bluuebunny/crossref_metadata_2025 huggingface dataset:
Reasons for referral to a palliative nursing team
Authors: Nash Ann
Published: July 2003

Referral patterns to a palliative nursing team are examined within the context of the developing role of the service Reasons for referral are identified and a checklist developed to encourage specificity in statement of need on referral Comparison is made with the assessment of the Macmillan nurse on assessment Use of the checklist encouraged greater awareness of need There was no correlation between the referrers’ perceived needs and the Macmillan nurses’ assessments on visiting The literature supports the need for more explicit referral criteria based on needs assessment There are implications for greater awareness of roles, better communication regarding intervention, and organizational review
Fluctuations in physical function: adults with non‐small cell lung cancer
Authors: Sarna Linda
Published: July 2003

Disruptions in physical activities (functional status) were measured over a 1‐month period in 24 patients with non‐small cell lung cancer with the Karnofsky Performance Status Index and two patient self‐report measures Changes over time were noted for the whole group, and mean scores of the treated subgroup were compared with an untreated cohort Prior weight loss was significantly associated with baseline functional status Age was not significantly associated with degree of functional disruption, though 42% of the sample was aged 65 years or older The greatest disruptions in physical activity were noted in ambulation A third of the sample had difficulty walking one block or more Serious fatigue was experienced by 79% of the subjects and 44% had difficulty with household chores Only 21% were completely satisfied with their level of activity Pain improved in the treated subjects over time Despite no significant differences at baseline, untreated subjects had more limitations in physical activities than treated subjects over time All three instruments were significantly correlated Careful monitoring of physical difficulties may help nurses focus interventions and decrease the physical distress associated with illness and treatment In this study, those receiving chemotherapy did not experience significantly greater physical dysfunction In fact, the untreated patients, who might not receive vigilant nursing assessment, demonstrated greater physical decline
Patient education at 25 years; where we have been and where we are going
Authors: Redman Barbara K
Published: July 2003

In the past 25 years the theory and research base for patient education has become considerably richer Definition of a core of educative functions has now been accomplished for most major disease entities or health problems, and standards of practice developed for a few In the United States, there is very inadequate information about the degree to which patient education is delivered, and institutional supports for it seem to have varied with fiscal conditions The reimbursement system for health care has not explicitly supported patient education or the outcomes it could achieve While there has been growth in instructional approaches, it would be charitable to say that there is a broad and well‐informed view of potential approaches or an organized research and development function to get these approaches on line If predictions of patient focus for business and ethical reasons are realized, a major shift in environment could occur, supportive of patient education Clearly, there is little evidence that patient education represents a mature technology or that it is delivered at acceptable standards to all those who need it Patient education content in key nursing textbooks published between 1988 and 1992 is analysed to examine the degree and character of conceptual penetration
Voluntarism: is it a useful concept for health education in the accident and emergency department?
Authors: McKenna Gilean
Published: July 2003

As the year 2000 looms closer, the emphasis on health education as a means of attaining the 38 targets for ‘Health for All’ increases Despite various initiatives, little, if any, progress has been made in narrowing the health divide Currently, terms such as ‘self‐care',‘individual responsibility’ and ‘community empowerment’ are often used with emphasis on individual freedom to choose The author contends that to assume all individuals have that freedom and act voluntarily, is to deny the impact of social structure on health Health education and the concept of voluntarism will be critically examined from the perspective of nursing in an accident and emergency department
Applicability of Orem's conceptual framework: a cross‐cultural point of view
Authors: Morales‐Mann Erlinda T , Jiang Shu Lin
Published: July 2003

Orem's conceptual framework for nursing is analysed and evaluated for its applicability in Chinese nursing practice The appropriateness of Orem's nursing theory for application in Chinese nursing practice is determined through an examination of its completeness, compatibility, practicality and feasibility Some insights and recommendations are offered for consideration
Mitral valve prolapse and its effects: a programme of inquiry within Orem's Self‐Care Deficit Theory of Nursing
Authors: Utz Sharon Williams , Ramos Mary Carol
Published: July 2003

The optimum growth and scientific progress of nursing knowledge during the next century will depend upon the development and execution of focused programmes of clinical and theoretical research The planning and design of such programmes must originate with the clear definition of nursing research questions Nesting such questions within established theoretical frameworks provides a nursing context, lends precise language and suggests relevant variables for study The development of a sequence of related studies exploring and describing the self‐care needs of people with symptomatic mitral valve prolapse illustrates one such systematic research programme Orem's Self‐Care Deficit Theory of Nursing was used as a theoretical framework for four completed studies which describe one population's need for nursing assistance The evolving nature of the research programme and plans for future research are discussed
The place of the family in mental health nursing: past, present and future
Authors: Tennant Duncan
Published: July 2003

