bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequalities in service provision: an examination of institutional influences on the provision of district nursing care to minority ethnic communities
Authors: Gerrish Kate
Published: March 2003

Inequalities in service provision: an examination of institutional influences on the provision of district nursing care to minority ethnic communities

This paper reports on the selected findings from a larger ethnographic study of the provision of district nursing care to patients from different ethnic backgrounds. The two‐stage study was undertaken in an English community National Health Service (NHS) trust serving an ethnically diverse population. The first stage comprised an organizational profile in order to analyse the local policy context, including specific responses to ethnic diversity. Data were collected by means of in‐depth interviews with managers. The second stage entailed a participant observational study focusing on six district nursing teams. Purposive sampling was used to identify four teams with high minority ethnic caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and field‐notes were analysed by drawing upon the principles of dimensional analysis. The paper focuses upon institutional influences on the provision of care to minority ethnic communities. An analysis of the allocation of district nursing resource to different general practitioner (GP) practices identified marked inequalities in the district nursing provision which impacted upon the services provided to minority ethnic patients. Single‐handed, inner city GP practices with a large minority ethnic practice population received a much smaller allocation of nursing staff than single group practices serving a smaller and predominately white practice population. The reasons why this situation existed are explored and an explanation offered as to why it had not been rectified. Observation of caseload management indicated that despite differences in the size of the practice populations served by the respective teams, all patients referred for nursing care received it. However, several covert processes appeared to limit the caseload size of those teams with large practice populations so that it remained manageable within the limited nursing resource available. It is concluded that although nurses at an individual level did not appear overtly to disadvantage minority ethnic patients, institutional forces conspired to perpetuate the disadvantage experienced by minority ethnic communities.
The first line of response for people who self‐poison: exploring the options for gut decontamination
Authors: Clegg Theresa , Hope Kevin
Published: March 2003

The first line of response for people who self‐poison: exploring the options for gut decontamination

The trend for increasing numbers of self‐poisoning incidents has been noted and a variety of policy initiatives have been launched. Nurses, particularly in emergency room environments occupy a pivotal place in the chain of response to such acts. Any such response needs to be firmly rooted in evidence‐based practice yet the initial management of self‐poisoning often involves a consideration of procedures, the application of which can vary enormously. This paper offers some contextual information prior to a critical perspective of management modes, namely emesis, lavage, the use of activated charcoal and whole bowel irrigation. A comparison of the relative advantages and disadvantages of each mode precedes suggestions for nursing practice.
Stress from working conditions among home care personnel with musculoskeletal symptoms
Authors: Brulin Christine , Winkvist Anna , Langendoen Stivia
Published: March 2003

Stress from working conditions among home care personnel with musculoskeletal symptoms

A large proportion of the working population experiences musculoskeletal symptoms, which affect the individual’s quality of life. Neck/shoulder and/or low back complaints are common among home care personnel. This occupational sector is characterized by high physical and psychosocial demands and the staff is typically female. The aim of this qualitative study was to gain a deeper understanding of those factors in the work environment of home care personnel that the individuals perceive as demanding and problematic. Eight employees in the home care service were interviewed in depth. Each interview was transcribed and Grounded Theory was applied. Stress, related to demanding physical and psychosocial working conditions, emerged as the core variable that probably contributed to the development and maintenance of musculoskeletal symptoms. Financial cut‐backs at the municipality was seen as a cause of the demanding working conditions. In future studies it is important to evaluate prevention programmes focused upon coping strategies against stress.
Do nurses and other professional helpers normally display much empathy?
Authors: Reynolds William J. , Scott Brian
Published: March 2003

Do nurses and other professional helpers normally display much empathy?

Empathy, the ability to perceive and reason, as well as the ability to communicate understanding of the other person’s feelings and their attached meanings, is held to be a core characteristic of a helping relationship. This paper examines some of the observations that motivated the authors’ interest in how registered nurses learn how to offer empathy to clients. First, while empathy is crucial to all helping relationships, professional helpers do not normally offer much empathy. Second, while nurses are meant to provide helping relationships, they do not tend to show much empathy to clients. The relevance of empathy to clinical nursing and the potential consequences of low‐empathy nursing for clients is considered. It will be shown that, in the past, a low level of empathy has been reported among the helping professions, including nursing, indicating that many professional helpers are not as helpful as they ought to be. While most studies of empathy in professional relationships are more than a decade old, more recent studies report similar results.
Family dynamics, parental‐fetal attachment and infant temperament
Authors: Wilson Margaret E. , White Marjorie A. , Cobb Brenda , Curry Ruthanne , Greene Diane , Popovich Deborah
Published: March 2003

