students attending five major academic schools of nursing in Israel. Students were divided into two groups: new immigrants (less than 4 years in Israel) and long‐time Israelis (more than 4 years in Israel). All completed a 30‐item questionnaire of proven validity and reliability. Findings were analysed by length of time in Israel and year of study. Using a series of statistical tests, we found that compared with the long‐time Israelis, the new immigrants came from a higher socio‐economic/professional stratum (in their mother country), had a less ‘technical’ perception of nursing, and were attracted to the profession primarily for extrinsic reasons (‘close to medicine’, economics). Both groups showed highest satisfaction in the clinical domain; however, the difference was significant only in the long‐time Israeli group, even though the new immigrants had rated this domain highest in importance. The new immigrants showed least satisfaction in the academic domain. These results could be explained by several factors: the financial and housing problems that accompany immigration; the higher proportion of married students in the new immigrant group; and especially language difficulties, which are multiplied in Israel, where mastery in both Hebrew and English is necessary. Of particular interest was the fact that many of the immigrant students had already begun or completed medical school in their old country but were forced to compromise their dreams on immigration. This affected both their image of nursing and their reasons for choosing it as a career. We believe these findings will help nurse educators identify areas in which they can help ease the absorption process for maximal benefit to both the students and the profession.
Using the ‘new’ statistics in nursing research
Authors: PhD Phillip Ratcliffe
Published: March 2003

This paper argues that quantitative methods are under‐used in nursing research. Although this is often because the qualitative approach is the most appropriate, it may also be because nurse researchers are not fully aware of modern, sophisticated data analysis techniques and have tended to use simple statistical techniques that often make the quantitative analysis of complex data very difficult and produce simplistic and unsatisfactory answers. The paper briefly discusses probability and survival modelling techniques suitable for use in complex nursing research situations and argues that these methods may help to bridge the qualitative–quantitative gap. Although these techniques are mathematically complex, they are easily applied in practice using dedicated computer programs. The paper describes their application using one such program, GLIM 4.
Caring for demented people in their homes or in sheltered accommodation as reflected on by home‐care staff during clinical supervision sessions
Authors: Olsson  , Hallberg
Published: March 2003

This study aimed to illuminate both the content of and the care given to demented people and the reflections of home care staff about it as revealed in two clinical group supervision sessions (n=36). Verbatim transcriptions were analysed using a phenomenological hermeneutic approach and the following were found to be reflected on: the pensioners’ personal situation—disease‐related behaviour, ADL‐functions, social network and self‐esteem;the pensioners’ environment—their relationships to significant others, adequate level of housing/care, access to activities, and satisfactory personal space;pensioner/staff interaction—their relations to each other, the staffs’ relation to the pensioners’ family, and the balance between reality‐orientation vs. validation; the staff’s situation—co‐operation with other professionals, in primary health care, hospital, and within the social services; job satisfaction, lack of knowledge and sharing of knowledge, and lack of resources, especially time. The reasoning of the participants under supervision was found to be based on medical, historical, psychological, andenvironmental explanations, or personal beliefs. Feelings explored during supervisionwere directed towards the pensioners or the pensioners’ families, towards themselves or towards the management. The findings were interpreted within a nursing model based on the four central concepts of nursing; person, environment, nursing intervention and health. The reasoning about nursing care revealed in the supervision sessions reflected a holistic approach and the relationship between the staff and the demented person stood out as central for care quality. Thus focusing on what promotes or, respectively, obstructs this relationship is likely to be one important focus in clinical supervision not only to achieve improvement and high quality in home care but also to develop and enhance the quality of the working life of the staff. Since the results could be understood within a theoretical nursing care model, it may well be that if the supervisor functions within some theoretical model the participants may reach a more conscious approach and the risk of losing important aspects of caring will decrease.
The theory and practice of health education applied to nursing: a bi‐polar approach
Authors: Piper  , Brown
Published: March 2003

