bluuebunny/crossref_metadata_2025 huggingface dataset:
A conceptual foundation for human suffering in nursing care and research
Authors: Rodgers Beth L. , Cowles Kathleen V.
Published: March 2003

Suffering is a significant, yet elusive, phenomenon in nursing and health care. Despite the importance and prevalence of suffering, there is only a small body of substantive literature on this topic. Some of the difficulty in expanding this knowledge base undoubtedly is related to the lack of a solid conceptual foundation for exploration of this phenomenon. Although there have been appempts to provide neede conceptual clarity, these efforts typically have not been based on systematic inquiry. In this study, the method of concept analysis was used to inductively generate a definition of the concept of suffering and to clarify various contextual aspects of the concept. Suffering is defined as an individulized, subjective, and complex experience that involves the assignment of an intensely negative meaning to anevent or a perceived threat. Implications of these findings and additional contextual aspects of the concept for nursing practice and inquiry are presented. These results help to provide the conceptual foundation needed to enhance recognition and understanding of the human experience of suffering.
Professionalism and community psychiatric nursing: a case study of four mental health teams
Authors: Morrall P.A.
Published: March 2003

In this paper I report on a 2‐year study of the professional status of 10 psychiatric nurses, working in four community mental health teams. The focus of the research was directed towards identifying the levels of clinical autonomy experienced by psychiatric nurses working in these teams. Diary‐interview schedules were used to record how new clients were processed by the psychiatric nurse. The other members of the teams were interviewed (as were the managers to whom the nurses were accountable), using focused‐interview schedules. The qunatitative data from the diary‐interview schedules were analysed using the Statistical Package for the Social Sciences. An adapted form of the technique advocated by Burnard was used to analyse qualitative data extracted from the diary‐interview schedules and the focused‐interviews. Conclusions from the research indicated that the nurses experienced a high degree of de facto clinical autonomy, which was characterized by unsupervised and arbitary decision‐making processes. In order to protect the user of mental health services, it is recommended that the espoused occupational strategy of professionalization for community psychiatric nurses is reconsidered.
The nature of social support as experienced by women treated for breast cancer*
Authors: Lugton Jean
Published: March 2003

This paper deals with one aspect of a major study, namely the meaning of social support, a concept loosely used in research and by practitioners. Grounded theory was adapted and discourse analysis used to retrospectively analyse data collected for a previous study exploring health visitors' support of patients with breast cancer. Patients' diagrams of their social networks illustrated their perceptions of support and strain. Respondents indicated that they faced six threats to their identities associated with the breast cancer experience and perceived social support to be actions/attitudes from formal or informal sources which maintained identities for many respondents who wanted to ‘get back to normal’ in their relationships and in their work. Women also needed support to accept identity changes, for example, adapting to an uncertain future. This paper focuses on the effects of informal support on identity. Respondents identified seven main types of informal support from various sources. Larger social networks were more likely to provide the different types of support needed. However, social intimacy of close relationships maintained important aspects of women's identities and were indeed part of their identities. Respondents' social contacts sometimes perceived breast cancer as threatening to their own identities and were consequently unsupportive. Informal support was vital for respondents copies with breast cancer. Nurses should help patients maintain and create their own informal support during illness.
Cognitive/concept mapping: a teaching strategy for nursing
Authors: All Anita C. , Havens Robyn L.
Published: March 2003

Cognitive/concept mapping is an educational strategy that takes into consideration the principles of educational psychology. The most important single factor that influences learning is what the learner already knows. Nursing students face a great need to understand the larger questions and problems of their chosen field. Unless there is understanding, students may only commit unassimilated data to short‐term memory and no meaningful learning will occur. The purpose of the following paper is to present concept mapping as a learning/teaching strategy for nursing students and nursing faculty. Examples of maps will be presented along with suggestion about how they can be used to plan care for a particular client or to learn more about the nursing care of a specific disease process.
A self‐assessment tool to measure older adults’Perceptions regarding physical fitness and exercise activity
Authors: Melillo Karen Devereaux , Williamson Eileen , Futrell May , Chamberlain Claire
Published: March 2003