Family dynamics, parental‐fetal attachment and infant temperament

The purpose of this longitudinal study of families having their first or second baby was to explore relationships among family dynamics, paternal‐ and maternal‐fetal attachment, and infant temperament. Data were collected from 156 women and 62 of their partners during the third trimester of pregnancy. One year later, when the infant was 8–9 months old, 75 of the women and 30 of their partners participated. In a hierarchical multiple regression analysis, after controlling for demographic variables, mutuality in the family was associated with greater maternal‐ and paternal‐fetal attachment. Family dynamics were stable across the transition to parenthood except for an increase in role conflict reported by mothers. Sensitivity to specific family experiences by clinicians can provide assistance to families during these periods.
Educational input and patient outcomes: exploring the gap
Authors: Jordan Sue
Published: March 2003

Educational input and patient outcomes: exploring the gap

Over the last two decades, the health care professions in the United Kingdom have seen an unparalleled expansion of continuing professional education (CPE) and development (CPD) programmes; however, there is little empirical evidence that these enhance the care delivered to patients. Further research is also needed to demonstrate that these initiatives are linked to improved patient outcomes. If health care educators are to move towards an ‘evidence‐based curriculum’, some restructuring of courses may be needed. Priorities should be set and decisions made, based on the results of reliable and valid research into the clinical outcomes of CPE. To evaluate courses and demonstrate educational effectiveness solely in terms of student satisfaction is not enough; to survive in the world of evidence‐based care, educators must also demonstrate their contribution to clinical effectiveness. However, the neoteric field of impact evaluation lacks not only validated research methods, but also an agreed agenda for future research. Drawing on interviews undertaken with nurses who have participated in education evaluations and the relevant literature, this paper discusses the available data collection instruments and the development of viable research designs and methods, which are urgently needed to assess the outcomes of professional education programmes.
Dreams that lie in tatters: the changing fortunes of nurses who left the British NHS to own and run residential homes for elderly people
Authors: Andrews Gavin J. , Kendall Sally A.
Published: March 2003

Dreams that lie in tatters: the changing fortunes of nurses who left the British NHS to own and run residential homes for elderly people

During the 1980s many nurses left the British National Health Service to own and run private residential care homes for elderly people. At the time, a public policy of guaranteed financial support for residents underpinned the rapid expansion in the sector and residential homes were considered as profitable low‐risk business ventures. However, since the introduction of the 1990 National Health Service and Care in the Community Act, this automatic funding has been withdrawn and residential homes have had to compete amongst each other for a finite number of clients funded by limited local budgets. The withdrawal of guaranteed state support and the introduction of social care markets have had negative impacts on many residential home businesses. Indeed, many homes are facing financial difficulties. This paper considers the actions and attitudes of former nurse proprietors under the new conditions based on a three‐stage survey in Devon, England. Proprietors are experiencing increased levels of stress and many are unhappy with their current work experiences. The paper concludes that although the small business private sector may seem attractive to nurses, any move into private sector ownership has an associated risk. Social policy conditions may change with concurrent consequences for businesses and business owners.
Clinical effectiveness in the post‐anaesthesia care unit: how nursing knowledge contributes to achieving intended patient outcomes
Authors: Prowse Morag A. , Lyne Patricia A.
Published: March 2003

Clinical effectiveness in the post‐anaesthesia care unit: how nursing knowledge contributes to achieving intended patient outcomes

This paper reports part of an ongoing study on how nursing knowledge develops in practice and influences patient outcomes. The practice focus is post‐anaesthesia nursing, an area which has been under‐represented in nursing research. A qualitative approach was used to explore narrative data, collected by in‐depth interviews, with 32 experienced post‐anaesthesia nurses. Data analysis and interpretation were informed by a phenomenological perspective consistent with a research focus on individual experiences. Interpretation of the narratives gave rise to a description of knowledge development which occurred as nurses gained experience, drew on the available knowledge base, and used knowledge in practice. This led to the identification and description of ‘referential’ and ‘effective’ types of knowledge. Referential knowledge comprises the variety of external knowledge sources available to inform practice. When referential knowledge was incorporated into the personal knowledge of the individual nurse in everyday practice, it was transformed into effective knowledge which was used by nurses to achieve desired patient outcomes. The study findings indicate that nurses used effective knowledge as evidence for decision making and interventions in everyday practice. The key finding of the study is that effective nursing knowledge requires practice for its development.
Nursing scripts and the organizational influences on critical thinking: report of a study of neonatal nurses’ clinical reasoning
Authors: Greenwood Jennifer , Sullivan Jennifer , Spence Kaye , McDonald Margaret
Published: March 2003

Nursing scripts and the organizational influences on critical thinking: report of a study of neonatal nurses’ clinical reasoning