The authors contend that health education is an intrinsic part of nursing practice. The paper outlines two models of health education each with different aims, methods and outcomes and these are related explicitly to nursing practice. The tensions between the two approaches are discussed and whilst the authors acknowledge that both models constitute legitimate health education activity within nursing, it is argued that emphasis should be given, where practically possible, to the patient empowerment model. In addition the authors argue that the social determinants of health and health‐related behaviour need to be considered by nurses as a powerful factor in the formation of health lifestyles. Therefore a range of approaches should form part of a repertoire of nursing health promotion interventions.
Importance of information following myocardial infarction: a study of the self‐perceived information needs of patients and their spouse/partner compared with the perceptions of nursing staff
Authors: Turton John
Published: March 2003

A non‐experimental research design using questionnaires, was undertaken to find out what information out of that commonly given following myocardial infarction (MI), patients and their spouse/partners rate as being most and least important. These results were then compared with the results obtained from nurse subjects, who were given the same instrument to complete. Eighteen subjects were recruited for each of the three subject groups. Results indicated that some congruency existed between the three groups in terms of what they perceived as the most and least important categories of information. Yet, the scores for some informational categories included on the instrument, were significantly different between the nursing and two other groups (P<0·01). However, in relation to the patient and spouse/partner groups, only a weak difference (P<0·10) was found for the category ‘dietary information’. These findings and others are discussed, and recommendations are made for improving the information giving process post‐MI.
The influence of various factors on breast‐feeding in Slovenia
Authors: Hoyer Silvestra , Pokorn Dražgost
Published: March 2003

This research on breast‐feeding was conducted with 881 randomly selected Slovenian mothers who gave birth in January and February 1992. At the time of the study the infants were about 15 months old. The survey was conducted in the homes of the mothers. Statistical analyses included descriptive statistics, the chi‐square test, t‐test and multivariate binary regression analysis. The mothers’ average age was 26·2 years. Their educational level was approximately 12 years of public schooling. On average there were 1·67 children per family. Of the total surveyed, 22 mothers (2·5%) did not breast‐feed their babies; 38 mothers (4·3%) were still breast‐feeding at the time of the survey. The average duration of breast‐feeding for mothers who stopped before or at 15 months of the infant’s age was 159·1 days (about 5 months). Having adequate information about breast‐feeding and failing to state problems during the breast‐feeding period were found to be positive influences which induced mothers to breast‐feed their infants. Characteristics of the mothers which influenced longer duration of breast‐feeding were: feeding eight or more times daily in the first month of breast‐feeding, the birth order of the infant, attending courses for parents, deciding before the birth to breast‐feed, living in the city, living with a partner, having a secure income, having no other problems during the period of breast‐feeding, spoon‐feeding liquids, having a secondary level or more of education, being well informed about breast‐feeding and giving the first feed within 12 hours after the birth. Breast feeding among Slovenian mothers is significantly on the rise and the period of breast‐feeding is being extended to 6 months. Nevertheless, greater efforts are needed in the education of health personnel to promote and support the healthy practice of breast‐feeding.
Cognitive behaviour therapy approach to disputing automatic thoughts: a two‐stage model
Authors: Lam Danny , Cheng Linda
Published: March 2003

Research shows that clients with automatic thoughts (dysfunctional thinking) often do not think of alternative explanations in relation to negative events. Furthermore, these automatic thoughts are characterized by a broad global, self‐evaluative and ambiguous nature that could make disputing (or changing the ways they think) the most difficult part of the therapeutic process. This paper proposes a two‐stage practise‐based disputing model, guided by research, that aims to ‘bring’ an automatic thought to a specific, objective, quantifiable and concrete level at which not only is the particular aspect(s) of the automatic thought that causes emotional disturbances finely focused, but the disputing is also likely to be effective and manageable. Furthermore, it will also generate alternative explanations that are helpful in reducing emotional disturbances and in facilitating problem solving approach. In this paper, the authors use a case example to discuss the rationale that underpins the conceptualization of the model and to illustrate the process in which the strategies of the model are effectively used.
Empowerment of dying patients: the strategies and barriers to patient autonomy
Authors: Martin Geoffrey W.
Published: March 2003

