bluuebunny/crossref_metadata_2025 huggingface dataset:
Variations in number and morphology of permanent teeth in 7‐year‐old Swedish children
Authors: Bäckman B. , Wahlin Y.B.
Published: March 2003

Summary.
Objectives. To establish the prevalence of numerical and morphological variations of permanent teeth in Swedish 7‐year‐olds and to accept or reject the hypothesis of a higher prevalence for these conditions in northern Sweden compared to other areas.

Design. Cross‐sectional.

Setting. Department of Odontology/Pedodontics, Umeå University, Sweden.

Sample and methods. A total of 739 healthy Caucasian 7‐year‐olds residing in the city of Umeå, northern Sweden in 1976. The children were examined clinically and radiographically.

Results. The prevalence of hypodontia (excluding third molars) in girls was 8·4%, in boys 6·5%, and in both sexes combined 7·4%. Of the children with hypodontia, the majority (90·9%) lacked one or two teeth. Lower second premolars were the teeth most frequently missing. The prevalence of hyperdontia was 1·9%; 11 girls and three boys were affected; 78% of the supernumerary teeth were mesiodenses. Of the morphological variations, peg‐shaped upper lateral incisors were found in 0·8% of the children, double‐formation (gemination) in 0·3%, taurodontism in 0·3% and dens invaginatus in 6·8%. One diagnosis was found in 18% of the children, and in almost 8% of them more than one diagnosis was found.

Conclusions. The results agree with those obtained in similar populations and are considered representative of this ethnic group. The hypothesis of a genetically determined higher prevalence of numerical and morphological variations in the study population was not verified.
Betel quid chewing among Bangladeshi adolescents living in East London
Authors: Prabhu N.T. , Warnakulasuriya K. , Gelbier S. , Robinson P.G.
Published: March 2003

Summary.
Objectives. Ascertain level and predictors of betel quid (pan) chewing in Bangladeshi adolescents.

Design. Cross sectional questionnaire study.

Setting. Bangladeshi cultural centres in East London.

Sample. Consecutive adolescents attending 4 randomly selected centres.

Method. Self‐completed questionnaire.

Results. 204 (70%) of 290 teenagers invited to participate did so. Fifty‐eight (28%) chewed pan; 30 (51%) of whom chewed on most days. The median age of first chewing was 9 years. Only 7 (2%) added tobacco to their quids. Pan chewers tended to come from lower socio‐economic status families, liked the taste of pan and were less inclined to think that it adversely affected their appearance or that it could cause cancer.

Conclusions. The prevalence of pan chewing was lower than that found among adults reported in earlier studies in the UK. This reduction in the level of pan chewing could be attributed to acculturation. Few teenagers knew about the association between pan chewing and cancer but the widespread concern about the effect of pan chewing on the appearance of their mouth suggests this is a useful health promotion message within common risk/health factor approach.
A review of clinical features in 13 cases of impacted primary teeth
Authors: Otsuka Y. , Mitomi T. , Tomizawa M. , Noda T.
Published: March 2003

Summary.
Aim. The aim of this study was to review clinical findings in 14 impacted primary teeth in 13 cases treated at a Paediatric Dental Clinic over a period of 18 years.

Method. The retrospective study used clinical records, radiographs and oral photographs. Data included age, gender, presenting complaints, location, radiographic findings, aetiological factors, treatment and prognosis of impacted primary teeth and their permanent successors.

Results. The patients included five males and eight females aged from one year two months to seven years five months. One case had impacted bilateral, mandibular primary central incisors and the remaining 12 cases each had one impacted tooth. The maxillary second primary molar was the tooth most frequently involved. Permanent successor tooth germs were identified in 12 teeth but not in two. Five cases were impacted because of odontomas, in the case with bilaterally affected mandibular primary central incisors these were malpositioned and were erupting ectopically. In seven cases, aetiology was unknown. Four impacted primary teeth were extracted because eruption was unlikely. In four cases, odontomas were surgically removed and the teeth kept under observation. The remaining six were surgically exposed. Traction was applied in two of the six. Eight of the teeth erupted. In two teeth in which traction was used, one was subsequently extracted, and one erupted. In the cases of seven, permanent successors erupted. These were hypoplastic teeth and were delayed in development and eruption.

Conclusions. Impacted primary teeth may be associated with defects in development and eruption of their permanent successors, long‐term observation is therefore necessary until the permanent successors erupt.
Tuberculous osteomyelitis of the mandible: a case report
Authors: Bhatt A. P. , Jayakrishnan Amrita
Published: March 2003

Osteomyelitis of jaws caused by infection with Mycobacterium tuberculosis is uncommon, especially in children. We present a case of tuberculous osteomyelitis in a young child. Its clinical presentation, with features similar to a dento‐alveolar abscess, underline the importance of considering it in the differential diagnosis of jaw lesions.