The importance of the family system has, in recent years, been de‐emphasized in the planning and delivery of mental health services A sample of the psychiatric nursing literature over the last 4 decades is reviewed to reveal that this is not a new phenomenon with regard to psychiatric nursing practice The shortcomings of such a de‐emphasis are discussed, some exceptions to the rule are described and some suggestions for future development of family interventions by mental health nurses are made
Audit: an exploration of some tensions and paradoxical expectations
Authors: Nolan Mike , Scott Gwenda
Published: July 2003

There can be very few nurses, at the moment, whose daily activity is not in some way influenced by the notion of audit and related concepts Yet despite an impressive growth in the literature relating to audit, conceptual clarity on a number of key issues remains elusive This paper suggests that there are major tensions inherent in much of the current thinking about audit In outlining the arguments supporting our position, we term these tensions primary and secondary The potential effects of ignoring such tensions are illustrated by reference to the development of day hospital care for older people in the United Kingdom This is used to highlight a number of paradoxical expectations and deleterious consequences for day hospital services which have arisen from a failure adequately to address a number of fundamental questions The lessons to be drawn are then applied to audit in general, with particular reference to services for individuals with on‐going health care needs
Leadership in the nursing unit: relationships with nurses’ well‐being
Authors: Boumans Nicolle PG , Landeweerd Jan A
Published: July 2003

The head nurse occupies an important position in the nursing unit Concerning leadership style, a distinction is traditionally made between consideration and initiating structure Sometimes a third style is distinguished as well, namely ‘production‐orientated’ leadership In a study of 561 nurses from 16 general hospitals in The Netherlands, the influence of two leadership styles upon the reactions of nurses (job satisfaction, experienced meaningfulness, health complaints and absenteeism) to their work situations was examined, namely the styles of social (i e consideration) and instrumental leadership (a combination of the styles initiating structure and production‐onentated) The separate effects of the two styles were studied, as well as the connection between combinations of leadership styles and reactions The results indicate that social leadership contributes positively to nurses’ reactions to their job Instrumental leadership, on the other hand, leads to health complaints From the analyses of combinations of leadership styles it appears that nurses are most satisfied if the head nurse pays much attention to both dimensions of leadership For health complaints, a tendency in this directions is also found Finally, it becomes clear that nurses with a great need for autonomy prefer a different type of leadership from nurses with little need for autonomy
Theory to practice: developing a Rogerian‐based assessment tool
Authors: Tettero Ildico , Jackson Sonja , Wilson Sharon
Published: July 2003

Nursing models are invaluable in the direction they provide for nursing practice, education and research The growth and development of the nursing profession is enhanced when its practice is guided by nursing theory Rogers’ Science of Unitary Human Beings is appealing to nursing because of its open‐systems perspective and focus on holistic and individualistic care Rogers’ model is utilized to develop a nursing assessment tool that may be used in a variety of situations The Rogerian‐based assessment tool is used to gather data from a postpartum mother experiencing the challenges of her first newborn Problems incurred while developing and utilizing the tool are discussed Rogers’ model is shown to be practical and effective in this case study
The relationship of nursing theory and research: the state of the art
Authors: Jaarsma Tiny , Dassen Theo
Published: July 2003

Recently, the relationship between theory and research has received more attention It seems that in the past 10 to 15 years more research studies have been published that are more or less conceptualized within (nursing) theories However, it is not always clear how the theory has been used The purpose of this Study Was to analyse the role of theory in nursing practice research To this end, papers published in six nursing journals between 1986 and 1990 have been studied It can be concluded that, in comparison with earlier analyses, the use of theories in nursing research studies has increased (from 13% to 21%), but the use of nursing theories has not become more frequent However, the testing of nursing theories is minimal On the other hand, research results are being cumulated progressively in regard to theory or to other research
Triangulation: a means of reconciliation in nursing research
Authors: Cowman Seamus
Published: July 2003

The nursing profession has adopted many of its theoretical foundations, including research approaches, from other academic disciplines This has resulted in the acceptance of one epistemological perspective to the exclusion of others In this context, the evolution of nursing research reflects a rather conservative approach The quantitative approach was the dominant paradigm of the 1950s, 1960s and during the 1970s and 1980s the research approach has been increasingly located in the qualitative paradigm It is noted that each research perspective has several inherent differences which give rise to a specific type of research endeavour Within the literature there is general support for the separateness of the quantitative qualitative paradigm However in accepting the inherent differences between the two methods, nurse researchers have been concerned that neither method in isolation from the other will truly provide an understanding of human beings and of their health‐related needs, problems or nursing care Triangulation as a research strategy represents a means of integrating the two research approaches Triangulation, first used in 1959, is defined as a combination of multi methods in a study of the same object or event to depict more accurately the phenomenon being investigated The literature exploring the merits of triangulation is incomplete However, it is reported that triangulation, by reconciling the paradigmatic assumptions inherent to quantitative and qualitative methods, provides rich and productive data Triangulation does offer an alternative to the bi‐polar quantitative and qualitative approaches and a means of reconciling the two methodological encampments
Identifying alternative linkages among philosophy, theory and method in nursing science
Authors: Kim Hesook Suzie
Published: July 2003