Empowerment of dying patients: the strategies and barriers to patient autonomy The growing debate about the ability of the nurse to empower patients has featured frequently in the nursing journals over recent years. This paper seeks to address the issue around the need to empower dying patients by an examination of nurses’ written reflections on critical incidents in their practice. Geertz's ‘thick description’ has been used to interpret the data. The issues of power and professionalism are central to the discussion. The results are tentative given the sample size but point towards a redefinition of the empathetic approach and the adoption of a ‘facilitative’ approach to the sharing of power. The paper recommends careful examination of the role of the nurse and the communication process to identify further barriers to patient empowerment.
Reconceptualizing rigour: the case for reflexivity
Authors: Koch Tina , Harrington Ann
Published: March 2003

Reconceptualising rigour: the case for reflexivity This paper is a critical review of recent discussions of rigour in nursing research. We will argue that ‘borrowing’ evaluation criteria from one paradigm of inquiry and applying them to another is problematic. We attempt to map the ‘rigour’ field and add a dimension to the existing debate about rigour and qualitative research through inclusion of reflexivity guided by philosophical hermeneutics. We describe reflexivity and appeal to writers to incorporate a reflexive account into their research product by signposting to readers ‘what is going on’ while researching. We contend that researchers bring to the research product, data generated, a range of literature, a positioning of this literature, a positioning of oneself, and moral socio‐political contexts. We suggest that reflexive research is characterized by ongoing self‐critique and self‐appraisal and that the research product can be given shape by the politics of location and positioning. We emphasize that in the creation of a text (the research product) it is desirable that the researcher be a skilled writer. Finally we claim that if the research product is well signposted, the readers will be able to travel easily through the worlds of the participants and makers of the text (the researchers) and decide for themselves whether the text is believable or plausible (our terms for rigour).
The hormone replacement therapy self‐efficacy scale
Authors: Ali Nagia S.
Published: March 2003

The hormone replacement therapy self‐efficacy scale¶This study describes the initial development and psychometric evaluations of an instrument to measure self‐efficacy in hormone replacement therapy (HRT) use. The development of the scale was based upon Bandura’s self‐efficacy construct. The sample was 116 women who were 50 years old and above and who were current or past users of HRT. Factor analysis was used to develop construct validity and Cronbach’s alpha was used to compute reliabilities. Factor analysis isolated two factors, efficacy beliefs in HRT (EBs‐HRT) and outcome expectations in HRT (OEs‐HRT). The developed tool contains 14 items, eight items compose the EBs‐HRT subscale and six items make‐up the OEs‐HRT subscale. The two subscales and total instrument were found to have good internal reliabilities. Implications for HRT intervention using the developed tool are discussed.
Fund‐holding and contracting for community nursing services: a selective review of the literature
Authors: Livesey Heather
Published: March 2003

In the context of social, political and economic pressures fund‐holding has been described as the ‘wild card’ in the Health Care Reforms in the United Kingdom of the 1990s. Set against an international drive to reform health care and increase the efficient and effective use of resources, fund‐holding by general practice is seen as one means of enhancing the contribution of a primary care led National Health Service (NHS). It is advocated that a primary care led NHS will enhance and strengthen the position of nursing in the health care context. In order to fully exploit such a position it is argued that primary care nurses must adopt a systems view, recognizing broader strategic issues upon which to base marketing approaches to the contracting process.
Quality of life and the right to die: an ethical dilemma
Authors: McCormack Paula
Published: March 2003

In an increasingly ‘patient‐centred’ health service individuals are demanding to make independent judgements about their own fate. In keeping with this trend there is now a growing drive to review the current laws on euthanasia and assisted suicide. The issues in the euthanasia debate usually revolve around patients who are terminally ill and/or suffering intractable pain. However, pain is not the only determinant of an intolerable existence and the problems become more complex when existential quality of life issues are the focus. This can lead to difficult decision making for the health workers involved in care. The paper uses a case study approach to examine the ethical and legal issues surrounding euthanasia. The dilemma under discussion involves a quadriplegic patient who wished to commit suicide by refusing nutrition. The discussion offered centres around the principles of beneficence, non‐maleficence and autonomy in relation to whether it was morally or legally appropriate to intervene with this patient's wishes by artificial feeding. Conclusions and recommendations are offered.
Health‐within‐illness: concept development through research and practice
Authors: Moch Susan Diemert
Published: March 2003