We discuss of the diagnostic techniques, management and preventive measures, and stress the importance of history taking during clinical examination.
Oral health behaviour of schoolchildren and parents in Jordan
Authors: Rajab L. D. , Petersen P. E. , Bakaeen G. , Hamdan M. A.
Published: March 2003

Summary. Objectives.  The objectives of the study were: (i) to assess the level of dental knowledge and attitudes towards child dental care among parents in Jordan, (ii) to analyse the oral health care habits of schoolchildren and parents, and (iii) to evaluate the oral hygiene habits and use of professional dental services of children in relation to socio‐demographic conditions.

Design.  Cross‐sectional, self‐administered questionnaires for parents.

Sample and methods.  National representative sample of 6–16‐year‐olds living in urban areas (n = 1556, children and parents, response rate 92%, 48·7% boys, 51·3% girls).

Results.  In all, 80% of the parents knew about the harmful effect of sugar and 79% thought that poor oral hygiene may induce dental caries. In addition to proper oral hygiene (79%) and restriction of sugar/sweets (42%), 36% of the parents emphasized regular dental visits for the prevention of dental disease in children. However, most children saw a dentist for symptomatic reasons only (86%), while 11% attended for dental check‐ups. At their last visit to the dentist, 49% of the children had tooth extraction and only 8% had preventive services (fissure sealing). Toothbrushing at least twice a day was reported for 31% of the children; 14% of children aged 6–9 years had assistance from adults in brushing. Dental care habits of children were highly affected by dental visiting habits of parents, and variations by level of education of parents were also found.

Conclusions.  The discrepancy between dental knowledge and attitudes of parents and oral health care practices indicate the need for oral health education. School‐based oral health promotion programmes should be established in Jordan to influence the oral health behaviour of children and parents and to avoid further deterioration in their oral health.
Investigation of the effect of FK506 (tacrolimus) and cyclosporin on gingival overgrowth following paediatric liver transplantation
Authors: McKaig S. J. , Kelly D. , Shaw L.
Published: March 2003

Summary. Introduction. Gingival overgrowth associated with immunosuppression following liver transplantation is a commonly recognized clinical problem. The aims of this study were to determine the incidence of gingival overgrowth in a group of children post liver transplantation and to compare gingival overgrowth in children receiving FK506 with those receiving cyclosporin.

Methods. Seventy‐nine children (aged 15–196 months) undergoing liver transplantation at Birmingham Children's Hospital between October 1998 and October 2000 were studied. Gingival overgrowth was assessed in a blinded fashion and scored in a previously validated manner. Gingival overgrowth scores of the patients on each immunosuppressant drug were then compared.

Results. Fifty‐two patients were treated with cyclosporin and 27 treated with tacrolimus. Eighteen children were also receiving nifedipine (also known to cause gingival overgrowth) and were considered separately. Of the 41 children receiving cyclosporin alone, 26 exhibited gingival overgrowth compared to zero of 20 patients receiving tacrolimus alone. Those children treated with immunosuppression plus nifedipine developed gingival overgrowth, however, this was much less marked in the tacrolimus group.

Conclusion. Tacrolimus, unlike cyclosporin, is not associated with gingival overgrowth when used for immunosuppression following liver transplantation in children, and may be the drug of choice for children.
Focal dermal hypoplasia – oral and dental findings
Authors: Al‐Ghamdi K. , Crawford P. J. M.
Published: March 2003

Abstract. This report describes the case of an 8‐year‐old girl with focal dermal hypoplasia. As well as deformities affecting her hands and feet she had marked facial asymmetry, one diminutive eye and coloboma affecting the other. Intraorally, the patient had papillomas at the base of the tongue and tonsils. Her teeth showed irregular spacing, hypodontia, enamel hypoplasia, anomalous tooth form and delayed development. Radiographically, several teeth showed abnormal form. The patient's previous surgical experiences had adversely affected her behaviour and treatment has been limited to patient motivation and oral hygiene instructions, acclimatization, and simple restorative care.
A study of consumer‐defined need amenable to community nursing intervention
Authors: Antonson Margaret G , Robertson Catherine M
Published: March 2003

