bluuebunny/crossref_metadata_2025 huggingface dataset:
The BARRIERS scale: Does it 'fit' the current NHS research culture?
Authors: Closs S. Jose , Bryar Rosamund M.
Published: March 2006

The BARRIERS scale was developed in the US as a method of identifying the main barriers to research utilisation reported by nurses. However, its appropriateness for assessing such barriers in the UK is not clear. The current drive for evidence-based practice makes it desirable to assess the availability of an instrument to measure the progress of nurses who have implemented research. Information about the appropriateness of the BARRIERS scale for use in the UK would allow its potential as a monitoring instrument to be assessed. This paper is a section of a wider study aimed at producing a general picture of the underlying types of barrier to the implementation of research findings. Objectives included exploring those factors which acted as barriers to research implementation; assessing the construct validity and the internal consistency of the BARRIERS scale in the UK; and identifying barriers which might be excluded or added in future studies.

A census survey of practice nurses and nurses from two hospital and two community trusts within one health authority, and one community trust from another health authority, was undertaken. The BARRIERS questionnaire was sent by mail to 4,501 nurses, with a 44.6% response rate.

Exploratory factor analysis was used to identify key factors underlying the 29 items of the BARRIERS scale which acted as barriers to the utilisation of research findings. Four factors were identified, which were conceptualised as: the benefits, quality and accessibility of research, and resources for implementation. These were similar, but not identical, to factors identified in the original US study. One factor appeared mainly to be concerned with critical appraisal, which could be considered to be a facilitator rather than a barrier. More than one-fifth of the original items were not included in the UK model. Under-reported (mainly research issues) and additional barriers (mainly organisational issues) were identified.

The four-factor solution was roughly comparable with that derived in the US, although fewer items were retained (22 instead of 28), and some of the factors were conceptually a little different. It was concluded that the internal reliability of the four-factor solution was fair. The scale may not be suitable for use in the UK without further development: a scale which includes positive as well as negative aspects of research culture, with a greater emphasis on organizational issues, may be more useful.
Substance misuse in older adults: An emerging policy priority
Authors: Phillips Peter , Katz Anthony
Published: March 2006

Demographic trends suggest that substance misuse is increasing significantly in the general population and is becoming the most prevalent psychiatric disorder. As the current younger generation ages, there will be significant implications for the provision of general and mental healthcare to this population. The generation most closely associated with a massive increase of illicit drug use ('the baby boomers') is approaching what is considered to be old age. Defining what constitutes drug and alcohol use and misuse among older people remains fraught with difficulties because of the problem of determining what constitutes both old age and drug and alcohol misuse. The few studies that exist are difficult to compare owing to methodological inconsistencies. Against this background, the current research evidence is described, and recommendations are made for healthcare policy changes to accommodate the needs of this population
Substance use and misuse: A public health perspective
Authors: Hussein Rassool G. , Marshall Fiona
Published: March 2006

Drug, alcohol and tobacco misuse (generically known as substance misuse) is a universal phenomenon that affects all levels of society. Increasing drug use generally has caused a host of social, behavioural, psychological and physical problems among populations. Substance use and misuse impinges on the five key areas for health promotion outlined in the Health of the Nation document (DoH, 1992): coronary heart disease and stroke, prevention of accidents, cancer, sexual health, mental health. The widespread misuse of psychoactive substances in the general population demands a healthcare workforce that can offer nursing interventions; is capable of providing effective preventive strategies; can offer counselling; and is qualified to give specialist care when necessary to substance misusers and their families.

The care of substance misusers is not the domain of any one profession or organisation, although professionals in both primary healthcare and hospital settings are usually the first point of contact for clients who have potential or even early substance use problems. From the late '80s, prevention and treatment have become much higher on the political and service agendas. Public health campaigns have been introduced that maximise awareness of the risks of tobacco smoking, of drink driving, and of the misuse of over-the-counter drugs, alcohol, prescribed and illicit drugs. As a result, the public health triangular model, which involves interaction between the host (the individual), the agent and the environment, has become more prominent. The increase in substance misuse means that research that identifies why nurses and other healthcare workers are unable to identify the factors that lead to substance misuse is of paramount importance. If nurses and other healthcare professionals are to respond to substance misusers, there need to be new models of care from those that have traditionally guided the work of generic healthcare professionals. This paper considers substance misuse in general, but concentrates particularly on drug misuse.
Organisation of care: Primary care organizational responses to mental health needs
Authors: MVcCollam Allyson , Hopton Sane
Published: March 2006

This paper considers a number of factors that give renewed prominence to organizational dimensions in developing primary care responses to mental health needs as the context for a new collaborative research programme in this area.