This paper presents the concept of health‐within‐illness as an opportunity that increases meaningfulness of life through connectedness or relatedness with the environment and/or awareness of self during a state of compromised well‐being. The conceptual development evolved through a research programme on women diagnosed with breast cancer and examples from the research are used to illustrate various components of the definition. Evidence from nursing literature and practicing nurses further enhances development of the health‐within‐illness concept. Although the health‐within‐illness idea was originally proposed byMoch (1989) and has been referred to in nursing literature, a conceptual definition is not available. Suggestions for further research and practice are included.
Enrolled nurse conversion: trapped into training
Authors: Dowswell Therese , Hewison Jenny , Millar Bobbie
Published: March 2003

The introduction of Project 2000 in the late 1980s aimed to replace the existing two levels of nurse training with a single level of entry. This entailed phasing out training for enrolled nurses (ENs) and ‘conversion’ courses were introduced to allow ENs to upgrade their qualification. As part of a larger study of continuing education and training in the National Health Service (NHS), a cohort of ENs taking part in an open‐learning conversion course were interviewed. Sixteen nurses described their motives for undertaking the course and the impact of the course on their work and home lives. Data collected in interviews were analysed using qualitative methods and revealed that all of these nurses felt under pressure to take part in the course. Participation in the course was associated with changes in home and work life. The findings of the study have implications in terms of study leave policy.
Social support and locus of control as correlates of UK nurses’ health‐related behaviours
Authors: Callaghan Patrick
Published: March 2003

Social support and locus of control as correlates of UK nurses’ health‐related behaviours¶Background: Despite the number of studies describing nurses’ health‐related behaviours, few have investigated psychosocial factors that influence these behaviours. Aim: To investigate the relationship of social support and locus of control to nurses’ health‐related behaviours. Design: A cross‐sectional survey was used. Subjects: 114 nurses’ attending tertiary level education courses in London and Essex. Measures: The Health and Behaviour Survey, The Six Item Social Support Questionnaire and the Multidimensional Health Locus of Control Scale. Results: Social support did not significantly relate to any health‐related behaviour except eating fruit. Subjects high on internal locus of control also significantly reported eating less red meat, eating three meals per day on a regular basis and eating fewer between meal snacks. Conclusions: Locus of control is more strongly associated with United Kingdom nurses’ health‐related behaviours than social support. Given the empirical links between nurses’ health‐related behaviours and their tendency to counsel clients about health issues, attempts to improve nurses’ internal locus of control may ultimately improve their health promotion role.
Coping in young women: theoretical retroduction
Authors: Gramling Lou F. , Lambert Vickie A. , Pursley‐Crotteau Suzanne
Published: March 2003

Coping in young women: theoretical retroduction¶Although there is increasing interest in women’s health, there remains little empirical evidence concerning concepts related to health and women’s life trajectory. Our purpose in conducting this research was to examine women’s developmental stressors and coping during young adulthood. Lazarus and Folkman’s coping model provided sensitizing concepts for data generation in a retroductive research methodology. The sample included 26 women of diverse perspectives who participated in interviews and groups. Philosophical concerns of subjectivity, context and gender sensitivity were actualized in iterative stages of data collection, analysis and comparison to extant theory. Rapidly expanding multiple roles were identified as developmental stressors for young women. Decontextualized coping strategies are arranged on a behavioural continuum: avoidance, distraction, and confrontation. Contextualized descriptions of coping are presented in two representative accounts: Lauren and Mary Ellen. A philosophical stance, assumed at about the age of 30, provides a lens for assessing developmental stressors that influence the appraisal process. Rich descriptions of young women’s coping and developmental influences move beyond abstract theory to a contextual understanding of young women’s experiences.
An education–service partnership: analysis of the development of a satellite baccalaureate nursing programme
Authors: Sullinger Helen , Ostmoe Patricia M.
Published: March 2003