This paper describes the first stage of a research project investigating unmet needs for community nursing services The research analyses the relationships between differences in perception of valid needs between the public and staff, ways of working and organizational constraints on community nursing practice, and the incidence and nature of consumer‐defined unmet needs The aim of the first stage was to analyse the level and kind of consumer‐defined need anemable to community nursing intervention and identify possible shortfalls in current provision The study used a postal questionnaire and samples were selected using proportional, stratified random sampling from a Community Health Index The sample size was 1770 and the response rate 38% Analysis involved frequency counts for all variable data and statistical analysis of relationships between variables, using the chi‐square test with the level of significance set al 5% Analysis of the questionnaire identified possible latent need in relation to activities of daily living and health problems The 57–69 and 70 + age groups were found to have the highest level of self‐perceived difficulties with the above, many of which were said to be unmet Fewer respondents in the younger age groups experienced these difficulties, however, those who did were less likely to be receiving help In most cases, respondents with perceived unmet needs had never sought help In relation to community nursing, this may be associated with the lack of knowledge and misconceptions about the roles of community nurses which were identified from questionnaire responses The study also indicated possible unmet need among carers for education and guidance about the services available for them and how to gain access to them Possible unmet need was identified in relation to health promotion activities Analysis of attendance and interest in health groups and sessions suggested the need for more of this type of activity and more education on the possible benefits which can be gained from them
Developing trusting, caring relationships: home care nurses and elderly clients
Authors: Trojan Lorraine , Yonge Olive
Published: March 2003

Trusting as an area of research has not been critically examined in nursing research literature In this study, nurses working in home care and elderly clients were interviewed to ascertain the process of developing a trusting relationship Data were obtained from seven home care nurses and six elderly clients who were interviewed from one to three times The data were analysed using grounded theory methodology and sorted using Microsoft Word software on a Macintosh computer The core category which was identified in the data was labelled ‘trusting, caring relationships’ This core category encompassed trusting which is developed and the caring which the nurses provide Home care nurses and elderly clients moved through four phases initial trusting, connecting, negotiating, and helping The findings have implications for novice nurses working with elderly people, as well as for programme development and education More research needs to be done on trust in different contexts to assist all nurses in establishing nurse–client relationships
Assessment of coping with muscular dystrophy: a methodological evaluation
Authors: RNT Gerd Ahlstróm , PhD Per‐Olow Sjodén
Published: March 2003

There is no published research on coping with muscular dystrophy among adults In the present study, two questionnaires, the Reaction to the Diagnosis of Cancer Questionnaire (RDCQ) and the Mental Adjustment to Cancer scale (MAC), were modified in order to measure coping with muscular dystrophy (MD) A total of 60 people (16–64 years) with diagnosed MD answered the questionnaires in two interviews including semi‐structured questions The replies to these questions were analysed by two independent judges on the basis of the RDCQ and MAC categories for coping The purpose was twofold to investigate if cancer‐coping categories could be used for the classification of interview answers concerning coping with MD, and to gain knowledge about specific coping with MD Analysis indicated that 82% of replies to semi‐structured questions concerned with emotion/appraisal‐focused coping with MD can be descnbed by means of RDCQ and MAC categories Eight new categories were developed to classify the remaining 18% Anticipation, Creation of new life values, Minimization, Establishment of control over everyday life, Secretiveness, Fear, Social comparison and Coping with heredity hi addition, 997 replies were classified to represent problem‐focused coping The judges reached good agreement with respect to the proportions of replies in the respective coping categories However, kappa (K) values were within the range of fair to good agreement
Acceptability and perceived effectiveness of a district co‐ordinating service for terminal care: implications for quality assurance
Authors: MacDonald L D , Addington‐Hall J M , Anderson H R
Published: March 2003

As part of a randomized controlled trial of a new district co‐ordinating service for the care of terminally ill cancer patients, the activities of the nurse co‐ordinators and the acceptability and perceived effectiveness of the service were assessed Co‐ordinators' activities were self‐recorded, professional caregivers completed a postal questionnaire, and family carers were interviewed at home Thirty‐eight per cent of patients allocated to the co‐ordmators were not visited at home Overall, 41% of professionals had heard of the co‐ordinating service and 20% had been contacted A third of relatives, whether allocated or not to the co‐ordinating service, felt that terminal care of their patient was not well co‐ordinated and that they did not know how to get the help they needed for their dying relative It may be that the nurse co‐ordinators were unwilling or unable to relinquish their skills in order to provide a‘broker’style of co‐ordination Perhaps less skilled co‐ordinators would have been more successful Moreover, the co‐ordinating service had no budgetary responsibility Those concerned with quality assurance in co‐ordination of terminal care might consider the skill mix and professional training of the co‐ordinators as well as their budgetary responsibilities and authority
Approaches to the problem of respondent attrition in a longitudinal panel study of nurses' careers
Authors: Robinson Sarah , Marsland Louise
Published: March 2003