The purpose of this research was to qualitatively generatively generate and psychometrically assess an instrument which assesses the self‐perceived physical fitness and exercise activity levels of community‐dwelling older adults and examines perceived factors which enhance or impede their exercise activity level. This research was carried out in two stages: qualitative and quantitative. Items for the instrument were generated through qualitative interviews with 23 community‐dwelling older adults, 9 males and 14 females, with an age range of 63 to 82 years. From this qualitative study, 50 items were generated, representing nine categories of elements which enhance or impede physical activity. The 50 items were incorporated into a 4‐point, forced‐choice, Likert format instrument which was pilot tested for clarity and ease of administration with a convenience sample of community‐dwelling older adults. Following the pilot testing, 41 items were retained. The 41‐item instrument, entitled physical Fitness and Exercise Activity Levels of Older Adults Scale, was categorized into the following subscales: Physical Fitness, Barriers, Motivators, and Exercise Activity Levels of Older Adults Scale seems to indicate adequate validity and reliability. Correlation coefficients for the total instrument, as well as the subscales, were significantly positive for both stability and internal consistency. Results with respect to predictive validity were mixed. The physical Fitness and Motivators subscales were significant predictors of Exercise Frequency. Although the correlation between the Barriers subscale and Exercise Frequency was negative, it was non‐significant.
Dovelopment of a tool to rate the quality assessment of randomized controlled trials using a Delphi technique*
Authors: Sindhu Fahera , Carpenter Lucy , Seers Kate
Published: March 2003

The aim of this study was to develop a quality of study tool to rates the methodological quality of individual primary randomized controlled trials (RCT) to be included in a meta‐analysis. A Delphi‐technique using several rounds of questions to seek consensus, among trialists, on criteria important in a RCT was used. Eight trialists formed the Delphi panel. The developed quality of study tool consisted of 53 items in 15 dimensions. The tool was tested for reliability and validity. Unlike many other quality assessment tools, the developed tool may be used to rate numerically each primary study. This is important in reviews or in meta‐analyses where one objectives may be to ascertain whether those studies of a higher quality exhibit different results to reviewing studies of lower quality. The tool needs further testing.
Male patients with congestive heart failure and their conception of the life situation
Authors: Måtensson Jan , Karlsson Jan‐Erik , Fridlund Bengt
Published: March 2003

Patients with congestive heart failure (CHF) are an extensive group in Sweden both with regard to prevalence and number of medical care events. As the age of the population and survival after myocardial infarction are increasing, the incidence of CHF is also on the rise. The aim of this study is to describe, from a nurse's perspective, how male patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: the biophysical, the sociocultural, the emotional, the intellectual, and the spiritual‐existential. A qualitative method was used with a phenomenographic approach as it examines aspects of the surroundings as conceived. In the results, six categories emerged: feeling a belief in the future, gaining awareness, feeling support from the environment, feeling limitation, feeling a lack of energy and feeling resignation. The mental and physical lack of energy which patients feel easily leads to limited working capacity and social activities. This limitation may cause patients with CHF to believe that neither they nor their environment can influence their life situation and there is a risk that these patients become resigned, In order to help them get out of this vicious circle of limitation and resignation, it is important that the nurse teaches them self‐care and shows them the possibilities that exist in everyday life. With increased awareness of their life situation, patients may adapt to their CHF and see that it is possible to improve their future themselves.
A literature review of advanced clinical nursing practice in the United States of America
Authors: Dunn Linda
Published: March 2003

Advanced nursing practice in the United States of America has evolved over the past decades in two related but distinct directions:‐ the nurse practitioner (NP) and the clinical nurse specialist (CNS). This two‐role evolution was in response to social demands for increased access to affordable, quality primary health care, and at the same time to the specialised nursing care requirements of increasingly complex patients. Thus, nurse practitioners became synonymous with primary and clinical nurse specialists with specialised, acute care. There is evidence that there is an advanced practice role for both the CNS and the NP and that much of the knowledge, skills and competencies are shared depending on the clinical situation. There have been successes and failures in the development of the two roles. The clinical nurse specialists have a more respectable image among the powerful nursing education elite, but nurse practitioners are widely recognised by consumers and other health care professionals and are valued by cost‐conscious managers as a viable, cheaper alternative to physicians. The literature suggests it may well be time to take the best attributes of the two roles and merge them under the term ‘advanced nurse practitioner’.
Patients' experiences of long‐term oxygen therapy
Authors: Ring Lena , Danielson Ella
Published: March 2003