An education service partnership: analysis of the development of a satellite baccalaureate nursing programme¶The development of a satellite education partnership between the School of Nursing at the University of Wisconsin Eau Claire and St Joseph’s Hospital in Marshfield, Wisconsin, is reported. The factors which were identified as key to this successful partnership are compared to the antecedent conditions and defining attributes of the concept of collaboration as described by Henneman, Lee and Cohen. These factors include: (a) enlisting organizational support; (b)␣identifying anticipated benefits to all parties; (c) scrutiny regarding the necessity of the project; (d) communication skills and trust among partners; (e)␣a␣contract including not only how to proceed but how to disband; and (f)␣assessment of the risks of failure and whether they can be endured. The defining attributes of collaboration were met in this satellite baccalaureate programme partnership. The consequences of this collaboration are discussed and support the conceptual literature. The success of this collaboration is evidence that partnerships between nursing service, education and research are not only worth the risks but necessary for our full participation in the health care system.
‘The Awful Rowing Toward God’: therapeutic conversations with a woman following major surgery
Authors: Jones Alun
Published: March 2003

‘The Awful Rowing Toward God’: therapeutic conversations with a woman following major surgery¶ Listening is a complex event requiring skills and competencies that encompass the personhood of the listener. This paper explores a clinical conversation with a woman experiencing serious illness. The ideas of Klein offer the theoretical means for understanding exchanges. Reflexivity is addressed through exploring the writer’s thoughts and feelings in response to significant events. The benefits of supervision, as support and guidance, are discussed in context. The discussion concludes with the suggestion that although many layers of interpretation are possible, and can be informed by various ways of knowing, the act of listening offers potential benefits.
A comparison of pre‐Project 2000 and Project 2000 nurses’ perceptions of their research training, research needs and of their use of research in clinical areas
Authors: Parahoo Kader
Published: March 2003

A comparison of pre‐Project 2000 and Project 2000 nurses’ perceptions of their research training, research needs and of their use of research in clinical areas¶Most of the literature on the research training and education of nurses has focused on teaching strategies. Only a few authors have assessed systematically the impact of research modules or courses on the knowledge and attitudes of nurses. There is a lack of research on nurses’ use of research following their preparation. This paper reports on some of the data from a large‐scale survey of the utilization of research among nurses in Northern Ireland. In particular, a comparison is made of the perceptions of pre‐Project 2000 and Project 2000 qualified nurses of their research training, research needs, and use of research in clinical areas. A questionnaire was distributed to a convenience sample of 2600 nurses from 23 hospitals in 14 Trusts in Northern Ireland. The response rate was 52·6% (n = 1368). The findings show, among others, a shortfall in research preparation of pre‐Project 2000 nurses in important aspects of research. While Project 2000 nurses reported receiving more training, they did not report higher rates of research utilization than pre‐Project 2000 nurses. Registered mental nurses (RMNs) and registered nurses mental handicap (RNMHs) also reported lower rates of research utilization than registered general nurses (RGNs), despite reporting the same amount of research preparation as RGNs. The implications of these findings are discussed.
Socio‐cultural perspectives on the image of nursing: the Hong Kong dimension
Authors: Foong Andrew L. S. , Rossiter Jo C. , Chan Po T.
Published: March 2003

Socio‐cultural perspectives on the image of nursing: The Hong Kong dimension¶Using structured interviews a study was undertaken with 19 high school students in Hong Kong to elicit their perceptions of nursing as a profession. The study also sought to gauge the extent of the students' intentions on pursuing a career in nursing. Responses were content analysed to determine the extent of knowledge and understanding held, intentions on choosing nursing as a career and their reasons. Findings suggest the image of nursing to be poor and that nursing as a career is far from desirable amongst the teenagers of Hong Kong. The reasons appear to be related to the notion of monetary rewards and status within the Hong Kong community. There is also a lack of knowledge as to what nurses do. The implications of such findings include the lost potential for recruitment of candidates of high calibre with a lot to offer the profession and their society. It suggests the need for the profession to find ways of publicizing and marketing the positive aspects with elements of realism which the general population in that part of the world could relate to more readily.
Safeguarding care gains: a grounded theory study of organizational change
Authors: Ardern Peter
Published: March 2003