The major concerns expressed in the literature regarding the development and expansion of nursing science stem from questions related to ‘what sorts of science’ and ‘which scientific methods’ are appropriate for nursing While there is a sector of nursing's scientific community that advocates a unified approach to philosophy and method, a growing sentiment for the position of philosophical and methodological pluralism is apparent This paper addresses the nature of scientific pluralism by presenting a framework for alternative linkages possible among the philosophy, theory and method appropriate for nursing science The nature of nursing knowledge that is produced within the discipline will thus depend on various forms of alternative linkages adopted by nursing scientists in addressing nursing's scientific questions In turn, such pluralism presents problems of choice to nurses in practice with respect to knowledge utilization
Can we insulate trainee nurses from exposure to bad practice? A study of role play in communicating bad news to patients
Authors: Parathian AR , Taylor F
Published: July 2003

This paper investigates the effects of three different role models in teaching trainee nurses to cope with the sensitive task of communicating a traumatic event to patients or their relatives This is a long‐standing problem with a high level of dissatisfaction within the field of nurse training This study, in contrast to other studies of telling bad news (TBN), has focused on the person who gave rather than received bad news This study also reinforces the view that role play and role modelling are not only effective learning methods in nurse training but are natural methods of learning in the profession Student nurses are constantly exposed to other people's attempts at caring Eighteen student nurses were randomly selected from a total student intake of 66 students for study in depth Nine main skills were identified in a TBN task Six student nurses were exposed to negative examples of a novice telling bad news, six to an expert model doing it and six to both models The results showed that nurses learned quickly from role models, whether it was the negative instance of a poor model or the positive instance of an expert model or a combination of both No significant difference in effectiveness between the three models was observed The findings are discussed with reference to implications for nursing education in general
The perspective of student nurses and their perceptions of professional nursing during the nurse training programme
Authors: Andersson Ewa Pilhammar
Published: July 2003

This study was undertaken to identify what preconceptions student nurses have of nursing when they enter the nurse training programme at university and how these views change during the course The term ‘perspective’ was chosen to describe how the students view themselves, their environment, ways of thinking and feeling about nursing and the opportunity to act in nursing and educational situations The data for this ethnographic study were collected by means of participant observations, interviews and document analysis The subjects were 41 nursing students enrolled in the nursing programme at a school of nursing in the Swedish Midlands Four different ways of perceiving the nursing function are discerned from the descriptions of the task, status and personality traits associated with nursing The results indicate that student nurses perceive nursing in a very traditional way and that their perceptions tend to be stable during the training period The findings suggest that about one‐third of the students develop a new perspective and a self‐concept as a nurse during the course, but the traditional image of the nurse persists
Identifying a role for the nurse teacher in the clinical area
Authors: Owen Sara
Published: July 2003

This paper describes a project which sought to identify a model to provide direction for nurse teachers working in clinical areas Using an action research approach, the clinical teaching role was explored by working with trained nurses on one psychiatric ward Two action plans were formulated, implemented and evaluated The first involved working towards improving the learning environment and the second towards developing the ward manager's teaching role The author concludes by recommending that teachers need to adopt a multi‐dimensional role in the clinical area working as researchers, teachers and change catalysts
Expectation and evaluation of occupational health nursing services, as perceived by occupational health nurses, employees and employers in the United Kingdom
Authors: Yoo K‐H , Ashworth PM , Boore JRP
Published: July 2003

A structured questionnaire was used to investigate the relationship between expectation and evaluation of occupational health nursing services as perceived by providers (nurses) and receivers (employers and employees) in the United Kingdom The response rate was 66·55% (254) from nurses, 5132% (194) from employees and 44 97% (170) from employers Data from 144 triads of nurse, employer and employee were used to test 13 null hypotheses, which were all rejected The strong positive correlation between nurses', employers’ and employees’ expectations and evaluations indicates that, on the whole, their expectations were met However, there were differences in the extent to which this was so and the level of expectation varied between groups Nurses perceived themselves as not meeting their high expectations as well in non‐traditional (care‐supportive) as in traditional (care‐orientated) services On the whole, employers had significantly lower expectations than nurses, except in the area of care and treatment Employees had high expectations of preventive services, but their lower evaluations indicate that these were not met Discussion of these and other findings suggests that employers need education on the value and scope of occupational health nursing, and a model may assist nurses’ conceptual understanding of it
An examination of touch between nurses and elderly patients in a continuing care setting in Northern Ireland
Authors: McCann Kathleen , McKenna Hugh P
Published: July 2003