A typology is proposed to describe a range of organizational responses to mental health need in primary care. This serves to draw attention to the fact that research and practice and service development have tended to focus on organizational arrangements that clarify the relationship between primary care and secondary mental health services and relate largely to the care and treatment of people with severe and enduring mental illness, with considerably less exploration of other forms of organisational responses for different types of mental health need.

The authors conclude by suggesting the need to develop greater understanding of lay perceptions of mental health and mental health needs, along with further exploration of help-seeking behaviour and of factors that promote self-care.
Factorial survey methods: A valuable but under-utilised research method in nursing research?
Authors: Lauder William
Published: March 2006

This paper describes the uses of factorial survey research methods. These were originally developed to measure social judgements, but have been developed to measure a large and diverse range of judgements. The method combines Feature of Both surveys and experimental methods and as such is a cost-effective way of sampling large numbers of subjects in a design which allows for manipulation and control of variables. The method is still being refined and issues such as sampling, development of vignettes, data management and data analysis are critically evaluated.
The hopes of the dying: Examining patients' experience of participation in early phase cancer clinical trials
Authors: Cox Karen
Published: March 2006

This paper presents a theoretical examination of the key findings from a longitudinal qualitative study of the experience of cancer clinical trial participation. The aim of the study was to identify the psychosocial impact of participating in early phase trials as experienced by the patients themselves; it sought to discover and interpret their ways of coping with what was happening to them and identify the meaning and consequences of trial involvement. The picture of trial involvement that emerged from the study was of a dynamic and changing experience that had a different impact and meaning for patients as they progressed through the trial process. When reflecting on the stories and experiences presented by those interviewed, the importance of two major themes in relation to how patients experienced trial involvement began to emerge: hope and dying. In order to explore and examine further the patients' trial experience revealed by this research, some of the theoretical perspectives on the emergent themes of hope and dying are examined and discussed. By engaging with some of the current theories on dying and hope and applying these to key points in the trial experience, an attempt is made in this paper to explain patients' behaviour in, and experience of, clinical trial participation.
Open awareness and dying: The use of denial and acceptance as coping strategies by hospice patients
Authors: Copp Gina , Field David
Published: March 2006

This paper examines the use of denial and acceptance as interdependent and fluctuating coping strategies by dying patients in a hospice, and discusses some of the reasons why denial and acceptance operate for these patients. 'Open awareness' of dying is now accepted as a central feature of palliative care, and full disclosure of prognosis and diagnosis is seen as a desirable element of care for patients who are dying. However, such openness is not without its tensions and conflicts. The study was conducted in a hospice where patients and nurses interact within an 'open awareness' context and where most patients live in the knowledge of 'certain death but at an unknown time'. The paper examines use of denial and acceptance by hospice patients at various times during their dying.

The data are derived from the findings of a prospective qualitative study on the experiences of 12 hospice patients and those of their nurses. Unstructured interviews and participant observation were used as the primary methods of collecting data. Data from interviews were coded and comparative analyses between cases were performed.

Denial and acceptance of dying among patients fluctuated during the period of dying and appeared to form an important aspect of their coping process. Denial and acceptance appeared to be used to avoid threats as well as to preserve existing relationships within the context of open awareness.

In contrast to some commonly held beliefs, which tend to view denial and acceptance as 'singular, either/or entities', denial and acceptance are best seen as interdependent and fluctuating strategies, used continually by dying patients.
A survey of sexual activity in HIV-positive gay men
Authors: Docherty Brendani Q.
Published: March 2006

The aim of this study was to explore the sociopsychological influences that affect decision-making processes regarding sexual practice before and after becoming infected with the human immunodeficiency virus (HIV). It was hoped to identify and describe the factors that influence sexual practices using multiple regression methods and to explore in more detail, using qualitative methods, the issues for gay men.

The study randomised participants to complete a questionnaire which included the short General Health Questionnaire (GHQ-12) and the National Survey of Sexual Attitudes and Lifestyles (NASSAL) questionnaire; carried out in-depth semi-structured interviews and invited participants to take part in a focus group. The study was undertaken in an HIV clinic in South London, and completed data from 60 gay HIV seropositive men were included.