The aim of this study, which was undertaken in patients' homes in Sweden, was to describe patients' experiences in the self‐management of continuous oxygen therapy and their view of managing their chronic disease. A phenomenological approach was used. Data were collected in interviews and analysis produced four categories. The findings show that the patients need help with relief for different physiological and psychological difficulties and from social isolation. The patients had insufficient resources for daily life. They were restricted to their homes, had mobility problems and were dependent upon a continuous life rhythm. Dependence upon another family member is therefore an important factor. But even with the presence of a significant other, social isolation is prevalent.
Engagement and detachment: understanding patients' experiences with nursing
Authors: Kralik Debbie , Koch Tina , Wotton Karen
Published: March 2003

This study aimed to understand what post‐operative patients perceived was important about the nursing care they had experienced. The participants were nine women recovering from total hip replacement surgery which had been performed in a large public, acute care hospital in south Australia. Participants volunteered to be involved in the study and were interviewed pre‐ and post‐operatively and interviews continued in their home environment following discharge. The study took place during 1995 within a 10‐month time frame. Methodological guidance was sought from the phenomenology literature, with the ideas from Husserl and Heideggar providing shape for the interpretive framework. The analysis of data utilized Colaizzi's (1978) seven procedural steps. For the purposes of this paper the authors have selected to focus only on the findings of this study. Two major themes emerged from the conversations with women. Patients described nurses as being engaged or detached with their nursing care. These themes will be explicated in this paper. In the light of these dominant themes the nursing literature around engagement and detachment are examined. The implications for nursing practice are discussed.
Promoting autonomy and independence for older people within nursing practice: a literature review
Authors: Davies Sue , Laker Sara , Ellis Lorraine
Published: March 2003

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research‐based literature in this field is limited by a focus upon older people in continuing‐care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.
Dilemma: a concept analysis
Authors: Sletteboe Aashild
Published: March 2003

In nursing practice we find different kinds of difficult situations. What is the difference between such kinds of situations? It is important to know what kind of situation one is confronting because the answer and solution depend on it. In the literature the term ‘dilemma’ has different meanings. I am therefore interested in what constitutes a dilemma, and have conducted a concept analysis. The defining attributes were engagement, equally unattractive alternatives, awareness of alternatives, need for a choice and uncertainty of action.
The politics of sex research and constructions of female sexuality: what relevance to sexual health work with young women?
Authors: Few Cheryl
Published: March 2003

By examining the relationship between the cultural construction of female sexuality and the lack of potential for many young heterosexual women to be truly sexually healthy this paper submits that messages for women within HIV prevention programmes can be confused, confining and at times dangerous to women's health and well‐being. It is suggested that these messages also reinforce a traditional, biologically determined medical understanding of female sexuality that does not take note of social or culturally based research or commentary on female experience or female desire, but rather confines many women to sexual restrictions, doing little to empower women to prevent sexual risk‐taking. The ideological basis of the discussion within this paper is informed by the awareness that applications and understandings of 'sexuality’are diverse and contested within sex research traditions and will influence the choice of research concerns. The‘deterministic’explanation of sexuality that 'sexuality’(the abstract noun referring to the quality of being ‘sexual’, Williams 1983) is your fate or destiny and that biology causes the patterns of sexual life, is abandoned in this paper in favour of a search for a definition of sexuality which brings together a host of different biological and mental possibilities which are given meaning only in social relations. This allows for a framework for the study of sexuality that relates it to other social phenomena, particularly economic, political and social structures (Foucault 1979); in other words, a study of the 'social construction’of sexuality. This paper suggests that health care professionals need to develop an awareness of the diversities within female sexuality and gain insight into their own values and assumptions about female sexuality if these are not to inhibit effective approaches and interventions in the areas of HIV and sexual health.
Methodological issues conducting sensitive research on lesbian and gay men's experience of nursing care
Authors: Platzer Hazel , James Trudi
Published: March 2003