During 1995–1997 a study was undertaken to explore the extent to which theoretical knowledge acquired through a distance education programme in neonatal nursing was brought to bear in the real‐world clinical reasoning of course participants. The study utilized a think aloud technique and included both concurrent (on‐the‐job) and retrospective verbal reports at 0, 6 and 12 months into the programme. Participants (n=4) were also interviewed individually on completion of the study. Results indicated that important inconsistencies existed between participants’ theoretical knowledge and their practice; they also pointed to some organizational influences on these theory–practice inconsistencies. Script (or schema) theory provided a useful explanatory framework for these results. The paper includes a brief description of data collection and analysis techniques; its main emphasis, however, is on these theory–practice inconsistencies and their explanation in terms of the nature and acquisition of nursing practice scripts. The implications of nursing scripts for the promotion of critical thinking and evidence‐based practice are discussed.
Coping strategies and health‐related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis, and transplant patients
Authors: Lindqvist Ragny , Carlsson Marianne , Sjödén Per‐Olow
Published: March 2003

Coping strategies and health‐related quality of life among spouses of continuous ambulatory peritoneal dialysis, haemodialysis and transplant patients

In the study reported here 55 spouses of patients living with end‐stage renal disease (ESRD) were investigated with respect to coping strategies and health‐related quality of life. Findings from the study were compared to two random samples of the Swedish general population (n = 454, andn = 1200). The study design was correlational and comparative. Coping was measured by the Jalowiec Coping Scale, and quality of life (QoL) by the Swedish Health‐Related Quality of Life Survey (SWED‐QUAL). Data were analysed using a number of statistical tests including Pearson’s product moment correlations, Student’st‐test and two wayANOVAs. The combined sample of spouses used significantly more optimistic and palliative coping than the general population, but less confrontative, self‐reliant, evasive and emotive coping. In the study fatalistic, evasive and emotive coping was associated with low perceived efficiency in handling various aspects of the partners’ situation. The male spouses used significantly less optimistic, supportive and palliative coping than did the female spouses. The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups, most likely due to the lower age of the former group. The study findings suggest that emotive, evasive and fatalistic coping are less than optimal ways to deal with problems occasioned by the partner’s treatment.
Community nurses’ perceptions of patient ‘compliance’ in wound care: a discourse analysis
Authors: Hallett Christine E. , Austin Lynn , Caress Ann , Luker Karen A.
Published: March 2003

Community nurses’ perceptions of patient ‘compliance’ in wound care: a discourse analysis

As part of an interview study of community nurses’ perceptions of their work, 62 staff working within the district nursing service in one English National Health Service Trust (grades B–H) were asked to recount occasions when they had been involved in wound care and to discuss the ways in which working with patients who required such care could be either enhanced or made difficult. A large number of respondents expressed the view that non‐compliance could pose serious problems for the management of wounds. Data relating to compliance are presented here and are interpreted in the light of discourse analysis, an approach which permits the researcher to focus on the meanings underlying the communications of research participants and to interpret those meanings in the light of social and cultural mores and influences. The authors found that non‐compliance could be explained by nurses in a number of different ways. These ranged from passive resistance, which could be due to ignorance or lack of motivation, through overt refusal, to deliberate interference in order to prolong treatment. It also seeks to outline some of the factors that appear to motivate the nurses’ desire to achieve compliance.
South Asian patients’ lived experience of acute care in an English hospital: a phenomenological study
Authors: Vydelingum Vasso
Published: March 2003

South Asian patients’ lived experience of acute care in an English hospital: a phenomenological study

Studies on utilization of hospital services by South Asian patients in the United Kingdom have consistently demonstrated levels of dissatisfaction with care in relation to meeting religious and cultural needs, although there are few studies on minority ethnic patients’ utilization of acute hospital services. This study aimed to describe and interpret from the consumer’s view the ‘lived experience’ of acute hospital care from the perspectives of South Asian patients and their family carers. The purposive sample of 10 patients and six carers consisted of 13 females and three males (five Hindus, six Muslims and five Sikhs) who were interviewed at home 2 to 3 weeks after discharge from hospital. Data were gathered through semi‐structured interviews that were tape recorded and transcribed. A phenomenological approach was used, and data were analysed using the principles of Heideggerian hermeneutics. Five themes were identified, ranging from feelings of satisfaction with care, unhappy about the service, fitting‐in strategies and post‐discharge coping mechanisms. Patients seemed to want to cause as little disruption as possible to the ward environment and tried to fit in to what they refer to as an ‘English place’. The findings, although not generalizable, offer important insights into how South Asian patients survive their journey through their hospital stay and have implications for the provision of nursing care for minority ethnic patients.
The Roper, Logan and Tierney (1996) Model: perceptions and operationalization of the model in psychiatric nursing within a Health Board in Ireland
Authors: Murphy Kathy , Cooney Adeline , Casey Dympna , Connor Mary , O’Connor Jean , Dineen Brendan
Published: March 2003