Safeguarding care gains: a grounded theory study of organizational change

The orientation towards a community focus of care challenges the need for National Health Service day hospital provision for people with dementia, thus forcing day hospitals to reorganize, relocate or close. Day hospitals were originally opened in the mid‐1970s as cost‐effective alternatives to the traditional in‐patient care for the dementia sufferer. Ironically, day hospitals are now under threat because they are considered an expensive luxury. Advances in dementia care have included the move away from the mechanistic model of care (routines and tasks), to the development of the social psychological model of dementia care. This paper examines the process of changes experienced by a group of staff working in a day hospital for people with dementia. Where the staff experienced a period of prolonged change and loss, their perception of support differed from that of the organization. When threats to the future and low support were encountered, defensiveness and risk containment allowed the mechanistic model of care to predominate. The concept of ‘safeguarding care gains’ was contained in the actions the staff took to prevent further perceived erosion of their care practice.
The meaning of learning in critical care nursing: a hermeneutic study
Authors: Little Christine V.
Published: March 2003

The meaning of learning in critical care nursing: a hermeneutic study

Many critical care nurses choose to undertake further, specialist education and have an expectation that the curriculum will reflect their common learning requirements. Although previous studies have addressed education‐related issues, few have explored fundamental learning needs as expressed by the students themselves. This paper summarizes a study which aimed to explore the meaning of learning to 10 intensive care/coronary care nurses who had recently undertaken specialist post‐registration study. Utilizing an interpretative human science approach (Heideggerian hermeneutic phenomenology) the study identified three major themes: learning as focusing, learning as questioning and learning as technological mastery. One theme, learning as technological mastery, was revealed to be a particular feature of critical care nursing and was subsequently identified as the constitutive pattern. An alternative view of the relationship between nursing and technology is presented from the perspective of Heideggerian hermeneutic phenomenology. As a phenomenological account, this study does not claim to be representative of the larger population of critical care learners; however, it is suggested that unique human experiences may also be shared by others with similar backgrounds.
The nurse’s role in drug handling within municipal health and medical care
Authors: Kapborg Inez , Svensson Håkan
Published: March 2003

The nurse’s role in drug handling within municipal health and medical care

In Sweden, elderly care has been transferred from the county councils to the municipalities, resulting in changes in the work tasks of nurses. Today, nurses within municipal health and medical care carry sole responsibility for large groups of care receivers, especially during evenings and weekends. A consequence of this heavy work load is that the nurses have to delegate a number of tasks to subordinate staff. Drug administration is a task which is often delegated. Cases of malpractice involving drug administration, reported from the municipal health and medical service to the regional supervisory units of the National Board of Health and Welfare during a 3‐year period, have been analysed in order to gain a deeper understanding of the underlying causes of malpractice. In addition, interviews were conducted with eight nurses, the objective being to find out how they rate their knowledge within this area. The analysis showed that the majority of errors occurred in nursing homes and that the most common errors were administration of the wrong drug, and levels of drugs administered exceeding the prescribed ones. These errors were also common among subordinate staff who had been delegated responsibility for drug administration. Of the nurses interviewed, six out of eight had been close to making errors or had noticed a colleague making an error in conjunction with drug handling. Not all nurses reported errors made to the physician in charge immediately on discovery. It is concluded that through the transformation of elderly care, nurses working within municipal health and medical care have been given a new professional role. This places new demands on their competence, requiring them to make independent judgements and to take their own initiatives.
A longitudinal study into the perceptions of caring among student nurses using multivariate analysis of the Caring Dimensions Inventory
Authors: Watson Roger , Deary Ian J. , Lea Amandah
Published: March 2003