Contracting HIV results in a complex disease process, and multiple factors may influence behaviour in sexual practices. Using stepwise regression, the study indicated that the strongest predictor of present and intended future sexual behaviours was past sexual behaviour. The other variable measures were weakly correlated and therefore not significant.

These results indicate that innovative methods to increase condom use in men during their first sexual experiences have to be considered. Although this applies to all age ranges, from this study, younger men (under 20 years) who were experiencing their first exposures to homosexual lifestyle were considered more at risk for learning unsafe sexual behaviours from older sexual partners.
Diana, Princess of Wales Children's Community Team: An evaluation of a multiprofessional service for children with life-limiting illnesses
Authors: Dancers Lesley , Freshwater Dawn , Cheater Franilme , Wilson Andrew
Published: March 2006

Caring for children with life-limiting illnesses in their own homes calls for an informed and knowledgeable healthcare professional. Personal attributes such as compassion and the willingness to take on the role of an 'informed friend' to the child, parents and siblings is crucial, as is the ability to recognise and respect the skills of the parents in caring for their child. As a memorial to the life and work of the late Diana, Princess of Wales, Diana Children's Community Teams were established across the United Kingdom to care for children with life-limiting conditions and their families.

This paper describes the evaluation of the Diana Service in Leicester and the counties of Leicestershire and Rutland. The evaluation has sought to identify the perceptions of the families, the service-users and providers. Both the families and the professionals who access the service have highlighted the need for the enhancement and further development of such an important and invaluable children's community service. Children with life-limiting illnesses and their families require and deserve a seamless service, and the evaluation recommends that this framework of care be developed for other teams of children's community services across the country.
A contribution to the history of learning disability nursing
Authors: Mitchell Duncan
Published: March 2006

This paper summarises a piece of research that considers the place of learning disability nursing within the nursing profession. Taking an historical perspective, the research asks why learning disability nursing became part of the nursing profession, and then explores subsequent debates about its continued presence in nursing. Its methodology is based on an historical approach combined with insights gained from contemporary policy issues within learning disability nursing. Archival material from the General Nursing Council and published material from the nursing press between 1913 and 1959 has been utilised, along with institutional archives and oral history. It is suggested that the history of learning disability nursing has been neglected within the history of nursing, yet on examination of the subject, significant insights were revealed into the current position of learning disability nursing specifically and nursing generally. In particular, the paper suggests that learning disability nursing has been marginalised within the nursing profession because it does not conform to an image of nursing based on ill health.
Developing research capacity: Identifying and quantifying nursing research activity in the NHS
Authors: Tanner Judith , Hale Claire
Published: March 2006

Many hospitals are beginning to implement strategies that should strengthen and support nursing research capacity. One large NHS trust hospital in England wished to identify the level and scope of its nursing research activity to provide a baseline against which to measure future progress and to provide information that would contribute to its capacity-building strategy. The primary aim of the study was to identify the number of research-active nurses within the trust. A 'walkabout', database search and interviews with senior nurses suggested that 34 out of 1,574 nurses (2.1%) were considered to be research active, with 14 of these nurses having at least one publication. When compared with other studies measuring nursing research activity, 2.1% was found to be significantly lower than the findings in all these other studies. However, analysis suggests that the differences in reported levels of research activity might be due to differing sampling methods and various definitions of what constitutes research activity. Comparing extrapolated data (number of publications) from each study suggests that research activity is comparable throughout the UK and in Australia.
Developing a national strategy to promote and extend nursing research in Spain
Authors: Moreno-Casba Teresa , de Frutos-Samninez David
Published: March 2006

The Health Research Funding Agency (FIS) is part of the Institute of Health Carlos III (ISCIII), which provides nationwide economic support for biomedical research project proposals. It is the scientific and technical support for the Spanish Ministry of Health. In 1996, the institute created the group Investén, which in January 2000 became a formal structure entitled the Centre for Coordination and Development of Nursing Research (Investen-isciii).

The centre's main objective is to develop a national strategy to organise and facilitate the integration of nursing research into clinical practice. Its functions are to advise professionals and agencies, public and private institutions interested in nursing research and its dissemination, to coordinate and develop projects, and promote new ones. Since the group's inception, many activities have been developed to encourage research in nursing-related fields, stimulate multidisciplinary research teams, and promote coordination between initiatives led by nursing researchers.