The use of touch is an inherent part of nursing practice This investigation examined the amount and type of touch received by elderly patients from nurses It also attempted to assess elderly patients’ perceptions of instrumental and expressive touch given by nurses The Extended Model of Interpersonal Interaction formed the conceptual framework for the study Non‐participant observation and semi‐structured interviews were the methods employed for data collection Results tentatively suggest that most nurse‐patient touch interactions in a care of the elderly ward are instrumental in nature Expressive touches are predominantly given to body extremities The gender of the nurse initiating touch and the part of the body touched influence the elderly patients’ perception of the touch interaction In particular, expressive touching behaviours by nurses that involve the leg, face and around the shoulders are perceived as uncomfortable The only touching behaviour perceived as comfortable by all respondents was instrumental touching of the arm and shoulder by a female nurse Elderly patients may misinterpret the goal or the motivation behind touch initiation by a nurse Therefore, an awareness and a sensitivity towards elderly patients’ needs and desires for tactile communication are required by nurses
The nursing shortage in the United States of America: an integrative review of the literature
Authors: Janiszewski Goodin Heather
Published: July 2003

Aim.  The aims of this paper are to review the literature to determine what factors are contributing to the nursing shortage in the United States of America (USA) and discuss possible solutions to this current and future nursing shortage.

Background.  The need for nurses is often depicted as cyclical in nature. Throughout history, the USA has experienced a series of nursing surpluses and shortages. However, the current shortage has been characterized as being unlike those experienced in the past. Trends of an ageing Registered Nurse (RN) workforce and limited supply to fill the impending vacancies are some of the unique aspects that bring a new dimension to an old problem. Today's nursing shortage will not be resolved by simply returning to the solutions of yesteryear, and strategies to reduce its impact will have to be more creative and focus on the long‐term.

Methods.  Integrative literature review of published literature on the current nursing shortage in the USA from 1999 to 2001.

Discussion.  Four main areas were identified as the major contributors to the nursing shortage in the USA: the ageing RN workforce; declining enrolment; the changing work climate; and the poor image of nursing. Solutions to the shortage followed similar themes to the contributing factors and encompassed four main areas: exploring recruitment efforts; exploring retainment efforts; improving the image of nursing; and supporting legislation that helps to rectify the shortage.

Conclusion.  There is firm evidence that the USA amidst a nursing shortage. Much is known about the many contributing factors but now nurses need to become proactive to help secure the future of their workforce. By forming partnerships within the profession and with other influential parties, nurses can be in the forefront of resolving their workforce issues.
Reconstructing mental health nursing in home care
Authors: Magnusson Annabella , Severinsson Elisabeth , Lützén Kim
Published: July 2003

Background.  Psychiatric care for people in Sweden with long‐term mental health problems has shifted from institutional to community and home settings.

Aim.  The aim of this study was to explore and describe mental health nurses’ experiences of how structural changes in mental health nursing influence interaction when providing home care to patients with long‐term mental health problems.

Method.  We conducted interviews with 11 mental health nurses who provided home care to people with long‐term mental health problems. The constant comparative method of grounded theory was used for data collection and analysis.

Findings.  The process of attempting to reconstruct mental health nursing by entering into the everyday reality of people with long‐term mental health problems was identified as the core category. Central to this process was a change in perspective from nurse‐controlled to client‐centred care. This led to changes in moral values, assessment of client needs, and ways of meeting clients and establishing relationships. However, attempts to reconstruct mental health nursing according to a client‐centred perspective became problematic when clients were at risk of harming themselves. In these situations, respondents felt the need to make decisions for clients, and this was experienced as burdensome and lonely.

Conclusions.  Our study indicates that the process of reconstructing mental health nursing in line with a client‐centred perspective is incomplete. Opportunities to interact with people with mental health problems in the home environment may lead to a broader perspective on the daily lives of these people, but also to a realization that home care cannot be modelled on institutional care.
Eating difficulties after stroke
Authors: Perry Lin , McLaren Susan
Published: July 2003

Background. Stroke is a common and enduring problem, producing a wide range of effects that may impact on all aspects of life. One area that has seldom been investigated is the effects of stroke on ability to eat and, particularly, stroke survivors’ subjective experiences of eating‐related difficulties.