Longitudinal panel studies have several distinct methodological and analytical advantages over cross‐sectional studies for gaining an understanding of nurses’ careers and developing strategies to facilitate retention Panel studies do, however, present the researcher with a number of substantial challenges if maximum potential is to be achieved from the investment of time and resources that such studies entail Respondent attrition at successive phases of data collection, for example, is a major problem, often with the consequence that respondents are not representative of the study group as a whole This paper discusses reasons for choosing a longitudinal panel design for a programme of research into careers of midwives and nurses The way in which the problem of respondent attrition has been approached in one of the projects in the programme, that focusing on the careers of registered general nurses, is then described
External examiners: roles and issues
Authors: Sheehan John
Published: March 2003

This paper is based on an analysis of the role of external examiners and a discussion of the various aspects of the role Fifteen facets of the role have been identified and each facet is discussed with reference to the relevant literature Among the issues discussed are the powers of external examiners in the decision making process, their role as the custodians of standards, and the significance of then‐ reports The discussion spans four levels of academic awards including diploma, bachelor's degree, master's degree and doctoral degree and deals with matters of principle as well as the mass of written and other material which external examiners are faced with Some strengths and weaknesses of the external examining system have been identified and finally a question is raised about its future
Nurses' attitudes and concerns to HIV/AIDS: a focus group approach
Authors: van Wissen Kim , Woodman Kate
Published: March 2003

An exploratory qualitative study was instigated to further identify nurses’ attitudes to the care of people with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) This follows as a sequel to a study using a questionnaire Data were collected from nine focus groups attended by a total of 29 nurses at a hospital within a New Zealand regional health authority The principal findings suggest that nurses’ attitudes to this patient group are varied and depend on social influences, personal expenences and the extent of knowledge regarding HIV/AIDS Other concerns raised included nurses’ rights to choose to care for HIV‐positive patients and the issue of universal precautions These findings may have implications for further educational initiatives and formation of hospital policy
Beyond measurement: fourth‐generation evaluation in nursing
Authors: Koch Tina
Published: March 2003

Whoever believes that the ‘scientific’ method should not be the sole approach to quality assurance and evaluation research may be attracted to fourth‐generation evaluation The first three generations of evaluation have been categorized as ‘measurement‐orientated,’ objective‐orientated’ and ‘judgement‐orientated’, whereas fourth‐generation evaluation is ‘negotiation‐orientated’ In the present paper the author embarks on a description of these generations and makes suggestions for the implementation of fourth‐generation evaluation in the health care setting The appeal of fourth‐generation evaluation is that it argues for all ‘stakeholders’ to have a right to place their claims, concerns and issues on the negotiating table The evaluator acts as a facilitator of the evaluation process ‘Stakeholders’ refers to all people in the setting who are affected by the evaluation, including managers, evaluators, medical and nursing staff Participation of patients/clients is central in the negotiation process
Changes in student learning styles and adaptive learning competencies following a senior preceptorship experience
Authors: Stutsky Brenda J , Spence Laschmger Heather K
Published: March 2003

The purpose of this pre‐post comparison study was to examine the effect of the preceptorship experience on the learning styles (the manner in which individuals process information from the environment), adaptive competencies (the congruences between personal skills and task demands) and environmental press perceptions (the subjects' perceptions of the importance of each adaptive competency to effective functioning in a designated environment) of 37 fourth‐ year baccalaureate nursing students Using Kolb's theory of experiential learning as the theoretical framework for the study, it was found that the students' learning styles were inconsistently categorized by two versions of Kolb's learning style inventory The preceptorship experience was perceived by students to have significantly (P<0 05) improved the development of their adaptive learning competencies Students perceived the importance of divergent, accommodative and convergent learning competencies to be lower after the preceptorship experience, with the only significant difference (P<0 05) being between pre‐ and post‐convergent competencies The preceptorship experience, however, was found to contribute significantly more (P<0 001) to the students' development of most adaptive competencies than their weekly clinical experiences The findings support the notion that a senior preceptorship programme is a valuable and worthwhile learning experience to include in baccalaureate nursing curricula
Low‐intensity, range‐of‐motion exercise: invaluable nursing care for elderly patients
Authors: Dawe Doreen , Moore‐Orr Robin
Published: March 2003

This study looked at the effect of a single session of mild exercise in a group of cognitively unimpaired institutionalized elderly patients, aged 70 +, on tests of cognitive performance Results indicate that mild exercise, such as range‐of‐motion, does improve the ability to recall and that the effect lasts for at least half an hour Mild exercise programmes appear to be a practical, low‐cost nursing intervention that can enhance memory and independence Programmes that are designed to meet individual needs and that are incorporated into daily routine and activities without imposing extra effort or inconvenience are more appealing to elderly patients Exercise can be easily learned and implemented by nurses, personal care attendants or nurse aides This is an extremely important consideration in a health care system that demands low‐cost quality care
The need for and process of collaborative international research: a replication study of Japanese staff nurse perceptions of head nurses' actions
Authors: Schmieding Norma Jean , Kokuyama Toshiko
Published: March 2003