A strategic plan for the next three years includes a range of objectives such as the dissemination of research, fostering development and training of future nurse researchers, providing opportunities for international exchange of research knowledge and experience, and promoting pan-European nursing research collaboration.
Transitions in care: Family carers' experiences of nursing home placement
Authors: Ryan Assumpta
Published: March 2006

With demographic trends predicting an increase in the number of older people and a reduction in the number of family carers (Royal Commission on Long Term Care, 1999), it is likely that admission to nursing homes will continue to increase. Although it might be expected that entry to a nursing home, with an anticipated reduction in 24-hour care, would result in a reduction in stress for carers, evidence to date does not support this expectation. Study findings indicate that this experience is associated with guilt, anger, despair, resentment and general psychological distress (Kellett, 1999; Ryan and Scullion, 2000a; Nolan and Dellasega, 2000; Davies, 2001). Therefore, although the physical burden of caring is relieved following nursing home placement, the emotional turmoil often continues, and is exacerbated by the circumstances surrounding the decision to end home care. Although there is evidence to suggest that, following placement, families are often expected to relinquish their dependent older relative to the bureaucracy of the institution, this is not always in the best interest of the resident, the family or the nursing home staff. This paper examines recent literature on the transition from home care to nursing home care and highlights the need for greater collaboration between families and nursing home staff.
Partnership with care homes: A new approach to collaborative working
Authors: Meehan Lyn , Meyer Julienne , Winter Jane
Published: March 2006

This paper reports ways of working and early findings from the Partnership with Care Homes Project (PCH). PCH is an extension to the ongoing CELEC Action Research Project: Care for Older People that is concerned with the development and evaluation of seven lead research and development nurses. These nurses have responsibility for improving care for older people in seven NHS trusts in North East London in line with the National Service Framework for Older People. Funded originally by CELEC (Central and East London Education Consortium), these nurses are using action research to blur the boundaries between education, practice and research. This innovative way of working has fostered closer working relationships, the cross-fertilisation of ideas and joint working between acute and primary care trusts; general and mental health services; users, carers and professionals; health and social care providers (NHS and voluntary sector), and commissioners and providers of education. The success of the action research project led to the North East London Workforce Development Confederation (CELEC's replacement), giving additional funding to extend the project into the private sector — the Partnership with Care Homes Project.

This work is ongoing and currently 25 care homes (representing more than 1,500 beds) are participating in the project, with the emphasis very firmly on partnership working to meet their education, research and practice development needs. The lessons learned from the project may lead to a new model of commissioning for both education and service delivery which is able to respond more promptly to emergent need. The purpose of this paper is to share the experience of working in this way, explore the early findings and, more importantly, celebrate some of the outcomes that are already emerging from the work.
Research-active nurses' perceptions of the barriers to undertaking research in practice
Authors: Tanner Judith , Hale Claire
Published: March 2006

The aim of the study was to identify how a small group of research-active clinical nurses perceived and overcame the reputed 'barriers' to carrying out research in practice. The nursing literature on research implementation tends to focus on barriers that prevent nurses engaging in research. This study takes a different approach and focuses instead on how some nurses manage to succeed despite the difficulties.

A purposive sample of 12 research-active nurses from one trust was recruited to the study. The small sample was a reflection of the comparatively small number of clinical practitioners involved in research activity. Interviews and rating scales were used to explore the practitioners' attitudes to research in general as well as barriers to research identified through earlier studies. The nurses studied did not consider the commonly perceived barriers to undertaking research to be 'barriers' - some nurses saw them as 'excuses'. The only barriers the nurses acknowledged were staffing, cost and lack of support, but they surmounted these by their determination to carry out their research studies and publish. The study suggests that the main kind of support needed by nurses who want to carry out research is that offered by facilitators, who give them confidence to carry out research and publish their findings.
The primacy of purpose and the leadership of nursing
Authors: Collinson Gill
Published: March 2006

A recent NT Research editorial (Bishop, 2002) posed the following questions: 'Has the nursing profession mapped out a course [for its own development], or are we being manipulated to tread the path of others? And if this is the case, do we mind?' This paper discusses these questions from the perspective of nursing as a form of public service, and explores the challenges, constraints and opportunities that leaders of nursing have in creating a compelling vision for a profession that functions primarily within the public sector. It will also consider various theories of leadership in relation to nursing and offer a concept of leadership that is congruent with the values of public service and which can support the development of the profession in the ever-changing and complex world of healthcare.
An evaluative study assessing the impact of the Leading an Empowered Organisation programme
Authors: Woolnough Helen , Faugier Jean
Published: March 2006

The development of strong, effective clinical leadership is currently high on the political agenda (DoH, 1999; 2000). It is central to the government's modernization agenda and the improvement of patient care and is reflected in the plethora of documents, strategies and initiatives currently permeating the NHS. The Leading an Empowered Organisation (LEO) programme is an integral part of the drive to increase and strengthen clinical leadership among the nursing and allied health professions. The NHS National Nursing Leadership Programme is coordinating the launch of the LEO programme to over 32,050 clinical staff. The programme is designed to create a critical mass of clinical leaders with the ability to make a real difference to patient care.