Aim. To investigate stroke survivors’ reports of eating‐related experiences 6 months after stroke.

Methods. Participants were 206 survivors of acute stroke who were admitted to hospital between March 1998 and April 1999. Those able to communicate and who gave informed consent participated in a semi‐structured interview and assessment of eating abilities in their homes 6 months after their stroke. Interviews were tape recorded and transcribed and 113 interviews with eating disabled participants were entered onto QSR NUD*IST 4 for thematic analysis. Analyses were later checked independently.

Findings. At 6 months, 34%, 61% and 5% had no, slight and moderate eating disablements, respectively. A range and variety of difficulties were discussed, but relationships between degrees of disablement and handicap were not straightforward; effects seemed more closely related to participants’ responses than objective difficulties. Eating and related activities were clearly important aspects of life for these stroke survivors, socially and psychologically, as well as functionally. Prestroke activities were sometimes maintained, with considerable effort.

Conclusions. Findings indicated issues of relevance for those involved with early rehabilitation interventions and highlighted aspects of continuing care service delivery that warrant review. The relative lack of attention paid to eating‐related aspects of care is an important oversight.
Self‐efficacy training for patients with end‐stage renal disease
Authors: Tsay Shiow‐Luan
Published: July 2003

Background.Patients with end‐stage renal disease often fail to follow a prescribed diet and fluid regimen, which undermines the effectiveness of care and leads to unpredictable progression of the disease and greater likelihood of complications.

Aim.The purpose of this randomized controlled study was to examine the effectiveness of self‐efficacy training on fluid intake compliance.

Methods.This study took place in northern Taiwan. Eligible patients were receiving routine haemodialysis; 20–65 years of age; living in a community setting; able to read and write; and willing to participate. Sixty‐two end‐stage renal disease patients participated in the study. Those in the experimental group (n = 31) received 12 sessions of structured self‐efficacy training; the control group patients (n = 31) received only routine care. The intervention was based on Bandura's theory and included an educational component, performance mastery, experience sharing, and stress management. The outcome measure was the mean body weight gain between dialysis sessions. Data were collected at baseline, 1, 3 and 6 months following the intervention and analysed by a descriptive and repeated‐measuresanova.

Results.Experimental group mean weight gains decreased gradually following self‐efficacy training. However, control group mean weight gains decreased only slightly over time. These results were statistically significant when baseline differences controlled for (P < 0·05).

Conclusions.The study supports the effectiveness of the self‐efficacy training in controlling mean body weight gains of end‐stage renal disease patients receiving haemodialysis.
Patient on display – a study of everyday practice in intensive care
Authors: Wikström Ann‐Charlott , Sätterlund Larsson Ullabeth
Published: July 2003

Background. This study investigates the situated organization in a workplace producing intensive care, that is an intensive care unit (ICU). The workplace research tradition concerns work and interaction/communication in technology‐intensive environments. Communication is seen as social action and cannot be separated from production or from the context in which the activities are situated.

Aim. The aim of the present study was to explore how intensive care is produced by analysing a recurrent situated activity in the ICU, namely the delivery and reception of a patient coming from the operation unit.

Method. In the fieldwork, participant observations was used to study everyday practice in an ICU, combined with written field notes.

Findings and discussion. Intensive care is to a great extent produced through routine practices. The division of labour is marked and is taken for granted: everyone knows what to do. The actors’ physical location in the room is connected to their functions and work with supportive tools. Verbal reports, visual displays and activities make the information transmission available to everyone in the patient room. Shared understanding of the situation seems to make words redundant when the activities of competent actors are co‐ordinated. There is also coordination between the actors in the ICU and the technological equipment, which constantly produces new information that must be interpreted. Enrolled Nurses are physically closest to the patients, the physician is the one most physically distant from patients and Registered Nurses bridge the gap between them. These actors produce and re‐produce intensive care through constant sense‐making in the here and now at the same time as the past is present in their activities.
Effects of episiotomy on bonding and mothers’ health
Authors: Karaçam Zekiye , Eroğlu Kafiye
Published: July 2003

Background. Historically, episiotomy has been carried out during labour to facilitate delivery, shorten the duration of the second stage and prevent spontaneous lacerations. However, recent studies of episiotomy have recommended that it be carried out only when necessary. In Turkey, midwives are authorized to perform episiotomy.

Aim. To analyse the effects of episiotomy on mothers’ health and mother–infant bonding.

Design. A cohort study of 100 women who gave birth by normal vaginal delivery in a Turkish hospital between 15 March 1999 and 6 April 2000.

Methods. Participants were divided into episiotomy (n = 50) and control (n = 50) groups. Data on biographical characteristics and the process of labour were collected in hospital, and follow‐up was conducted at home 1, 3 and 12 weeks after labour.