Despite differences between countries, people's health needs are similar, as are nursing problems and issues Collaborative nursing research is needed to identify similarities and differences among countries Visiting researcher(s), however, must understand the host country's culture and traditions to avert exploitation and misunderstanding Collaborative research should enhance nursing in each country The authors describe a replication study, in a Japanese hospital, of nursing administration research previously conducted in the United States, which compared the type of head nurse response staff nurses (n = 126) would prefer in a problem situation with what they perceived their head nurse would use Included are (a) a discussion of the need for research with attention to selecting a culturally compatible theory, (b) the history of the visiting and host researcher's relationship, (c) gaining approval to conduct the study, (d) a discussion of all aspects of the research methodology with special attention to reliability and validity in instrument translation, (e) a description of what occurred in Japan prior to and after data collections, and (f) elaboration of the problems and benefits of collaborative international research Data comparison of the two studies indicated marked similarities between the staff nurses in these two countries
Women in transition: access and barriers to social support
Authors: Harrison Margaret J , Neufeld Anne , Kushner Kaysi
Published: March 2003

As little is known about how support assists individuals during a normative life transition, this qualitative, prospective study explored how women chose sources of informal support Women having their first child, returning to work after an extended absence or recently retired from full‐time employment were interviewed Support during a life transition was described as having someone who would listen while the woman problem‐solved Women preferred to get their support from close family members or others experiencing a similar life transition A number of barriers to the use of support were identified perception that the use of support would be a burden on others, lack of reciprocity, reluctance to ask for support, and nonsupportive messages included within supportive actions The transition often took more than 2 years to complete and, for a subgroup of women, involved major changes in their self‐expectations and ability to access support The findings identify areas that nurses should consider in health promotion activities with women who are experiencing these life transitions
Exploring the lived experiences of psychiatric nursing students through self‐reflective journals
Authors: Landeen Janet , Byrne Carolyn , Brown Barbara
Published: March 2003

This study explores the use of journals to identify important issues facing nursing students when learning in a psychiatric setting During a 13‐week psychiatric clinical experience, 18 third‐year students kept journals describing the most significant event that occurred each week, reflecting on the impact and accompanying attitudes of that event Throughout the clinical experience, the nursing faculty read the students' journals and provided written feedback on a bi‐weekly basis Major themes that students wrote about in their journals were identified These included meaningful learning, issues of the novice, relationships, control, self‐reflection, and identification with clients Keeping a journal provided the students with an opportunity to become more self‐reflective in their practice The issues identified by students in their journals may assist nurse educators to anticipate the learning needs of their students in psychiatry
Written patient information: a review of the literature*
Authors: Arthur Valerie AM
Published: March 2003

In the United States during the 1940s Flesch and Gunning pioneered the movement to improve the comprehensibility of government documents Since that time the provision of comprehensible information to the general public has become increasingly important Indeed, most computer programs have the facility to assess what percentage of the population will understand certain forms of written information Vast quantities of written patient information have been produced over the decades and more are being produced daily This literature review sets out to provide an insight into the studies which have looked at the value and purpose of such literature Considering the amount of written patient information in existence the amount of research into this interesting subject is small Many concepts have to be considered Is this information of any use to patients? Can they understand and recall it and does it increase compliance? Are patients satisfied with the amount, quality and detail of written information? If health professionals are to inform their patients fully, written information is an area which should be more fully researched for ethical, quality and economic reasons
Nursing, humanism and transcultural theory: the ‘bracketing‐out’ of reality
Authors: Mulholland Jon
Published: March 2003

This paper addresses the emergence of a humanist discourse within nursing and questions the extent to which it represents the panacea implied within much of the humanist nursing literature. Particular attention will be given to whether it represents an ontological and epistemological framework capable of understanding the social, economic and political dynamics formative in the structuring of nurse‐client relations. It will be argued that the humanist analyses extant within much nursing literature are vague, idealistic, inconsistent and inadequate in the sense that they offer little by way of a meaningful analysis of power. A critique will also be made of the methodological individualism implicit within much humanist analyses. The paper will go on to identify the influence of humanist approaches on transcultural theory, and the manner in which the epistemological foundations of the latter have shared the limitations of the humanist nursing approach generally. As such, the transcultural nursing literature is often vague, inconsistent in its use of terminology, lacking in any rigorous analysis of power, and suspect in its conceptualizations of culture. Its capacity for enabling nurses to examine critically the socio‐economic and political dynamics of nurse‐client relations and develop strategies for addressing racisms, considered by many to be endemic within nursing and the health care system generally, is seriously undermined.
Attitudes and stereotypes: nurses’ work with older people
Authors: Pursey Ann , Luker Karen
Published: March 2003