The Roper, Logan and Tierney (1996) Model: perceptions and operationalization of the model in psychiatric nursing within a Health Board in Ireland

This study aimed to determine whether the Roper, Logan & Tierney model was an appropriate model for planning nursing care for clients who are mentally ill. Data were collected from two sources in one Health Board region in Ireland. A care plan audit was used to evaluate the extent to which the Roper, Logan & Tierney model was used to assess, plan and evaluate nursing care in nursing documentation. Qualitative interviews with nurses explored their experiences of using the model and their perceptions of the model’s usefulness and appropriateness for planning care. Both data sets were complementary, the qualitative data often providing contextual information which helped put the findings into perspective. It was found that there was little evidence that the Roper, Logan and Tierney model guided care planning and that goals and nursing interventions were frequently not explicitly documented. Interviews with nurses indicated that they lacked educational preparation for using the model and found the model constraining and physically orientated. The appropriateness of the Roper, Logan and Tierney model for planning care for clients who are mentally ill is questioned. It is suggested that nurses need to be adequately prepared if they are to use a model appropriately. Consideration should be given when selecting a model as to its ‘fit’ with the needs of the client group and the ward team philosophy.
British nurses in behavioural psychotherapy: a 25‐year follow‐up
Authors: Gournay Kevin , Denford Lindsey , Parr Ann‐Marie , Newell Robert
Published: March 2003

British nurses in behavioural psychotherapy: a 25‐year follow‐up

Background The National Service Framework for Mental Health has emphasized the need to prioritize the provision of cognitive behaviour therapy as the central evidence‐based non‐pharmacological intervention for mental health problems. For 25 years one programme (English National Board Course No. 650 — Diploma in Behavioural Cognitive Therapy, formerly called Nursing in Behavioural Psychotherapy) has trained nurses in such methods. This is the only programme in nursing which qualifies graduates to be fully certified as a cognitive behaviour therapist by the British Association of Behavioural Psychotherapy and by the United Kingdom Council for Psychotherapy. The practice of these nurse therapists (most commonly known as nurse behaviour therapists, NBTs) is the most rigorously evaluated in mental health nursing, with several randomized controlled trials to testify to clinical and economic efficacy. Aim The aim of this study is to continue the systematic follow‐up of all NBT graduates previously undertaken in two earlier surveys published in 1986 and 1994. These previous surveys examined clinical practice, organizational context and career and professional development issues. This up‐to‐date picture of NBTs will provide useful baselines for the implementation of the National Service Framework, and may be used by the Department of Health, education providers and services. Method A postal survey (using the same template for categories of information as the two earlier surveys) was used and questionnaires were sent to 237 of the 274 trained NBTs whose name appears on the Central NBT Register, maintained at the Institute of Psychiatry/Maudsley Training Centre. Results One hundred and five of 230 eligible respondents (45·6%) returned questionnaires and additional data were obtained from 27 NBTs who provided information to the Register in the year before the survey. Thus, some data were available for 57% of the sample. As in earlier surveys, it was found that the majority of therapists remain in clinical practice, undertake substantial further education and training and are involved in research and teaching as part of their overall role. The two central developments are an increasing move towards working in primary care and an increased emphasis on cognitive interventions. NBTs complete a substantial number of treatments per year and increasingly treat clients with difficulties not encountered during their basic training. NBTs now receive much more supervision than in previous surveys and continue to use valid and reliable measures of change in practice. However, the number of NBTs remains small and the impact on potential populations who would benefit from effective psychological interventions is minimal. This paper discusses the implications for service delivery.
Stress, pre‐term labour and birth outcomes
Authors: Mackey Marlene C. , Williams Carol A. , Tiller Cecilia M.
Published: March 2003