A longitudinal study into the perceptions of caring among student nurses using multivariate analysis of the Caring Dimensions Inventory

A longitudinal study involving student nurses’ responses to the Caring Dimensions Inventory (CDI) was carried out to investigate the development of perceptions of caring. This study continues previously reported work in which the development of the CDI was described. The current study was designed to see if the CDI could detect changes in perceptions of caring among student nurses as they progressed through their training. Data were collected on the same subjects at three points, each a year apart, throughout the study. A cohort of 168 student nurses entering training was recruited into the present study and data from the CDI was analysed using exploratory factor analysis. A four factor structure for perceptions of caring throughout the study was supported, with some evidence for a five factor structure at 24 months into the programme of nurse education. A professional and technical factor increased in congruence with a similar factor, identified in a previous study, throughout the present study and was used to provide factor scores for individual students. There was a statistically significant and moderately sized correlation between the score on this factor and the age of the student nurses. The five factor solution yielded a factor of accountability. Professional and educational consequences of the study are discussed along with the problem of attrition in longitudinal studies.
Clinical guidelines: promoting clinical effectiveness or a professional minefield?
Authors: Mead Paula
Published: March 2003

Clinical guidelines: promoting clinical effectiveness or a professional minefield?

The development of clinical guidelines as one means of implementing evidence‐based practice is currently a topical issue. The recent Government White Paper, The New NHS. Modern. Dependable, proposes the establishment of a National Institute for Clinical Excellence whose expressed aim will be to produce and disseminate guidelines based upon evidence of clinical effectiveness in health care. There will be an expectation that practitioners adapt these national guidelines for local needs and particularize them to individual patients. There has been considerable debate in the medical press between the critics and advocates of evidence‐based medicine surrounding the relative usefulness of clinical guidelines. However, there has been limited corresponding debate within the nursing literature, which has largely limited itself to descriptions of the implementation of guidelines. This paper examines some of the advantages and limitations of clinical guidelines as a means of operationalizing research evidence to promote effective health care. Finally, some recommendations surrounding the implementation of guidelines will be made.
Responses of family caregivers and family members with Alzheimer’s disease to an activity kit: an ethnographic study
Authors: Hutchinson Sally A. , Marshall Melody
Published: March 2003

Responses of family caregivers and family members with Alzheimer’s disease to an activity kit: an ethnographic study

This qualitative evaluation research focused on individuals with Alzheimer’s disease cared for at home by a family caregiver. It aimed to assess the responses of family caregivers and family members to an activity kit containing 20 therapeutic activities (The BAG or ‘Be Active with Games’ kit). In‐depth interviews with and observations of 21 caregiver/member dyads were analysed according to Spradley’s ethnographic method. Responses to The BAG were contingent upon the family member’s symptoms, prior experience, and time of day. For some caregivers The BAG was useful in filling time, inspiring additional activities, facilitating connections with the family member, and connecting family members with their past; for others it was an additional burden in an already frenetic life. The BAG engaged some family members with AD while it ‘insulted’ others. The value of activities for individuals with AD requires more theoretical and methodological exploration.
The patient’s thoughts and feelings about their transfer from intensive care to the general ward
Authors: Odell Mandy
Published: March 2003

The patient’s thoughts and feelings about their transfer from intensive care to the general ward

This qualitative, phenomenological study was undertaken to find out how patients felt about being transferred from the intensive care unit to the ward. The six patients who took part in the study, had been in intensive care for more than 4 days. Their transfer was planned as part of their recovery from a critical illness. Following transfer to the ward, the patients were interviewed using a semi‐structured approach. The interviews were audio‐taped, and transcriptions from the tapes were analysed for meaning and interpretation.

Findings supported the literature that was reviewed, in that transfer from intensive care to the ward was a traumatic experience for the patient, who often found it confusing, stressful and tiring.