The study reported here sought to describe the differences between nurses’ attitudes towards work with older people in the collective sense and their attitudes towards the individuals with whom they work A convenience sample of 136 community nurses was obtained Data were collected by means of a questionnaire incorporating the report of two critical incidents — one of effective practice and one of ineffective practice with older people In addition in‐depth qualitative interviews were conducted with 22 respondents The findings lead the authors to challenge the common assumption that an identified lack of desire in nurses to work with older people is due solely to negative attitudes which nurses hold towards older people themselves The paper concludes that the high dependency levels of older people and structure of nursing work with older people in hospitals means that fewer nurses make this area a positive career choice
To call it work somehow demeans it’: the social construction of talk in the care of terminally ill patients
Authors: May Carl
Published: March 2003

The nurse has an important role in helping the terminally ill patient come to terms with the imminence of death Such work is highly demanding and often stressful, but is work which is accorded a high moral priority by respondents in the study reported in this paper The paper explores the ways in which nurses work to respond to patients’ expressed psychosocial problems and the emphasis that they placed on providing opportunities for patients to speak about their impending death
Assessment and management of children's pain in community hospitals
Authors: Caty Suzanne , Tourigny Jocelyne , Koren Irene
Published: March 2003

Registered nurses (n= 72) working in 10 paediatric units in community hospitals in north‐eastern Ontario, Canada, participated in a descriptive study investigating how nurses assess and manage pain in children A four‐part questionnaire was used to collect the self‐reported data Twenty‐five (36%) of the respondents defined pain as an individual and personal experience and another 25 (36%) respondents defined pain as a more or less localized sensation or discomfort resulting from the stimulation of specialized nerve endings In response to three different clinical situations, the subjects’ mean pain ratings were 5 72 for an infant, 7 34 for a 3‐year‐old, and 7 29 for a 12‐year‐old child The criterion ‘nurses’ judgment’was cited as being used frequently in both the assessment and decision making process, however, there was indication that some of the current knowledge in the assessment and management of pain in children was not known or being used
Alcohol use amongst community‐dwelling elderly people: a review of the literature
Authors: Lakhani Nina
Published: March 2003

Alcohol use amongst elderly people is an increasingly important area to understand, yet relatively little research has been undertaken and our knowledge remains limited. This paper contains a review of the literature, concentrating on alcohol use in community‐dwelling elderly people. Both cross‐sectional and longitudinal research papers are reviewed; their findings suggest high abstinence rates amongst the population under consideration, with consumption consistently associated negatively with increasing age and female gender. A summary of the largely non‐specific, descriptive literature available is also included. Research concerned with elderly people and alcohol use is problematic and therefore the limitations of the available research are examined in detail. Firm conclusions are difficult to draw from the research to date because, for example, there are varying definitions of terms such as ‘alcoholism’ and ‘heavy drinking’ and instruments used for detection have not been validated with older age groups. The need for increased awareness amongst health professionals, especially nurses, about issues surrounding community‐dwelling elderly people and alcohol use and misuse is discussed. Finally, the importance of further research, especially amongst largely neglected groups of the elderly population, such as ethnic minority groups and elderly homeless people, is suggested.
Nurses' attitudes towards suicidal behaviour – a comparative study of community mental health nurses and nurses working in an accidents and emergency department
Authors: Anderson Martin
Published: March 2003

The purpose of this study was to explore and compare the attitudes towards suicidal behaviour of community mental health nurses (CMHNs) and registered nurses working in an accidents and emergency (A&E) department. The sample consisted of 80 nurses working in the same locality. An instrument was desined using statements from Domino's 'Suicide Opinion Questionnaire’(SOQ) and new statements based on a comprehensive survey of research in this area. The instrument contained four attitudinal categories consisting of: acceptability; morality and mental illness; professional role, work and care; and communication and attention. Results reveal that both groups of nurses held generally positive attitudes towards suicidal behaviour, contrasting with previous studies where more negative attitudes amongst nurses were found. A t‐test showed no statistically significant differences between the two groups of nurses in any of the four attitudinal categories. Attitudes were significantly different in accordance with nurses' length of experience and age within both groups. Further research is needed in this area in nurses are to develop their role alongside other professionals working towards the objectives of suicide prevention policies.
A reply to Goddard's ‘spirituality as integrative energy’
Authors: Dawson P.J.
Published: March 2003