Stress, pre‐term labour and birth outcomes

Preliminary studies have suggested that stress may be associated with the onset, treatment and outcomes of pre‐term labour; however, a systematic comparison of the stress of women with and without pre‐term labour has not been reported. Therefore, the purpose of this exploratory study was to compare the stress (daily hassles and mood states) and birth outcomes of black and white women who experienced pre‐term labour (PTL) during pregnancy with those who did not. The convenience sample consisted of 35 pregnant women hospitalized in 1996–1997 for the treatment of PTL (24–35 weeks gestation) and 35 controls matched on age, race, parity, gestational age and method of hospital payment. Women in the PTL group had significantly higher tension‐anxiety and depression‐dejection on the Profile of Mood States (POMS), lower mean birthweight and mean gestational age, and a higher percentage of babies born <37 weeks and weighing 2500 g or less. Black women in the PTL group and white women in the control group had significantly higher scores on the fatigue sub‐scale of the POMS and the work and future security sub‐scales of the Daily Hassles Scale. Women in the PTL group whose babies weighed 2500 g or less had significantly higher scores on the health, inner concern and financial responsibility sub‐scales of the Daily Hassles Scale. The findings from this study indicate the need for further exploration of the interaction of race and stress in understanding and preventing PTL and low birthweight and the need to examine the role of social support in preventing pre‐term birth after an episode of PTL.
Predicting well‐being among breast cancer survivors
Authors: Dirksen Shannon Ruff
Published: March 2003

Predicting well‐being among breast cancer survivors

The purpose of this descriptive study was to test a conceptual model that predicts well‐being among women who have survived breast cancer. The model was derived from empirical research findings that identified health care orientation, uncertainty, social support, resourcefulness and self‐esteem as significant predictors of well‐being in persons diagnosed with cancer. The convenience sample was of 84 women who had completed primary treatment for breast cancer and were currently disease‐free. After informed consent was obtained each woman completed six questionnaires which measured the study variables. Multiple regression techniques were used to empirically test the predicted conceptual relationships and to estimate predictive validity for the model. Findings indicated that uncertainty and social support were significant predictors of resourcefulness and explained 12% of the variance in resourcefulness. Resourcefulness and social support were significant predictors of self‐esteem and explained 33% of the variance in self‐esteem. In combination, social support, resourcefulness, and self‐esteem were significant predictors of well‐being and explained 42% of the variance in well‐being. Health care orientation was not a significant variable. This study confirmed hypotheses and provided insight into the variables that significantly influence well‐being in women who have survived breast cancer. Recommendations for practice are given with suggestions made for further research.
Ethnicity in pressure ulcer risk assessment, with specific relation to the Pakistani ethnic minority in Burton, England
Authors: Anthony Denis , Johnson Mark , Reynolds Tim , Russell Linda
Published: March 2003

Background.  There has been little work on ethnicity related to pressure ulcers in general and little or nothing specific to South Asians, and the Pakistani ethnic group in particular.

Aim.  To explore the relevance of ethnicity in pressure ulcers.

Methods.  All admissions over a 5‐year period to a District General Hospital in Burton, United Kingdom (UK) were considered where data were present on Waterlow Score, ethnicity and pressure sore status. Logistic regression analysis was conducted using ethnicity and other variables to predict ulcer formation.

Results.  Age is predictive, but ethnicity was not found to be a significant predictor.

Conclusion.  There is no evidence that members of the Pakistani ethnic minority are at higher risk than the majority White population in Burton, with respect to pressure ulcers.
Herbal products and conventional medicines used by community‐residing older women
Authors: Yoon Saun‐Joo Lee , Horne Claydell H.
Published: March 2003

Herbal products and conventional medicines used by community‐residing older women

There is a risk of interaction between herbal products and conventional medications, therefore, more needs to be known about the use of herbals by older persons. The purpose of this research was to explore the use of herbal products for medicinal purposes and to compare differences in the demographic characteristics and health status of herbal product users and nonusers among community‐dwelling older women. In 1998, a random sample of 86 women aged 65 years and older who lived independently in a North Central Florida county was selected. Names were obtained from the Florida State Department of Highway Safety and Motor Vehicles. Structured interviews using questionnaires were completed for 86 subjects. The interview questionnaire addressed health status and the use of conventional medicines, use of herbal products, and demographic data. Findings indicated that herbal products were used by 45% of the sample in the previous 12 months. The average number of herbal products used by the 45% was 2·5. Herbal products were used to prevent health problems (41%), to treat illness (23%), and for both prevention and treatment (36%). The women reported using an average of 3·2 prescribed medicines and 3·8 nonprescribed medicines. No differences in demographic characteristics and health status were found for users and nonusers of herbal products except that herbal product users were more concerned with memory problems than nonusers. No difference in perceived seriousness of memory problems existed between the two groups. It is important for health care providers to be knowledgeable about the use of herbal products to provide comprehensive health care to older women.
Exploring caring using narrative methodology: an analysis of the approach
Authors: McCance Tanya V. , McKenna Hugh P. , Boore Jennifer R.P.
Published: March 2003

Exploring caring using narrative methodology: an analysis of the approach

The investigation of caring in nursing practice and the need to explicate what it is nurses do when they care present a challenge for nurse researchers. This is due largely to the complex and nebulous nature of caring as a concept and the contextual elements that influence its perceived meaning. Consequently, the use of qualitative methods in the exploration of caring is the method of choice, with researchers employing a variety of such approaches. In particular, the use of stories as a primary way of making sense of an experience has gained attention in the literature and the narrative method is being seen increasingly as a valid means of tapping into the patient experience. However, the use of narratives is complex with a diversity of approaches often being presented. This paper discusses the use of narratives in the exploration of caring, focusing specifically on an approach developed by Donald Polkinghorne. Issues associated with the collection and analysis of narrative data using this approach are examined.
The parturient woman: can there be room for more than ‘one person with full and equal rights inside a single human skin’*?
Authors: Burrows Julia
Published: March 2003

The parturient woman: can there be room for more than ‘one person with full and equal rights inside a single human skin’?