The study was undertaken as part of a larger evaluation to assimilate evidence regarding the impact of the LEO programme. The research also addressed contact and communication with senior staff and the impact of these on the leadership agenda.

The results indicate that the LEO programme is empowering clinical staff to facilitate new ways of working and providing participants with the practical tools to perform their roles effectively and create an environment in which others can grow and develop. There is still much to be learned from the LEO programme and, as such, the evaluation process continues.
Leading opinion and managing change in complex organizations: Findings from the South Thames Evidence-based Practice project
Authors: McLaren Susan , Ross Fiona , Redfern Sally , Christian Sara
Published: March 2006

Opinion-leaders have been described in the research literature as credible experts, capable of supporting, facilitating or advocating change and influencing health professionals to adopt innovatory, evidence-based approaches to their practice (Lomas et al., 1991; Thomson et al., 1999). However, information is lacking on the complexity of selection and training, and of the role support that is necessary to enable opinion-leaders to function effectively. This paper focuses on the experience of using opinion-leaders to implement practice change as part of a multi-faceted approach within the South Thames Evidence-based Practice project (STEP), drawing on information integrated from a cross-case analysis and the independent evaluation. Key findings are that the opinion-leader role is complex and challenging, and requires a broad balance of research, management and leadership competences to inform selection and training.
A regional evaluation of the impact of the Leading an Empowered Organisation leadership programme
Authors: Werrett Julie , Griffiths Magiie , Clifford Collette
Published: March 2006

This paper reports on an evaluation of the Leading an Empowered Organisation (LEO) leadership programme. The aims of the study were to evaluate the first phase of the programme in the West Midlands Region and to identify changes in practice as a result. The study focuses on the first cohorts on the programme in 2001 and 2002.

The study involved administering a pre-test survey at the outset of the programme and completing a post-test survey of the same group three months after the programme was completed. There were 550 participants in the pre-test and 181 in the post-test.

Data were collected via a structured scale designed to measure perceived importance and use in practice (performance) of 33 dimensions of leadership. Open questions enabled participants to comment on their experience when responding to the post-test.

Analysis of quantifiable data shows differences in performance measure at the post-test in aspects of practice related to team and management issues, staff support and development, and creative management and assertiveness. Qualitative data supported these findings in that they highlighted areas of development since participants had completed the LEO programme.

Further longitudinal evaluation is recommended to monitor the long-term impact of LEO programmes on clinical practice.
Research ethics and complex studies
Authors: Normand Charles , Meyer Julienne , Bentley Jane
Published: March 2006

The operation of research ethics committees in England now follows standard procedures. However, the new ethical review process favours research where research questions and protocols can be clearly specified in advance of the study. While this may not be problematic for those conducting clinical trials, it can prove more difficult for qualitative researchers seeking to study complex and changing environments, such as the health service. Here, the changing nature of the services being investigated and the emphasis placed on involving users and carers in the research process, makes it hard to predict methods in advance of the study. This paper argues for greater flexibility within the ethical review process better to respond to the needs not only of this type of research, but also to other research and development activities, such as audit and practice development. It highlights the need for trust, ongoing dialogue, approval of frameworks and codes of practice.
Research governance and diversity: Quality standards for a multi-ethnic NHS
Authors: Johnson Mark R.D.
Published: March 2006

The NHS and its clinical workforce are committed to evidence-based practice, which requires quality evidence to assist and justify change. Such evidence can be used to inform best practice and to create new standards. The risk is that where needs are under-researched, developments - and resources - can be delayed until relevant research is conducted and completed to adequate standards. New research governance regulations have spelled out what these standards should be. However, black and minority ethnic communities, and individuals, express a high level of 'research fatigue', feeling that they have been the objects of much previous research and experimentation. They therefore question whether there is any reason for delays in the implementation of change. The problem is that 'validated' research often excludes their experiences, while that which includes them is rarely 'best practice' or 'peer-reviewed' research. Nevertheless, it does create evidence, and often the research generated by, or based within, communities holds considerable detail and insight. However, it is not 'owned' in turn by the NHS and the scientific establishment.