Nancy Goddard's ‘spirituality as integrative energy’ serves to highlight the importance of spirituality, while at the same time seeking to transform its nature. In this reply I take issue with the concept of spirituality as integrative energy, arguing that such a reconceptualization effectively strips spirituality of its meaning in the name of spurious scientism. I argue that science is not the only valid mode of knowledge, and that, indeed, the scientific way of knowing may be particularly inappropriate in the context of the spiritual sphere. I briefly consider the gradual separation of spirit from body in the development of western medical science, and point out the commonalities between the scientific and spiritual modes of apprehending the world. While it is important that nurses be aware of the spiritual dimension. I argue that this awareness should not be purchased by reducing spirituality to more ‘acceptable’‘scientific’ terms, but rather that nurses should be afforded the opportunity to study the concept in its historical, literary and philosophical context.
Mixed messages in nursing research: their contribution to the persisting hiatus between evidence and practice
Authors: Hicks Carolyn , Hennessy Deborah
Published: March 2003

The current emphasis in the United Kingdom on evidence‐based health care requires that medical and non‐medical professionals ensure that their clinical practice is founded on scientifically derived findings rather than on intuition and ritual. To this end, many initiatives have been introduced which are intended to increase both the corpus of available research evidence and the extent to which it informs practice. To date, however, there has been a disappointing shortfall in published research in the paramedical domain, which has been largely attributed to a number of structural and organizational issues. This paper suggests that confusion about what constitutes valid and useful research may be an additional significant contributory factor in the documented research/practice hiatus. Moreover, the emphasis on experimentation and Randomized Controlled Trials (RCTs), with the relative marginalization of alternative, more qualitative forms of research may seriously limit the nursing research data‐base because of its inappropriateness for many nursing investigations. It is suggested that a more eclectic approach to evidence‐based care is considered, with more attention being diverted to qualitative methodologies at the funding and dissemination stages. In this way, a comprehensive and balanced overview of relevant information can be obtained which has the potential to influence some of the less quantifiable aspects of care delivery.
Caring for a child with a progressive illness during the complex chronic phase: parents’experience of facing adversity
Authors: Gravelle Anna M.
Published: March 2003

This qualitative study explored the day‐to‐day experiences of parents caring at home for a child with a progressive life‐threatening illness at a certain point in their illness trajectory. This point in the trajectory is when the child lives with a complex chronic condition, and is in need of specialized and time‐consuming care, but is not yet in a terminal phase. The naturalistic research design of phenomenology was chosen for the study's methodology. Parents’experiences of caring for their child were conceptualized as an ongoing process of ‘facing adversity’, as parents had continuously to redefine and then manage those changes resulting from the progressive nature of their child's condition. Concepts of normalization and chronic sorrow are considered in the conceptualization, as are the challenges of caregiving (particularly of mothers) who faced many hardships in their role, including the myriad of changes related to the increased burden of care. Implications for nursing practice are identified.
Can action research be applied in developing clinical teaching?
Authors: Hyrkäs Kristiina
Published: March 2003

Nursing education has undergone significant changes during the last two decades in Finland. However, clinical teaching has remained unchanged even though it forms the most extensive part of nursing education. National and international research results have also exposed several problems for clinical teaching. In the Finnish nursing education system these problems have remained unsolved probably because many of the suggestions for development, based on research results, presuppose changes in both the college and health care systems. The whole system of clinical teaching was changed during the years 1992–1993 in one nursing college and in one hospital in Tampere, Finland. Action research as a research strategy was applied in this study. The purpose of this paper is to describe the solutions sought and to assess if action research can be applied to the development of clinical teaching.
Analysis of data over time: a difficult statistical issue
Authors: Faithfull Sara
Published: March 2003

The aim of this paper was to review the literature on time series analysis and describe its use within the context of a nursing research project. The author utilized the method to investigate the symptoms of somnolence and fatigue that patients experienced following cranial irradiation for cancer. The need for longitudinal research in all areas of health care is a current concern. This is especially true in clinical areas where small patient numbers and palliative settings make large quantitative studies difficult. There are few studies or texts that help the practising researcher to explore data analysis over time in a way that reflects the time‐series nature of these data. This raises questions of how to analyse such data. The study indicated that symptoms following radiotherapy were different from that previously described in the literature. Time‐series analysis indicated a cyclical pattern that gave valuable information for planning supportive services. This paper explores some of the issues of time‐series analysis and illustrates the process of analysis, exploring the benefits and disadvantages of this approach for research.
Health patterns of women with fibromyalgia
Authors: Schaefer Karen Moore
Published: March 2003