This paper is a methodological discussion on a qualitative research project which involved interviewing lesbians and gay men about their experiences of nursing care. The research project arose primarily because most of the knowledge available on the subject was based on hearsay and anecdote. It is worthy of note that those who felt there was an issue to be addressed, as well as the bearers of anecdote, were by and large what would be termed ‘insiders’ in ethnographic research, and zealots with an axe to grind in less academic circles. It is the nature of this ‘insider’ status which is of interest throughout the research process of what was and remains a sensitive research topic. ‘Insider’ status can reduce many of the problems associated with conducting sensitive research in terms of access, rapport with subjects, ethical concerns, and stigma contagion, but by the same token lays researchers open to the charge of bias thought to be inherent in going native, or rather in this case being native. However, there are some problems associated with ‘insider’ status as well and this paper offers a discussion of the methodological problems we have encountered in relation to this, as well as more general methodological issues when conducting research considered to be sensitive. Ethical dilemmas also arose during the research when lesbian and gay patients who were currently receiving hospital care contacted the researchers directly because they felt threatened by nursing and medical staff. The paper is an attempt to describe some fairly conscious strategies to use the research team's ‘insider’ status for methodological reasons and to explain the ethical position we took when we felt compromised.
In whose ‘best interests’? Ethical issues involved in the moral dilemmas surrounding the removal of sexually abused adolescents from a community‐based residential treatment unit to a locked, forensic adult psychiatric unit
Authors: Welsh Johnathan R.
Published: March 2003

This study scrutinizes the ethical and moral dilemmas surrounding the removal of sexually abused adolescents from a community‐based residential treatment unit to a locked, forensic adult psychiatric unit. Adolescent victims of sexual abuse exhibit a plethora of psychopathological symptomatology which can lead in many cases to the adolescent resorting to self‐injurious behaviours in an attempt to relieve feelings of tension, anxiety and guilt. Because the unit in which the writer is involved is an open, community‐based treatment centre with limited staffing levels, a completely secure environment may be compromised. Consequently self‐injurious adolescents may become so disturbed that a more secure environment must be sought. The limited resources for disturbed adolescents in Northern Ireland means that occasionally the only option available to health care professionals who find themselves in this situation is to utilize the services of the psychiatric adult, forensic unit in Belfast which is contained within a large psychiatric hospital. Many would agree that such a placement for a disturbed adolescent seems inappropriate but is at the same time unavoidable. This study will examine the ethical and moral minefield that only recently has become a dilemma for health care professionals and particularly for nurses endeavouring to adhere to the code of professional conduct.
Evaluating the efficacy of reflective practice within the context of clinical supervision
Authors: Fowler John , Chevannes Mel
Published: March 2003

This paper explores the efficacy of reflective practice within the context of clinical supervision. It examines some potential limitations that reflective practice has within the context of clinical supervision drawing upon the literature and the early stages of the author’s empirical work. It concludes that whilst there is considerable congruence in the use of reflective practice within clinical supervision sessions, there are potential disadvantages in making the assumption that reflective practice should be an integral part of all forms of clinical supervision.
Cultural safety: a new concept in nursing people of different ethnicities
Authors: Polaschek
Published: March 2003

Cultural safety is a concept which has been developed by Maori nurses in New Zealand in order to reflect on nursing practice from their point of view as the indigenous minority in our country. The paper contrasts this new concept critically with Leininger’s well‐known model of transcultural nursing in order to suggest its potential significance. To date work on cultural safety in New Zealand has focused on the attitudes which individual nurses bring to their practice, attempting to change the effects of their social conditioning on their approach to nursing. The paper supports the view that all nursing care is provided in a social context which influences its efficacy, and specifies that the structural elements, such as the institutional context within which nursing care is provided and policies which influence how care is the provided, need to be explicitly recognized. The paper concludes that until the effects on the health care system of inequalities in power between groups in society are addressed we cannot ensure that the needs of persons from minority cultures will be met. Because it illuminates this dimension of nursing care, cultural safety is a concept of general significance for all nurses.
Empirically generated attributes of experience in nursing
Authors: Radwin Laurel E.
Published: March 2003

Researchers examining clinical decision‐making often explored the role of the nurse’s experience. In these studies, experience was conceptualized as either the time spent in nursing or the knowledge which came from practice. This paper reports on the conceptualization of the nurse’s experience emerging from a grounded theory study describing one decision‐making process: ‘knowing the patient’. Data included in‐depth interview text, participant observation fieldnotes, and documents. Data were analysed using the constant comparative method and open, axial and selective coding techniques. In the analysis, the nurse’s experience was conceptually defined as ‘the application of that learned from previous practice situations’. Three attributes of the nurse’s experience emerged. These included a focus on the patient, confidence in practice, and knowledge of antecedents and consequences of similar patient situations. Each aspect enhanced the individualization of nursing interventions. The findings are related to other investigations in nursing and insights for practice are offered.
Relationships between infant temperament, demographic variables, and family dynamics of childrearing families
Authors: Hakulinen Tuovi , Laippala Pekka , Paunonen Marita
Published: March 2003