Results. Mean duration of the second stage was longer in the episiotomy group than the control group, but the difference was not significant. The number of spontaneous lacerations was significantly lower in the episiotomy group. Mean time from delivery to maternal rest and time taken to bond with the infant were significantly longer in the episiotomy group. There were significantly higher scores for overall incidence and severity of pain on the first day, and pain incidence and severity at 1 week in the episiotomy group. Significantly fewer women in the episiotomy group were able to do chores and to sit/stand up comfortably in the first postpartum week

Conclusion. Episiotomy should not be used unless indicated. Measures should be taken to avoid perineal trauma during labour, establish bonding between mother and infant as soon as possible, and minimize perineal discomfort after delivery.
Bullying in the nursing profession
Authors: Randle Jacqueline
Published: July 2003

Background. Self‐esteem is a major predictor of behaviour. Nurses with healthy self‐esteem are likely to deliver therapeutic patient care, while those with low self‐esteem are less likely to do so.

Aim. The aim of the 3‐year study discussed here was to explore students’ self‐esteem and how their experiences of preregistration education influenced its development over the period of the programme.

Research methods. Students participated in unstructured qualitative interviews at the beginning and end of their 3‐year preregistration course and a grounded theory approach was used for data collection and analysis.

Findings. Bullying was found to be commonplace in the transition to becoming a nurse. Students were bullied and also witnessed patients being bullied by qualified nurses. The internalization of nursing norms meant that students then bullied others. Students’ self‐esteem was low.

Conclusion. Bullying, and its effects on self‐esteem, are perpetuated by practices within nursing. This situation will only be changed if nurses and educators transform their practice and the context in which bullying occurs. Otherwise, each new generation of nurses will continue to be socialized into negative practices which undermine both their own feelings of self‐worth and standards of nursing care.
Critical realism: a way forward for evaluation research in nursing?
Authors: McEvoy Phil , Richards David
Published: July 2003

Background. Critical realism is a relatively new philosophical perspective that combines a realist ontology with a relativist epistemology in subscribing to a form of ‘robust’ relativism. The potential benefits of adopting a critical realist approach are considered in two areas of evaluation research: theory‐driven programme evaluation and policy evaluation.

Aim. The aim of the paper is to identify the main features of critical realism and explore its potential as a philosophical framework in the field of evaluation research.

Conclusion. We argue that critical realism provides a coherent framework for evaluation research that is based on the understanding of causal mechanisms. This is particularly important for frontline services seeking to use evidence‐based interventions, as interventions need to be properly understood if they are to be used effectively in the context of clinical practice. Critical realism can also add depth to policy analysis. However, there is a potential for critical realists to drift beyond the boundary that separates scientific knowledge from speculative theory when making recommendations about the best course of action to follow.
Improving documentation using a nursing model
Authors: Björvell Catrin , Wredling Regina , Thorell‐Ekstrand Ingrid
Published: July 2003

Background.The present investigation is part of a study where the Registered Nurses on three hospital wards received a 2 year intervention programme on nursing documentation in accordance with a keyword structure based on the nursing process.

Aim.To describe the Registered Nurses’ perceptions of and attitudes towards the effects of the intervention, and to generate hypotheses for further research.

Method.Focus group discussions were used to collect data, with a qualitative content analysis method for the processing of the data.

Findings.The most interesting finding in these group discussions was the statements made by participants that the structured way of documenting nursing care made them think more, and think in a different way about their work with their patients. Two types of role changing were reported; from a medical technical focus to a more nursing expertise orientation and from a ‘hands on clinician’ to more of an administrator and secretary.

Conclusion.A number of issues debated among the participants in this study could be seen as organizational matters and lead to the important issue of multidisciplinary and organizational work when implementing innovations within nursing.
The role of visually rich technology in facilitating children's writing
Authors: Vincent J.
Published: July 2003

Abstract A significant sample of children in any class may be categorised as having a preferred visual learning style. The writing outcomes of a case study group of five upper primary children with a strongly preferred visual learning style were examined when the children were encouraged to write with the aid of a computer and a visually rich software medium. A constructionist classroom environment was established in which children were exhorted to dare to experiment, play and problem set, especially when using microworlds and laptop computers. The writing outcomes of this group grew in volume and linguistic complexity when the students were offered the opportunity to use the visual and animation features of the software at the same time as engaging in narrative writing tasks. These outcomes are situated in recent neuro‐psychological theory of the role of the right brain hemisphere as a platform for language development and comprehension, and suggest the possible vital place of computers in the full realisation of their potential by children with a visually preferred learning style.
Correction of autofocusing errors due to specimen tilt for automated electron tomography
Authors: Ziese U. , Geerts W. J. C. , Van Der Krift T. P. , Verkleij A. J. , Koster A. J.
Published: July 2003