Aims of the paper. The aim of the paper is to raise awareness around the legal and ethical issues involved in the enforcement of caesarean sections on non‐consenting women. The paper considers the competing rights of mother and foetus in situations where a mother’s wishes may result in harm or death to the foetus.

Background/Rationale. In this light of various court decisions about enforcing caesarean sections, the paper examines the pertinent legal and ethical issues, recognising that health professionals need to operate within an explicit legal and ethical framework.

Content. The arguments about a woman’s right to autonomous decision‐making and a foetus’ absolute right to life are examined with the focus throughout being on the legal framework. The need for health professionals to work within this as well as to avoid the temptation to base individual clinical decisions or professional behaviour on subjective moral judgements is emphasized.

The attitudes of the judiciary are considered along with recent legal developments. There is an analysis of the way in which established legal principle is sometimes circumvented to override a woman’s right to autonomy. The part played by lawyers and health professionals in denying a woman’s competence to consent in order to achieve an outcome of which they approve is critically appraised. The basis for the decisions in these cases is deconstructed, along with a discussion of the role of health professionals in contributing to the dilemmas highlighted.

Conclusion. It is essential that nurses or midwives caring for pregnant women have a full understanding of the legal and ethical issues surrounding this complicated and emotive area and where they, as health professionals, fit within this. The subject matter is also a useful arena for debating such ethical and legal issues as capacity and competence to consent as well as the extent of the right of any patient to full autonomy.
Simplified Japanese Self‐Perception Scale for Young Adults (SJS‐PSYA) to identify risk cases
Authors: Reiko Ueda , Okamura Jun
Published: March 2003

Simplified Japanese Self‐Perception Scale for Young Adults (SJS‐PSYA) to identify risk cases

Aim. The purpose of this study was to investigate the effectiveness of the newly devised Simplified Japanese Self‐Perception Scale for Young Adults (SJS‐PSYA) for identifying risk cases. The SJS‐PSYA was used to measure self‐perception of young adults and its validity was examined. The subjects were 196 Japanese young adults (91 males, 105 females) who had participated in the longitudinal study of Ueda (1996, 1998) from infancy and preschool years to adolescence.

Method. Questionnaires for subjects and their parents were mailed separately and then interviews were conducted for possible risk subjects and their parents.

Results. (1) The total score of the SJS‐PSYA was correlated negatively with the total number of risk variables. (2) Eight out of 10 single risk variables were correlated with the total self‐perception score. Better subjective health, higher aspiration for future, employed at present, much satisfaction in life, much support from friends as well as family and higher appraisal of nurturance of own parents, higher was the total self‐perception score. These results suggest that the SJS‐PSYA could be used in identifying young adults at risk and for intervention.
The conceptual structure of physical touch in caring
Authors: Chang Sung Ok
Published: March 2003

The conceptual structure of physical touch in caring

Aims of the study. This study was conducted to clarify and to conceptualize the phenomena of physical touch in caring.

Background. Physical touch occurs frequently in patient care situations and has specific meanings within the context of caring. However, the concept of physical touch in caring has not been well articulated in the literatures, although the phenomena of touch and physical touch have been studied in relation to comfort, sense of well‐being and connectedness.

Design/method. The Hybrid Model of concept development was applied to develop a conceptual structure of physical touch in caring, which included a field study carried out in Seoul, South Korea using in‐depth interviews with 39 adult subjects consisting of health‐care professionals, in‐patients, and healthy persons.

Results/findings. The concept of physical touch in caring emerged as a complex phenomenon having meanings on several different dimensions which were encompassed several attributes and the conceptual structure of physical touch in caring centred around five aspects of goals for physical touch: promoting physical comfort, promoting emotional comfort, promoting mind‐body comfort, performing social role, and sharing spirituality.