Relationships between infant temperament, demographic variables, and family dynamics of child‐rearing families were investigated in this study. The revised Infant Temperament Questionnaire (RITQ), the Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were sent to 118 families who had participated in the first stage of the study as child‐bearing families. About 8 months after childbirth 96 mothers and 95 fathers completed the questionnaires. The characteristics of infant temperament and demographic variables related to the variance of dimensions of family dynamics. Characteristics of the temperamentally easy baby related to more positive family dynamics perceived by child‐rearing parents. Fathers rearing their first child reported that their families functioned better than fathers with their second infant. In child health clinics families rearing their second child should also be supported, especially families with arhythmic and negative mood infants.
A comparative study of death anxiety in hospice and emergency nurses
Authors: Payne  , Dean  , Kalus
Published: March 2003

A comparative study of death anxiety in hospice and emergency nurses This paper describes a preliminary cross‐sectional study which aimed to compare levels of death anxiety and coping responses in palliative care and accident and emergency (A & E) nurses. Forty‐three nurses (23 from palliative care and 20 from A & E) were recruited from a district general hospital and nearby hospice. Both sites had the same mean annual death rate of 150 patients. Death anxiety was measured by the Death Attitude Profile‐Revised Questionnaire and coping responses were elicited by a semi‐structured interview. As hypothesized, hospice nurses had lower death anxiety and they were more likely to recall both good and difficult experiences related to patient care. Unlike the hospice nurses, a subgroup (20%) of A & E nurses reported that they were unable to discuss problems with colleagues. The study has implications for the development of institutional support for staff to enable nurses to provide good quality care for dying patients and bereaved people.
A study of the ‘lived’ experience of change during a period of curriculum and organizational reform in a department of nurse education
Authors: Knight Stephen
Published: March 2003

In this paper an attempt is made to illustrate the experience of lecturers in a department of nursing preparing to implement the adult branch component of the pre‐registration Higher Education Diploma in Nursing Studies. The study was conducted in a college of health in England at a time when the college was only beginning to discuss the possibility of closer links with universities. It highlights the grief responses associated with change exhibited by nursing lecturers during a period of organizational upheaval and curriculum change and maps the transition through stages of adaptation over a 2‐year period. The analysis of the effects of change and the coping strategies adopted by nursing lecturers presented here is most relevant to educational managers who are charged with integrating nurse education into higher education.
Women’s lay knowledge of cervical cancer/cervical screening: accounting for non‐attendance at cervical screening clinics
Authors: Neilson Anne , Jones R. Kenneth
Published: March 2003

An assessment of women’s knowledge of cervical screening and cervical cancer was considered important as up to 92% of those dying from this form of cancer had never been tested. What were the reasons which determined their non‐attendance? Issues to be addressed were reactions to invitation, women’s knowledge of screening, and the possible factors which they envisaged as being associated with cervical cancer. Other issues to be considered were practical problems associated with attendance, and preference for the sex and professional status of the health professionals involved; 187 women in a general practitioner practice in Lothian, Scotland were targeted by questionnaire. As with other studies in this field 50% of those contacted were ineligible for a variety of reasons. Seventy‐two women completed the questionnaire, providing a mix of qualitative and quantitative data. Although the majority of women felt the invitation to attend screening was clear and easy to understand, there was a lack of knowledge with regard to both the screening itself and the possible causes of cervical cancer. The main ‘causes’ were seen as higher sexual activity among those aged under 37 and smoking and a virus by those over 37. The majority of women showed preference for a female professional to take the smear. Practical problems of time and venue were not considered insurmountable. The main reasons cited for non‐compliance were the fear and dislike of the test itself.
Caring, patient autonomy and the stigma of paternalism
Authors: Woodward Vivien M.
Published: March 2003