Transmission electron microscopy images acquired under tilted‐beam conditions experience an image shift as a function of defocus settings – a fact that is exploited as a method for defocus determination in most of the automated tomography data collection systems. Although the method was shown to be highly accurate for a large variety of specimens, we point out that in its original design it can strictly only be applied to images of untilted samples. The application to tilted samples and thus in automated electron tomography is impaired mainly due to a defocus change across the images, resulting in reduced accuracy. In this communication we present a method that can be used to improve the accuracy of the basic autofocusing procedures currently used in systems for automated electron tomography.
Conventional, confocal and two‐photon fluorescence microscopy investigations of polymer‐supported oxygen sensors
Authors: Bowman R. D. , Kneas K. A. , Demas J. N. , Periasamy A.
Published: July 2003

Luminescence‐based, polymer‐supported oxygen sensors, particularly those based on platinum group complexes, continue to be of analytical importance. Commercial applications range from the macroscopic (e.g. aerodynamic investigations in wind tunnels, monitoring of oxygen concentration during fermentation, and measurement of biological oxygen demand) to the microscopic (e.g. imaging of oxygen in blood, tissue, cells and other biological samples). Problems hindering the design of improved oxygen sensors include non‐linear Stern–Volmer calibration plots and the multi‐exponentiality of measured lifetime decays, both of which are attributed primarily to heterogeneity of the sensor molecule in the polymer support matrix. Conventional, confocal and two‐photon fluorescence microscopy have proven to be invaluable tools with which the microscale heterogeneity and response of luminescence‐based oxygen sensors can be investigated and compared to the macroscopic response. Results obtained for three ruthenium(II) α‐diimine complexes in polydimethylsiloxane polymer supports indicate the presence of unquenched microcrystals within the polymer matrix that probably degrade oxygen quenching sensitivity and linearity of the Stern–Volmer quenching plot. Two‐photon fluorescence microscopy proved most useful for imaging microcrystals within sensor films, and conventional microscopy allowed direct comparison between microscopic and macroscopic sensor response. The implications of the results in the rational design and mass production of luminescence‐based oxygen sensors are significant.
In vivo response to HA‐polyhydroxybutyrate/polyhydroxyvalerate composite
Authors: Luklinska Z. B. , Schluckwerder H.
Published: July 2003

This study examined the morphological and compositional structure of bone–implant interfaces after in vivo implantation into the tibias of rabbits. The implants were composed of biodegradable polyhydroxybutyrate/polyhydroxyvalerate copolymer reinforced with synthetic hydroxyapatite (HA) particles. Optical and scanning electron microscopy techniques were used, including energy‐dispersive X‐ray analysis. The interface was found to be morphologically, biologically and chemically active throughout the period of study. There was a strong tendency to rebuild the bone structure at the interface after implantation, independent of the composition of the implant, but direct bone bonding with the implant depended on the bioactive nature of the interface, as represented by the HA particles. At all implantation times, lamellar bone formed at the interface and replaced degrading polymer matrix, while engulfing HA filler particles. In regions about 50–100 from the interface, the bone region displayed an osteon organization. Osteoblasts and osteocytes were identified throughout the interface region. The thickness of the newly formed bone significantly increased over the period of the experiment from about 130 µm at 1 month to about 770 µm at 6 months. Materials that behave in this manner may be useful in some bone replacement therapies.
A simple approach to the determination of the crystallographic orientation: applications and accuracy
Authors: Wang S. C. , Starink M. J.
Published: July 2003

A simple analytical solution for the crystallographic orientation is described. This method is based on one indexed Kikuchi pair in a known zone rather than the corresponding diffraction spots. The accuracy of this method is shown to be better than 0.1° even for cases in which a zone axis deviates by a large angle (e.g. 10°) from the centre of the beam direction. This approach simplifies experiments beacuse only one pair of Kikuchi lines and a zone axis are needed, and is especially suited when it is difficult or cumbersome to resolve a second pair of Kikuchi lines with sufficient accuracy.
All‐digital image capture and whole‐field analysis of ciliary beat frequency
Authors: Sisson J. H. , Stoner J. A. , Ammons B. A. , Wyatt T. A.
Published: July 2003