The research governance regulations provide a framework that might lead to new understandings of best practice in research, create ownership, and generate more inclusive, equitable research with greater validity in a multi-cultural society. Researchers are urged to consider what would assist them to ensure that their studies meet this ideal and comply with scientific and community-based moral standards.
The turn to a narrative knowing of persons: One method explored
Authors: Jones Kip
Published: March 2006

This paper discusses the increasing use of narrative studies and biographical research in the social sciences as a way of knowing persons. Dangers inherent in the making of false assumptions of knowledge from interviewing and semi-structured probes are noted. Personal experience with the biographic narrative interpretive method is discussed, using examples from my research on identity and the informal care role to explain the method.

The method uses a minimalist-passive interviewing technique and reflecting teams for analysis of data. Microanalysis of the 'lived life' and thematic field analysis of the 'told story' are described. The use of small sample frames to generate meaningful case studies is defended. The interview technique is expanded upon, paying attention to the concept of gestalt. The post-interview reflective process is described, followed by a case being made for analytic induction as both the foundation of grounded theory and an alternative to it. The use of reflective teams is expanded upon vis-a-vismy research. Unique approaches to the data analysis, which developed my use of the method, are argued as adding flexibility to the biographic narrative interpretive method. The paper concludes with a discussion of concepts of truth and veracity in storytelling and the reconstructive process I employed in piecing together images of a whole through the imaginative subjective dramas of everyday lives.
Knowing and acting — A strategic practitioner-focused approach to nursing research and practice development
Authors: McCormack Brendan
Published: March 2006

Clinical outcomes, effective decision-making and the use of evidence in practice have been part of the nursing agenda for many years and a key focus of knowledge generation and utilisation activities in nursing research. However, while this focus prevails, the ability of our organizational systems to support nursing research in practice is still limited. There continues to be a divide between the 'knowledge generators' and the 'knowledge users', and while considerable progress has been made in the use of research in practice, less progress has been made in formally connecting academic and practice communities.

This paper argues for such a connection through a focus on practitioner research — a focus that can enable the sharing of academic and practice agendas at a variety of levels. It will be argued that if we are serious about creating 'research cultures' in practice settings, the most feasible way of doing so is through practitioner research, as this approach integrates knowledge-generation with knowledge-utilisation. A strategic approach to practitioner research in one organisation will be described and implications for research career structures discussed.
Practitioner research: An approach to developing research capacity in primary care
Authors: Bryar Rosamund Mary
Published: March 2006

The development of research capacity is a priority in healthcare. However, little information is available on the outcomes of different approaches to capacity-building. This paper provides a description of the approach taken in a primary health care (PHC) project (Teamcare Valleys) to support the development of research skills by PHC practitioners. The 35 practitioners were all experienced nurses, midwives, health visitors, GPs, practice managers and health promotion specialists. Research capacity development was supported by colleagues with experience in a range of research approaches in PHC and social science research.

A case study was designed to examine the impact of the capacity-building process on the development of research and other skills. Data were collected at the end of the three-year project and five years later to identify the development of research skills and their utilisation in subsequent posts. Evidence indicates that the practitioner researchers developed considerable skills in research and associated areas; for example, in methods of research dissemination. However, their subsequent utilisation of these skills resulted from their own motivation rather than from being a requirement of subsequent posts. It is concluded that development of practitioner research skills needs to be supported by a career strategy enabling clinical research careers in the NHS.
Issues impacting on registered nurses providing care to older people in an acute care setting
Authors: Cheek Julianne , Gibson Terri
Published: March 2006

The worldwide phenomenon of ageing populations in developed countries has led to an increased emphasis on how best to meet the healthcare needs of people aged 65 years and older. One area identified as requiring particular attention is the care provided to older people in acute settings. This paper reports on the findings of an exploratory qualitative study that investigated issues having an impact on registered nurses' ability to care for older people in a publicly funded teaching hospital in Australia. Issues identified pertain to the complexity of managing the healthcare needs of the older person with an acute illness; the acute care environment as being problematic for the older person, and maintaining continuity of care in an often fragmented and under-resourced healthcare system.

It is clear from the study findings that registered nurses in the acute setting play a central and pivotal role in the multidisciplinary team caring for older people with regard to the management and coordination of care as well as in the provision of direct care. However, tensions arise from the curative focus dominant in acute care settings, which privileges and resources technically focused acute care skills and does not place as high a priority on developing appropriate knowledge, attitudes and skills specific to the care of older people.