Caring, patient autonomy and the stigma of paternalism¶This paper utilizes data generated during a qualitative study in palliative and maternity care settings to guide discussion of the current discourse, which emphasizes patient autonomy and derides paternalism. Data are presented which illustrate that this ideology is established in nursing practice. Respect for patient autonomy is identified as an essential element of individualized, patient‐centred and ethical care but conversely, it is suggested that over‐emphasis may confuse and suppress beneficent intervention. The value of ethical theory to provide an objective means to explore ethical dilemmas in practice is not debated, but exploration of the issues raised by the data suggest, that principle‐based ethical theory suffers the following constraints: the predetermined balance of ethical principles in favour of respect for autonomy prevents an unbiased perspective and optimum guidance; in contrast to caring relationship, application of ethical theory does not reveal the particulars necessary to guide ethical decisions aimed at promoting good for the individual; current discourse appears to disregard the inherent inequality in the relationship between the helped and helper and practitioners’ need to preserve their own moral integrity. Consequently, this paper argues that beneficence derived through caring should not be superseded uncritically and suggests that mutual nurse‐patient relationship, which balances respect for patient autonomy and beneficent guidance based on practitioner’s clinical expertise, protects the moral integrity of both patient and practitioner. For conciseness, the term patient will be used to indicate recipients of both nursing and midwifery care and while both nurses and midwives are not always specified, any term referring to nurses, denotes both.
Are electronic thermometry techniques suitable alternatives to traditional mercury in glass thermometry techniques in the paediatric setting?
Authors: Smith Joanna
Published: March 2003

Are electronic thermometry techniques suitable alternatives to traditional mercury in glass thermometry techniques in the paediatric setting?¶Three thermometers, mercury in glass, Becton‐Dickinson digital and IVAC tympanic membrane thermometer, were compared. The study was designed to test the null hypothesis that there is no difference between the thermometer recordings, meaning that electronic thermometry is a suitable alternative to traditional mercury in glass thermometry. Children aged between 0 and 15 years old were entered into the study, n = 114. Standard procedures were used throughout the study to minimize the risk of errors in the data collection and technical errors were recorded. The data were analysed using graphical techniques described by Bland and Altman. The differences between the temperature recordings were plotted against their mean (the estimated true value), with the bias and limits of agreement (2 standard deviations from the mean) calculated for the mercury in glass/digital, mercury in glass/tympanic and digital/tympanic temperature recordings. The range of temperatures were 35·1°C–38·5°C, with a mean of 36·85°C for the mercury in glass thermometer, 36·8°C for the digital thermometer and 36·65°C for the tympanic thermometer. The bias for each comparison was 0·36°C, 0·21°C and 0·17°C and the limits of agreement were wide, −0·516°C to 1·234°C, −0·84°C to 1·252°C and −0·94°C to 1·244°C for the mercury in glass/digital, mercury in glass/tympanic and digital/tympanic recordings respectively. A difference of 0·2°C is usually accepted for clinical practice, therefore the null hypothesis was rejected.
Team midwifery: the influence of the midwife‐woman relationship on women's experiences and perceptions of maternity care
Authors: Tinkler Angela , Quinney Deborah
Published: March 2003

The need to provide woman‐centred maternity services which take account of womens’ views and specifically address their need for choice, control and continuity has been advocated and team midwifery has been suggested as one of the ways to achieve these objectives. This paper explores women's descriptions of their maternity care experiences in England, specifically focusing on: their experiences of communication; being informed and making choices; being involved in the process of care; and their own perceptions of care. It is suggested that the midwife–woman relationship is an important aspect of satisfaction which needs greater recognition. Analysis of the data highlighted the importance of the quality of women's relationships with caregivers. Findings revealed how positive relationships facilitated conditions which influenced satisfaction with care and suggest that, for the development of genuine woman‐centred services where women exercise informed choice, and are involved in, and have some control over, the process of care, the nature and quality of the midwife‐woman relationship must be accepted as an integral and crucial aspect of the service.
Preserving moral integrity: a follow‐up study with new graduate nurses
Authors: Kelly Brighid
Published: March 2003

Preserving moral integrity: a follow‐up study with new graduate nurses¶The purpose of this follow‐up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the ‘real world’ of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow‐up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the ‘real world’ of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho‐social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self‐concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one’s moral convictions. Data supported that the most pervasive attributes of moral distress were self‐criticism and self‐blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.
The patient’s perceived caring needs as a message of suffering
Authors: Fagerström Lisbeth , Eriksson Katie , Bergbom Engberg Ingegerd
Published: March 2003