We hypothesized that a high‐speed all‐digital video imaging system, with computerized analysis, would precisely capture and measure ciliary beat frequency (CBF) and would shorten the time from data capture to data analysis. We compared a conventional analog video system with a new high‐speed digital system we developed for CBF analysis. Using ciliated primary bovine bronchial epithelial cells we made simultaneous analog and digital CBF measurements of the same region of interest (ROI) while temperature was varied. This yielded nearly identical data over a wide range of frequencies (7–15 Hz) using either system. Unlike the digital system however, the analog system did not accurately detect CBF above 15 Hz (temperatures higher than 30 °C). We also compared ROI analysis with a new analysis algorithm we have named whole‐field analysis (WFA). WFA measurement of CBF agreed with ROI and reduced operator time required to analyse data by more than 90% compared with the analog system. We conclude that all‐digital computerized CBF analysis correlates closely with standard video methods, markedly speeds up data analysis and provides new ways, including WFA, to analyse entire fields of motile cilia simultaneously. We have termed this system ‘Sisson–Ammons Video Analysis’ (SAVA).
Statistical analysis of intramembranous particles using freeze fracture specimens
Authors: Schladitz Katja , Särkkä Aila , Pavenstädt Iris , Haferkamp Otto , Mattfeldt Torsten
Published: July 2003

We studied the point processes of intramembranous particles of mitochondrial membranes from HeLa cells using the freeze fracture technique. Three groups – under normal conditions, after exposition with rotenone, and after exposition with sodium acid – were compared. First, we used several summary statistics in order to study the two‐dimensional point patterns of intramembranous particles within each group. Then, we compared the patterns in different groups by bootstrap tests using the K‐function and the nearest neighbour distance function G(r). Estimation of the G‐function provided significant results but no significant differences between groups were found using the classical K‐function; estimation of G(r) should therefore not be omitted when studying observed planar point patterns.
Wavelet‐based image restoration for compact X‐ray microscopy
Authors: Stollberg H. , Boutet De Monvel J. , Holmberg A. , Hertz H. M.
Published: July 2003

Compact water‐window X‐ray microscopy with short exposure times will always be limited on photons owing to sources of limited power in combination with low‐efficency X‐ray optics. Thus, it is important to investigate methods for improving the signal‐to‐noise ratio in the images. We show that a wavelet‐based denoising procedure significantly improves the quality and contrast in compact X‐ray microscopy images. A non‐decimated, discrete wavelet transform (DWT) is applied to original, noisy images. After applying a thresholding procedure to the finest scales of the DWT, by setting to zero all wavelet coefficients of magnitude below a prescribed value, the inverse DWT to the thresholded DWT produces denoised images. It is concluded that the denoising procedure has potential to reduce the exposure time by a factor of 2 without loss of relevant image information.
Preparation of site‐specific cross‐sections of heterogeneous catalysts prepared by focused ion beam milling
Authors: Haswell R. , McComb D. W. , Smith W.
Published: July 2003

Focused ion beam (FIB) milling offers a novel approach to preparation of site‐specific cross‐sections of heterogeneous catalysts for examination in the transmission electron microscope (TEM). Electron‐transparent sections can be obtained without the need to embed or grind the original sample. Because the specimen can be imaged in the FIB with submicrometre resolution before, during and after milling it is possible to select precisely the region from which the section is removed and to control the thickness of the section to within tens of nanometres. The ability to produce sections in this way opens the possibility of studying a range of catalyst systems that have previously been impossible to examine with the TEM.
Four‐dimensional imaging and computer‐assisted track analysis of nuclear migration in root hairs of Arabidopsis thaliana
Authors: Van Bruaene N. , Joss G. , Thas O. , Van Oostveldt P.
Published: July 2003

Nuclear migration is a fundamental mechanism necessary for the proper growth and development of many eukaryotic organisms. In this study root hairs of Arabidopsis thaliana were used as a research model to gain insight into the dynamics of nuclear migration. Root hairs are long tubular outgrowths of epidermal cells and are responsible for the uptake of water and nutrients. During the development of root hairs, the nucleus migrates into the hair after the bulge is formed. The position of the nucleus relative to the tip plays an essential role in the growth process. However, what is happening to the nucleus in full‐grown root hairs is still unclear. To study nuclear dynamics in living root hair cells, stably transformed plants with the fusion proteins Histone2B‐YFP and NLS‐GFP‐GUS were used. Four‐dimensional confocal laser scanning microscopy made it possible to monitor the exact position of the nucleus in different root hairs. To analyse the sequential positions of the nuclei in the root hairs, a new computer‐assisted method was developed. After track analysis a number of parameters could be extracted from the movies, such as the average speed, the amplitude, direction factor and the range of movement in the root hairs. Our results show that nuclei do not reach a final position in full‐grown root hairs and this sustained movement seems to be more similar in root hairs lying close to each other. Moreover, with this methodology it could be quantitatively demonstrated that the integrity of actin is necessary for nuclear movement.