Using diaries, eight women documented how they were living with their fibromyalgia on a daily basis for 3 months. Aches and pains were the most common symptoms experienced on nine to 81 of the 84 days of data collection. Cross‐correlations revealed significant patterns related to pain, sleep and weather conditions for individual women. The narrative portion of their diaries supports that pain is physical and mental, knowing the self helps to control the intensity of the illness, and distraction helps to decrease the associated discomforts. Use of diaries and active listening (validation) are supported as interventions for these women.
Relaxation for the relief of chronic pain: a systematic review
Authors: Carroll Dawn , Seers Kate
Published: March 2003

The effectiveness of relaxation techniques in the management of chronic pain was determined in this systematic review of published randomized controlled trials. Reports were sought by searching MEDLINE, psycLIT, CINAHL, EMBASE and the Oxford Pain Relief Database. Studies were included in this review if they were randomized controlled trials of relaxation techniques in chronic pain. Studies which investigated the effects of relaxation in combination with other interventions were not considered. Nine studies involving 414 patients met the predefined inclusion criteria and are critically appraised in this review. Meta‐analysis was not possible, due to lack of quantitative data in the primary studies. Studies involved patients with a range of chronic pain conditions. The McGill Pain Questionnaire was the most common pain outcome used. Whilst four studies were able to show a significant difference for the pain outcomes in favour of relaxation for the pre‐ and post‐treatment assessments, few statistically significant differences were reported in favour of relaxation when between treatment comparisons were used. Only three studies reported statistically significant differences in favour of relaxation (judged as a significant difference for at least 1 of the pain outcomes) compared to the other treatment groups. In rheumatoid arthritis the McGill Pain Questionnaire scores were significantly lower for patients receiving relaxation compared to those who were in the routine treatment control group. In ulcerative colitis significant differences were reported for six of seven different pain outcome measures in favour of progressive muscle relaxation compared to patients in the waiting list control group. In one of the two cancer pain studies, relaxation taught by nurses produced significantly lower pain sensation scores compared to the control group. Two studies reported significant differences in favour of the experimental control groups rather than for relaxation. There is insufficient evidence to confirm that relaxation can reduce chronic pain. Many of the studies both positive and negative suffer methodological inadequacies. Recommendations for future research into the effectiveness of relaxation techniques for chronic pain are made.
Infertility and early parent–infant interactions
Authors: Holditch‐Davis Diane , Sandelowski Margarete , Harris Betty Glenn
Published: March 2003

Approximately 50% of infertile couples will become parents through pregnancy or adoption, but they experience major difficulties while working towards this goal. Infertility treatments are associated with physical pain and psychological distress, and adoption procedures are prolonged and emotionally stressful. The extent to which these stressors alter the parenting of these couples is not known. The purpose of this study, therefore, was to examine the early parent–infant interactions in infertile couples who become parents through pregnancy or adoption. Two groups of infertile couples (30 who achieved pregnancy and 21 who adopted) and a group of 19 couples without fertility problems were observed interacting with their infants twice, 7 to 21 days after the infant's arrival and a week later, at a time when both parents were at home. Their babies were between 9 days and 5 months of age. Behaviours of the mother, father and infant were recorded every 10 seconds, beginning when the baby was picked up and ending when the baby was put down asleep or 1½ hours had passed. Repeated measures ANOVAs were used to compare the three groups over the observations. There were no differences between fertile and infertile biological parents. Adopted infants showed more alertness, less sleeping, more smiles, and more looking than biological infants. Adoptive mothers spent less time as the sole interactor. Adoptive parents spent more time in playing with their infants and held and touched them less than did biological parents. Infertility, therefore, does not appear to affect early parenting. In general, the amounts of behaviours exhibited by infertile biological parents were very close to those of fertile parents. Differences in the behaviours of adoptive as compared to biological parents can best be explained as responses to the behaviours of their older infants, rather than as evidence of different parenting styles.
Process consent: a model for enhancing informed consent in mental health nursing
Authors: Usher Kim J. , Arthur David
Published: March 2003

Informed consent, essentially a legal doctrine, is designed to protect the rights of patients. However, in an area of practice such as psychiatry, informed consent imposes many problems if one considers it to be a static process. In this paper we propose that process consent, the type of consent considered essential in qualitative research projects, is not only appropriate but necessary for mental health nursing practice. This type of consent is an ongoing consensual process that involves the nurse and patient in mutual decision making and ensures that the patient is kept informed at all stages of the treatment process. We have used neuroleptic medications as an example throughout the paper and have suggested that seeking informed consent should be added to the role of the nurse in the mental health setting.