The patient’s perceived caring needs as a message of suffering¶The aim of the study was to arrive at a deeper understanding of the patient’s experience of caring needs, that is, of problems, needs and desires, by investigating and explaining how these will be expressed and shaped in the caring relation and to illuminate its implications for caring. The target population consisted of 38 patients in a medical ward and 37 patients in a surgical ward in a central hospital in Western Finland. The patients were interviewed in the wards and asked about perceived caring needs. By means of a hermeneutical process of interpretation a pattern emerged which was interpreted as pictures of themselves and of the nurses. These types of patients fell into three groups: the satisfied, the complaining and satisfied, and the complaining and dissatisfied patients. The types of nurses were divided into the competent and friendly, the competent and contact‐creating and the competent and courageous. The patients’ caring needs can be interpreted and understood from the standpoint of their experience of suffering, but also in relation to their experience of pleasure and comfort. The most conspicuous caring needs were experiencing confidence in the competence of the nurses, comfort, guidance, dialogue and closeness, which the patients expressed as problems, needs and desires. The patients’ caring needs can contain new possibilities of growth and development. The nurse can relieve patients’ suffering by promoting their experience of comfort. If the nurses’ view of the limits of reality are extended to comprise the existential/spiritual dimension of human beings as well, new possibilities will emerge of interpreting and understanding patients’ caring needs as a message of suffering.
The information concerns of spouses of women with breast cancer: patients’ and spouses’ perspectives
Authors: Rees Charlotte E. , Bath Peter A. , Lloyd‐Williams Michael
Published: March 2003

The information concerns of spouses of women with breast cancer: patients’ and spouses’ perspectives¶ A user‐centred study employing focus group methodology was conducted in the United Kingdom in order to establish the key information concerns of spouses of women with breast cancer from both patients’ and spouses’ perspectives. Four unstructured focus group discussions were convened, three with women with breast cancer (n = 11, n = 7 and n = 12) and one with spouses (n = 9). The discussions were audio‐taped and transcribed in full. All transcripts were analysed manually using theme analysis and considered patterns common to the data. Themes were established and corresponding quotations used to support all themes. Emergent themes were grouped into the following categories: information needs of spouses; sources of information for spouses; and family information. Several important points emerged within each of these categories and these are discussed. Validity was established by participant evaluation of the findings. Findings clearly indicate the key information concerns of spouses from patients’ and spouses’ perspectives. These findings are of value to health care professionals and have a number of nursing implications. The study also highlights particular areas where further research and development are needed.
Interpersonal relations in nursing: a philosophical‐ethical analysis of the work of Hildegard E. Peplau
Authors: Gastmans Chris
Published: March 2003

Interpersonal relations in nursing: a philosophical‐ethical analysis of the work of Hildegard E. Peplau¶ Nursing typically has been viewed as a moral practice, for instance by new developments in the ethics of care. Nevertheless, many philosophical‐ethical presuppositions of nursing theories remain to be clarified. This paper presents a philosophical‐ethical analysis of the work of Hildegard E. Peplau. Analysis of the philosophical‐ethical background of Peplau’s works illuminates a view on nursing practice that is relevant today. Three main components are analysed more deeply, i.e. the professionalization of nursing, the philosophical underpinnings of Peplau’s view on nursing science, and the nurse–patient relationship as the central event in nursing.
Story telling: is it really research?
Authors: Koch Tina
Published: March 2003

Story telling: is it really research?¶ In this paper I will suggest ways in which you may consider a story as a legitimate research product. I view the story as interpreted work communicated through writing as the research product. ‘Doing’ interpretive research is not an easy option in research. In this paper I will focus upon some of the complexities in creating an acceptable and accessible research product. I will cover five interrelated areas: journaling, observing, listening, writing and rigour. The term ‘research product’ refers to the outcome of the research process. By that I mean the dissertation, the research report or the published article. The notion of legitimacy is informed by Gadamer’s philosophical hermeneutics which does not show us what to do, but asks us to question what is ‘going on’ while researching. In this paper I ask you to consider the entire research process as a reflexive exercise which provides answers to the question: ‘What is going on in methods?’. I claim that if the research product is well sign‐posted, the readers will be able to travel easily through the worlds of the participants and makers of the story and decide for themselves whether the story is a legitimate research endeavour.
Evidence‐based practice. A philosophical and political analysis: some matters for consideration by professional practitioners
Authors: Colyer Hazel , Kamath Purushotham
Published: March 2003