The findings provide a base from which to progress further research as well as a challenge to those working in acute settings to develop systems of care that maximise the role of the registered nurse in improving outcomes for hospitalised older people.
Exploring suicide risk and the therapeutic relationship: A case study approach
Authors: Dfff Dazsid
Published: March 2006

This paper uses a case study approach to explore issues for mental health nurses in relating with suicidal patients. The phenomenon of 'malignant alienation' is described, whereby the suicidal tendencies of some mentally ill patients are thought to be exacerbated by negative attitudes and interactions with staff and other patients. The study seeks to establish whether such a process can occur with regard to mental health nurses, to explore the process in detail and to identify causative and preventive factors. Case study methodology is used to answer the research questions. The rationale for this methodology is explained. A case study is then presented, demonstrating, first, that the process of malignant alienation can indeed occur as a result of interaction between nurses and a patient whose behaviour they find challenging and, second, that a more positive approach by nurses to the same patient can have therapeutic outcomes.
Identifying priorities for strengthening and developing the nursing contribution in a field of practice: A case study in stroke care
Authors: McMahon Ann , Irwin Penny , Redehan Eion
Published: March 2006

Building on earlier work, this paper describes a coordinated and systematic method for identifying priorities for nursing development within a field of practice. The nursing contribution in stroke care serves as a case study, the primary aim of which was to establish priorities for research and development in stroke care from a nursing perspective. The initiative was a partnership between the Royal College of Nursing and the Stroke Association, supported by the Royal College of Physicians.
Adapting to a new culture: A study of the expectations and experiences of Filipino nurses in the Oxford Radcliffe Hospitals NHS Trust
Authors: Withers Judy , Snowball Jan
Published: March 2006

Many UK hospitals are recruiting nurses increasingly from overseas to alleviate acute shortages. Nurses recruited from the Philippines were chosen for this study because they form the largest group of overseas nurses recruited to the Oxford Radcliffe Hospitals NHS Trust and they are required to undertake an adaptation programme before achieving Nursing and Midwifery Council registration to practise. The study explores the expectations and experiences of nurses from the Philippines and ascertains whether their expectations match their experiences

Following ethical approval, 120 questionnaires were distributed. Data were collected from 45 of the questionnaires and eight semi-structured interviews. Participants were asked the reasons for their migration, their experiences of recruitment, pre-arrival expectations, their thoughts of the trust's adaptation programme, and their good and bad experiences. They were also asked to evaluate the opportunities they were given for training and career development in the trust.

Differences emerged between respondents' high expectations of nursing and living in the UK and their actual experiences. The majority described their financial expectations as being unmet. Many of their experiences were good, but some experienced certain problems during recruitment and in their clinical areas. Some participants also experienced what they perceived as racial discrimination from patients and colleagues.

It was concluded that participants had high expectations of earning more money, of having a higher standard of living and of gaining professionally, but that unmet expectations could lead to dissatisfaction, affect attitudes and behaviour and promote eventual resignation from the organisation. The majority of the ward managers were regarded as being friendly and supportive, and the trust's adaptation programme was thought to be invaluable. However, recipients of discrimination and indifference are reluctant to report incidents, but host staff and recruits can learn from each other and gain mutual benefit.
Randomised controlled trials in the evaluation of non-biomedical therapeutic interventions for pain: The gold standard?
Authors: Walker Jan , Sofaer Beatrice
Published: March 2006

This paper offers a critical review of important issues in the implementation and interpretation of randomised controlled trials (RCTs) used to evaluate non-biomedical therapeutic interventions for pain. The analysis of methodological issues focuses on the validity, relevance and clinical importance of outcome measures; sampling and randomization bias; blinding procedures used to control for the placebo response and therapist influences, and treatment standardisation. A key issue is that pain management is inextricably linked to the establishment of a therapeutic relationship. In such circumstances, it is argued that the 'gold standard' double-blind RCT is impracticable. Those relying on RCTs as sources of evidence need to be aware that an 'unblinded' RCT can enhance placebo responses to the intervention and introduce important sources of bias. The challenge faced by healthcare researchers is to identify alternative research designs able to provide valid and reliable evidence that the proposed therapeutic intervention is capable of achieving cost-effective, clinically important and personally relevant outcomes in naturalistic settings.
Recognising pain as a component of symptom clusters: A means of informing the nursing management of symptoms and side-effects
Authors: Niven Catherine A.
Published: March 2006