Conclusions. Physical touch in caring as a concept having the dimensions of physical, emotional, social, and spiritual significance needs to be treated in a holistic way and it is possible to enrich the meanings and methods of physical touch in nursing so that its application may have effects that have positive impacts on patients’ well‐being and comfort.
Beneath the surface: collaboration in alcohol and other drug treatment. An analysis using Foucault’s three modes of objectification
Authors: Curtis Janette , Harrison Lindsey
Published: March 2003

Beneath the surface: collaboration in alcohol and other drug treatment. An analysis using Foucault’s three modes of objectification

Aim of study.  This study investigated the perceptions of alcohol and other drug (AOD) clinicians and consumers regarding the concepts of collaboration and empowerment.

Background/rationale.  Working collaboratively is seen as a cornerstone of empowerment, a concept used extensively over the last decade in an attempt to isolate power and control issues. It is generally assumed that health professionals strive to achieve collaboration, but little research has been undertaken.

Design/methods.  The study was carried out in a variety of AOD treatment facilities in a large regional city in Australia. Facilities included an inpatient detoxification unit, an outpatients’ clinic, a methadone maintenance clinic, a residential detoxification and rehabilitation unit using a 12‐step treatment model and a residential unit using cognitive behavioural therapy (CBT). The nonprobability sample consisted of 57 staff and consumers who were interviewed using a semi‐structured format. Data were analysed thematically using a Foucauldian analysis of discourse.

Research findings.  Findings suggest that clinicians may be unwittingly imposing their beliefs and prejudices on consumers and in fact disempowering the very people they want to empower. Collaboration is not happening. Foucault’s theory of objectification illuminates the processes involved.

Conclusions.  There is much more happening than originally thought between consumers and staff when Foucault’s three modes of objectification are used to examine this practice area. Analysing discourse enables us to see how health workers interact with consumers and the effect this may have on treatment objectives, outcomes and self‐esteem. It also illuminates the work environment where the therapeutic encounter takes place. The need for further effort in empowering both consumers and staff and working collaboratively becomes evident.
The quality of life for Hong Kong dialysis patients
Authors: Suet‐Ching Weety Luk
Published: March 2003

The quality of life for Hong Kong dialysis patients

Aim. This study set out to measure the quality of life (QoL) of the dialysis patient. The first aim was to investigate the QoL of Hong Kong dialysis patients, and the second to understand the relationship between the demographic data and the QoL of the subjects.

Rationale. Patients undergoing dialysis experience problems with disease‐specific symptoms. The combination of a decrease in energy, the unavoidable emergence of socioeconomic problems, and emotional reactions compounds the stress facing the patient. The life of a dialysis patient may be lacking in quality. Few studies have examined the QoL of Hong Kong dialysis patients. More information is needed to establish how patients can be helped to lead more productive lives.

Methods. The Chinese Dialysis QoL Scale was used. A convenience sampling method was used to recruit patients from the outpatient clinics of dialysis centres. The distribution score on each item and the overall score were computed, with a lower score indicating greater negative impact of dialysis. To compare whether there is a difference in the average QoL score obtained between different groups on each of the demographic variables, one‐wayANOVAfollowed by Tukey’spost hocanalysis were used. Pearson’s product moment correlation was used to examine the relationships between the demographic variables and the overall QoL score.

Findings. Of the 180 scales distributed, 164 were returned, giving a response rate of 91%. The mean of the total score was 132·5 withSD16·68, varying between 97 and 179. The item mean score was 3·31. Marital status, type of modalities, and age appear to have no relationship to QoL.

Conclusion. Patients undergoing dialysis in this study experienced multiple physical, social, economic and psychological changes. The priority of healthcare services should therefore be to provide support in the areas of family and social life, information and employment.
HeartCare: an Internet‐based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery
Authors: Brennan Patricia Flatley , Moore Shirley M. , Bjornsdottir Gyda , Jones Josette , Visovsky Constance , Rogers Michelle
Published: March 2003

HeartCare: an Internet‐based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery

HeartCare is an Internet‐based information and support service for patients recovering at home from coronary artery bypass graft (CABG) surgery. The system is designed to meet the nursing challenges in health information to support needs of CABG patients. HeartCare (a) provides information and support, tailored to patients’ individual and changing recovery needs during CABG recovery, (b) makes recovery information more accessible for timely use by patients, and (c) extends the scope of nursing services to CABG patients from hospital through home. An ongoing randomized controlled study is underway to evaluate the clinical outcomes of patients’ use of the HeartCare system and to examine its acceptance as a usable resource for postCABG patients who have limited previous computer experience.
Effects of injection duration on site‐pain intensity and bruising associated with subcutaneous heparin
Authors: Chan Harriet
Published: March 2003

Effects of injection duration on site‐pain intensity and bruising associated with subcutaneous heparin

Aim. The research evaluated two subcutaneous heparin injection techniques to determine the effects of different injection duration (10‐ and 30‐seconds) on site‐pain intensity and bruising.