Evidence‐based practice. A philosophical and political analysis: some matters for consideration by professional practitioners¶ This paper evaluates the concept of evidence‐based practice (EBP) and appraises critically the implementation process of the EBP initiative, noting its consonance with the aspirations of the dominant political culture and offering a critique of the inherent contradictions and ethical dilemmas associated with it. A critical evaluation of the implications for practitioners and service users is offered and the authors argue that while the concept of EBP is a laudable one, there is a need to exercise caution about uncritical acceptance and evidence that a more eclectic and less reductionist approach to EBP is essential for quality service development.
Translation of questionnaires and issues of equivalence
Authors: Chang Anne M. , Chau Janita P.C. , Holroyd Eleanor
Published: March 2003

Translation of questionnaires and issues of equivalence¶ The validity of studies using translated instruments may be questioned when there is a lack of attention to and/or minimal explanation of the procedures used for determining the equivalence between the primary and secondary language tool. Ensuring equivalence of a translated Chinese version of the Menstrual Distress Questionnaire is an important prerequisite for identifying culturally specific expressions of concepts under investigation and for cross‐cultural comparisons. This paper examines the principles and procedures for determining equivalence of translated tools and their application to the development of an equivalent Chinese version of the Menstrual Distress Questionnaire. Translation and back‐translation were used to develop a Chinese version of the Menstrual Distress Questionnaire. Bilingual university students completed both versions of the Menstrual Distress Questionnaire. Most of the Menstrual Distress Questionnaire items had an acceptable Kappa openface> 0·4. Intraclass correlation coefficients indicated moderate to high levels of equivalence for total scores and all scales. Improvement in the translation of some items is needed to further enhance the equivalence of the Chinese version of the Menstrual Distress Questionnaire.
A comparative study of stress between pre‐ and post‐Project 2000 students
Authors: Lindop Edward
Published: March 2003

A comparative study of stress between pre‐ and post‐Project 2000 students¶This paper reports upon a comparative study in an English health authority of stress experiences between 146 current Diploma in Nursing (Project 2000) Adult Branch students and a prior study of a sample of 146 students who undertook a Certificate course leading to Registered General Nurse (RGN) in 1988. Both groups were administered the same questionnaire. The number of stressors common to both groups were two in education and nine in the clinical environment. Three prominent feelings of stress were expressed by both groups along with two methods of coping with stress. A constellation of 11 personality type characteristics labelled `determination', which enabled students to sustain themselves, was identified. Three characteristics of `determination', plus a feeling of uselessness and inability to contribute to the nursing team effort, and the intense amount of academic work were statistically significantly higher for Diploma students. Six prominent clinical stressors were experienced more intensely by third‐year Diploma students than first‐ or second‐year students. Stress was found to increase with the level of training. This finding replicated the picture found among 324 students in 1988. Differences in stress experiences for different age groups were not statistically significant with the exception of physical hard work. A number of stressors experienced by students in 1988 were also experienced by students in 1997.
The early post‐operative concerns of men after radical prostatectomy
Authors: Moore Katherine N. , Estey Angela
Published: March 2003

The early post‐operative concerns of men after radical prostatectomy

The aim of this study was to explore the concerns of men with urinary incontinence in the early weeks of recovery after radical prostatectomy for early stage prostate cancer. As part of a larger study evaluating effectiveness of intensive physiotherapy for post prostatectomy incontinence, semistructured interviews were conducted at study entry. Sixty‐three men approximately 8 weeks post‐surgery participated. The descriptive data were analysed for themes. Pre‐operative concerns focused on dealing with the diagnosis of prostate cancer, information gathering and decision‐making. Post‐operatively, a frequently repeated concern was lack of knowledge about the post‐surgery recovery period. Specifically, men stated they did not process much of the detailed pre‐operative teaching provided by the urologists and the nurses because of the overwhelming nature of the diagnosis. As a result, at discharge, they revealed many knowledge gaps about catheter care, post‐operative pain, incontinence and erectile dysfunction. Participants also perceived a lack of health care professional support. These information deficits severely affected quality of life and healthy post‐operative rehabilitation. The results of the informal interviews provide a deeper understanding of the post‐operative recovery experience and suggest some strategies for improving the early weeks of recovery after radical prostatectomy including telephone follow‐up, additional written information and on‐going support.