This paper argues that pain should not be regarded as a symptom in isolation but as a component of symptom clusters. Recent research on symptom clusters that involve pain is overviewed, together with data from a single case study. These sources of evidence suggest that pain is commonly associated with other symptoms, especially fatigue, and is an important but not necessarily dominant component of clusters of three or more symptoms. Much more research into the interactions between symptoms, their synergistic effects and their impact on the patient's decisions about symptom management is needed. Nurse researchers are ideally placed to play a leading role in this research agenda, given the focus of nursing practice on symptom and side-effect management.
Perspectives on pain: A qualitative analysis of the Hispanic pain experience
Authors: Sherwood Gwen D. , McNeill Jeanette A. , Palos Guadalupe , Starck Patricia
Published: March 2006

As a primarily subjective phenomenon, pain expression may vary among different populations. Patients from minority populations may be more likely to have poor pain management, less analgesia prescribed, and lower doses administered for their pain. To understand better the Hispanic pain experience, qualitative methods were used to gather data from postoperative adult Hispanic patients in both an urban and rural setting regarding their perspective and response to the pain experience. Descriptive qualitative analysis of interview data from a sample (n=35) of predominantly female, married and Catholic respondents, ranging in age from 23-80 years yielded five categories: Characteristics of the pain experience; Managing pain; Information about pain; Interactions with providers, and Cultural considerations. Several themes defined each category and were used in a larger study to develop a Spanish language instrument to measure pain outcomes.

Descriptions of the categories and themes and implications for further research and clinical care are presented. For Hispanic populations, cultural issues having an impact on research regarding pain, such as simpatia (a striving for harmonious relationships without interpersonal conflict), respect, and family involvement, as well as problems with recruitment of minority patients to research studies, must be addressed to improve the effectiveness of pain management for this group.
Making a difference? Teaching communication skills in preregistration nurse education in England. A comparison of Project 2000 and Making a Difference curricula
Authors: Randle Jacqueline , Webb Christine , Jenkinson Tim , Chant Simon , Russell Graham
Published: March 2006

This paper reports on a survey of the teaching of communication skills on pre-registration nursing programmes in England in 2000. Questionnaires were devised for the Common Foundation Programme and the four Branch Programmes. These were sent to academic staff responsible for both Project 2000 and Making a Difference curricula. Comparisons are made between the two curricula, between matched pairs of curricula in institutions offering them both, and according to whether the institutions were designated as pilot sites for the Making a Difference curricula. The overwhelming finding was that there was no difference between any of the particular comparisons made. Lecturer-practitioners were more likely to be used to teach communication skills on Making a Difference curricula, but otherwise the picture was one of inconsistency and widespread differences between curricula and institutions. The lack of a greater emphasis on communication skills in Making a Difference curricula is surprising, given that it is intended to be skills-based. Recommendations are made for further research.
Expanding the case study: The narrative thread
Authors: Alorrie Peter
Published: March 2006

A new research framework is described in this paper, termed 'the narrative thread'. It is a development of the case study, but argues that the paradigm of physical boundaries that has been used to define the case, can be shifted so that it is the phenomenon itself that defines the case, not where the case takes place. In addition, this framework has a number of attractive attributes, in that it is highly flexible, supports an inductive then a deductive approach, and gives formal guidance for both the incorporation of knowledge gained in literature reviews and the generation of theory.
Seeing things differently: Evaluating psychodynamically informed group clinical supervision for general hospital nurses
Authors: Ashburner Charlotte , Aleyer Julienne , Cotter Angela , Youog Guy , Ansell Richard
Published: March 2006

This paper reports the findings from the development of psychodynamically informed group supervision for 52 clinical leaders in nursing at a general NHS hospital over four years. The initiative was evaluated through a variety of methods, underpinned by action research. This paper is based on the findings generated by semi-structured interviews (n=24) and descriptive statistics of staff sickness and turnover.

The findings suggest that clinical supervision using a psychodynamically informed approach helps nurses acknowledge their feelings and see their work from a different perspective; builds confidence; provides support through a crisis and reduces their isolation in their role. Other findings suggest that, while having no impact on staff turnover, clinical supervision might reduce staff sickness. However, not all staff were comfortable with the experiential nature of clinical supervision and there was fragmented attendance at sessions. Embedding supervision into nursing practice remains a challenge; this paper offers an approach that has proved sustainable over four years.