Improvements to the transfer process can be guided using the information from the literature review and findings of the study.
Adjusting stroke patients’ poor position: an observational study
Authors: Dowswell George , Dowswell Therese , Young John
Published: March 2003

Adjusting stroke patients’ poor position: an observational study

Although nurses’ role in rehabilitation has been generally ill‐defined and consistently undervalued, of all professional groups, nurses working with stroke patients have potentially the greatest contribution to make. Stroke patients are believed to benefit from good posture yet they can spend long periods in inappropriate positions. This study examined the positioning, handling and mobilizing of stroke patients in hospital. Non‐participant observation was used to gather data on stroke patients’ position and nurses’ activities. This paper addresses two basic questions — what causes the adjustment of patients from poor to good position and who is involved in achieving this adjustment. Poor position was observed to end 158 times in 380 ‘patient hours’ of observation. The most frequent causes of positional improvement were activities whose primary intention was unrelated to position correction. The deliberate adjustment of patients’ position by nurses was a rare event which occupied a small part of nurses’ time. The potential for a more considered and consistent nursing approach appears to be great.
Liaison nursing for stroke patients: results of a Dutch evaluation study
Authors: Arts Suzanne E.J. , Francke Anneke L. , Hutten Jack B.F.
Published: March 2003

Liaison nursing for stroke patients: results of a Dutch evaluation study

Liaison nurses, employed by a home care organization, were introduced into two Dutch hospitals to improve discharge planning for stroke patients. The main aim of the study presented was to gain insight into the effects of liaison nursing on the quality of the discharge process and related outcomes. After the introduction of liaison nursing, hospital nurses completed a questionnaire on satisfaction with the liaison nurse. In addition, both before and after the introduction of liaison nursing, two groups of discharged stroke patients were interviewed by telephone. The records of these patients were also studied with respect to background characteristics and duration of hospital stays. The hospital nurses were, generally, positive about the liaison nurse and the job she did (e.g. they found that home care was better organized). Further, after the introduction of liaison nursing, more patients stated that their post‐discharge needs had been discussed not later than 48 hours prior to discharge, and more patients said their aftercare had been discussed with community nurses. However, the number of patients whose medication had arrived at home on time had decreased. The results also indicated that there was no significant difference in the duration of stay between the before and after group. The overall conclusion is that the liaison nurses have been moderately successful in their jobs. However, since the study was conducted in only two Dutch hospitals, findings may not be representative of other settings. Future research on liaison nursing is therefore recommended.
Suicide and self‐harm in inpatient psychiatric units: a national survey of observation policies
Authors: Bowers Len , Gournay Kevin , Duffy David
Published: March 2003

Suicide and self‐harm in inpatient psychiatric units: a national survey of observation policies

There is little empirical literature on observation as a psychiatric nursing procedure to prevent patients from harming themselves or others. National guidelines for this practice do not exist, with a consequence that local policies might be variable in content and quality. This paper reports a national survey of observation policies and usage based upon a stratified random sample of 27 psychiatric inpatient service providers in England and Wales. Extreme variation in terminology and practice was encountered. The terminological confusion is likely to reduce nurses’ clarity about their responsibilities and increase risks to patients. Further variation exists from place to place as to whether, and to what extent, student nurses and family members should be entrusted with the responsibility to observe patients. More than one in 10 services of the sample still have no written observation policy, and four in 10 have no clinical recording system of the procedure in place. Nurses commonly amend the procedure and terminology on an ad hoc basis. The results of this survey confirm that the Department of Health should set national standards for the policies and procedures for patient observation and that as an interim step practice guidance should be issued to all nurses (and other mental health workers) involved in this procedure.
Protecting children: intuition and awareness in the work of health visitors
Authors: Ling Margaret S. , Luker Karen A.
Published: March 2003

Protecting children: intuition and awareness in the work of health visitors

This paper is based upon an ethnographic study of a group of health visitors engaged in child protection work. The purpose of this paper is to explore the meanings individual health visitors attach to events concerned with identifying children who may be at risk of harm from child abuse, and also the idiosyncratic nature of health visiting in this complex but everyday social situation. The paper focuses on understanding the importance of a particular form of knowledge which the health visitors referred to as ‘intuitive awareness’.