Background. The research was instigated because nurses and patients in the hospital under investigation reported a high incidence of site‐pain and bruising associated with subcutaneous heparin therapy. This research was conducted over a period of 7 months between September 1998 and April 1999. The Ethic Committees of the University and the hospital approved the research.

Methods. The research used a within‐subjects, quasiexperiment, which would yield more convincing causal inferences, owing to the assumption that pain perception and physiological factors affecting coagulation varied less in the same subject than in two comparable subjects. The research involved 34 stroke patients receiving low‐molecular weight heparin. For each subject, one of the two injection techniques was used as the first injection and 12 hours later the other injection technique as the second injection. Subjects rated the level of perceived site‐pain intensity using the vertical visual analogue scale (VAS). Injection‐site bruising were measured at 48 and 60 hours after each injection. Digital planimetry was used to measure the surface‐area of bruise tracings. The final data set for analysis consisted of 68 VAS pain scores and 136 bruise sizes. As normality of the data could not met after transformations, Wilcoxon Signed‐Rank tests were used to determine the effects caused by injection duration on site‐pain and bruise size. The level of significance was determined at P < 0·05.

Results. Results indicated that the 30‐second duration injection technique resulted in significantly less intense site‐pain and fewer and smaller bruises.

Conclusions. It was concluded that administering a subcutaneous heparin injection over longer duration reduces injection site‐pain and bruising. However, the convenience, relatively small sample may limit the generalisability of the research findings.
Development and testing of the parental coping strategy inventory (PCSI) with children with cancer in Taiwan
Authors: Yeh Chao‐Hsing
Published: March 2003

Development and testing of the parental coping strategy inventory (PCSI) with children with cancer in Taiwan

Rationale. This study describes the development and psychometric testing of the parental coping strategy inventory (PCSI).

Methods. The PCSI was developed on the basis of previous qualitative study on the Taiwanese parental adaptation process, when caring for children with cancer. In order to develop the measure of parental coping strategy inventory (PCSI), relevant parameters or items for the assessment subscales were then identified and tested in a three‐stage process: item development, content validity testing and reliability testing. The PCSI consisted of 48 items in 12 scales after item selection, and the internal consistency of the scales were acceptable. In order to test the psychometric characteristics of the PCSI, data were collected from 183 mothers with children with cancer.

Results. Confirmatory factor analysis supported a good overall model fit of the construct validity of PCSI. In order to test the generalizability of the factor structure, mothers with children with epilepsy were used. The factorial validity of PCSI was supported from the population of those mothers with children with epilepsy.

Conclusions. This version of the PCSI was developed with an explicit prior conceptual model based on grounded qualitative study findings. The PCSI is a specified coping behaviour measure with the conceptual framework that adaptation problems can be solved through specific coping strategies. It can be administered in 20 minutes and is the first documented measure of the adaptation process administered directly to Taiwanese parents. It demonstrates acceptable psychometric properties and could be used as a quick screening instrument in evaluating parental problems when caring for children with cancer as well as chronic illness (such as epilepsy, as tested). It could also be used as a predictor of parental adaptation outcome. This report presents preliminary data on the initial instrument development and psychometric properties of PCSI.
An exploration and advancement of the concept of trust
Authors: Hupcey Judith E. , Penrod Janice , Morse Janice M. , Mitcham Carl
Published: March 2003

An exploration and advancement of the concept of trust

Background. Trust is a concept used both in everyday language and in the scientific realm. An exploration of the conceptualizations of trust within the disciplines of nursing, medicine, psychology and sociology, revealed that trust is an ambiguous scientific concept.

Aims. In order to increase the pragmatic utility of the concept of trust for scientific application, further clarification and development of the concept was undertaken.

Methods. First, a concept analysis was conducted with the aim of clarifying the state of the science of discipline‐specific conceptualizations of trust. The criterion‐based method of concept analysis as described by Morse and colleagues was used (Morseet al.1996a,1996b,Morse 2000). This analytic process enabled the assessment of the scientific maturity of the concept of trust. The interdisciplinary concept of trust was found to be immature. Based on this level of maturity it was determined that in order to advance the concept of trust toward greater maturity, techniques of concept development using the literature as data were applied. In this process, questions were ‘asked of the data’ (in this case, the selected disciplinary literatures) to identify the conceptual components of trust.

Results. The inquiry into the concept of trust led to the development of an expanded interdisciplinary conceptual definition by merging the most coherent commonalties from each discipline.

Conclusions. The newly developed interdisciplinary conceptualization advances the concept toward maturity, that is, a more refined, pragmatic and higher‐order concept. The refined concept of trust transcends the contextual boundaries of each discipline in a truly interdisciplinary scientific fashion.