bluuebunny/crossref_metadata_2025 huggingface dataset:
Harm reduction theories and strategies for control of human immunodeficiency virus: a review of the literature
Authors: Hilton B. Ann , Thompson Ray , Moore‐Dempsey Laura , Janzen Randy G.
Published: March 2003

Harm reduction theories and strategies for control of human immunodeficiency virus: a review of the literature

Aim. To provide a comprehensive review of the literature on harm reduction theories and strategies related primarily to licit and illicit drug use.

Background. Although human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) disease transmission is well understood, it continues to spread, particularly among injection drug users (IDUs). Despite early indications that HIV would be contained within the IDU community, it is spreading to non‐IDU sexual partners and to children of IDUs, threatening a more widespread epidemic.

Methods. An examination of research studies and theoretical writings including reviews and policy papers published in English between 1990 and 2000.

Results. Harm reduction does not seek to eliminate drug use; it focuses on minimizing the personal and social harms and costs associated with drug use and spread of HIV. It seeks to ameliorate conditions surrounding drug use responsible for the spread of HIV in the IDU community: unequal access to health services; sharing of infected needles; racial and social discrimination; poverty; exposure to street violence; inadequate housing; lack of employment; poor general or mental health and other demographic and social determinants. Some controversial harm reduction strategies are described: methadone maintenance programmes, illegal drugs dispensing under controlled conditions, needle exchanges, HIV testing, vein maintenance, safe‐sex and would‐care programmes.

Conclusion. The main challenge is to get IDUs to protect themselves against HIV when suffering physical and social privations and addiction needs. Diverse perspectives on harm reduction are problematic with consequences for success of drug use initiatives. Practical, ethical and theoretical complexities exist but further research is needed to build support for a harm‐reduction orientation in practice and policy formulation.
The meaning of preceptorship: nurses’ lived experience of being a preceptor
Authors: Öhrling Kerstin , Hallberg Ingalill R.
Published: March 2003

The meaning of preceptorship: nurses’ lived experience of being a preceptor

Aim of the study. This phenomenological study is aimed at illuminating nurses’ lived experience of the process of preceptoring and the meaning of preceptorship in a Swedish context.

Methods. Seventeen nurses from the North of Sweden with varied previous experience of preceptorship volunteered to participate. Their narratives, describing their experience of being a personal preceptor for a student nurse during practical training on a hospital ward in the third year of a 3‐year diploma programme within a university college of nursing in Sweden, were transcribed verbatim. A phenomenological‐hermeneutic interpretation disclosed the themes ‘sheltering the students when learning’ and ‘facilitating the students’ learning’, together with eight sub‐themes, which created an understanding of the meaning of preceptorship.

Findings and discussion. The meaning of preceptorship was understood as reducing the risk of the students learning helplessness and empowering the students when learning in practice. The meaning of preceptorship highlighted the need for further preceptor support and development of the role of the preceptor. On the basis of the findings, suggestions were made to increase the preceptors’ awareness of values in nursing practice and use of pedagogical strategies in the process of preceptoring. Through such strategies a reciprocal development of the preceptors’ and the faculty’s knowledge may take place, to the best advantage of the students’ learning and the development of the profession.
Nursing competencies: personal characteristics contributing to effective nursing performance
Authors: Zhang Zhi‐xue , Luk Weety , Arthur David , Wong Thomas
Published: March 2003

Nursing competencies: personal characteristics contributing to effective nursing performance

Aims of the study. Core competencies are important in enabling an individual to adapt to new environments and perform superior professional practice. This study was to identify the underlying competencies which contributed to effective nursing performance.

Background. Most of the previous competencies are either derived from researchers’ conceptual analysis or based on practitioners’ direct report. Competencies derived from these methods either are subject to bias or are unable to identify the essential elements for effective nursing care.

Method. Following the McBer method, 50 experienced nurses in China were asked to report 82 valid critical incidents in their jobs. Two individuals coded the scripts and decided the presence of each competency according to a pre‐established coding system.

Results. Ten competencies including interpersonal understanding, commitment, information gathering, etc. were identified. Each competency was illustrated by behavioural indicators.

Conclusions. Skills, traits, motives and attitudes all contribute to effective nursing performance. The findings assist in the delineation and development of nursing competencies and thus provide realistic working behaviours for nursing education and management.
‘Chatting’: an important clinical tool in facilitating mothering in neonatal nurseries
Authors: Fenwick Jennifer , Barclay Lesley , Schmied Virginia
Published: March 2003

‘Chatting’: an important clinical tool in facilitating mothering in neonatal nurseries

Aim. This paper explores the use of ‘chat’ or ‘social talk’ as an important clinical tool that can assist nurses achieve family‐centred care in neonatal nurseries.

Background. The study was undertaken to increase knowledge of women’s experiences of mothering in the neonatal nursery and the relationship they share with nurses.

Method. The discussion presented is elicited from a grounded theory analysis of over 60 hours of interview data with 28 women, a thematic analysis of 50 hours of interviews with 20 nurses and a content analysis of 398 tape‐recorded interactions between nurses and parents.

Findings. The analysis identifies the importance of the nurse–mother relationship and demonstrates that it is both the context and method by which nursing care is delivered. We found the verbal exchanges that take place between nurse and mother influence a woman’s confidence, her sense of control and her feelings of connection to her infant. It appears from the data that the nurse’s ability to effectively ‘engage’ the mother is dependent on the use of language that expresses care, support and interest in parents.

Conclusions. The data suggests that ‘chatting’ is the strategy and the process through which positive interactions are initiated, maintained and enhanced. This study confirms that nurses’ language acts as a powerful clinical tool that can be used to assist parents in gaining confidence in caring for their infants and in becoming ‘connected’ to infants resident in nurseries.
Doctors’ and nurses’ perceptions of ethical problems in end‐of‐life decisions
Authors: Oberle Kathleen , Hughes Dorothy
Published: March 2003

Doctors’ and nurses’ perceptions of ethical problems in end‐of‐life decisions

Aims. To identify and compare doctors’ and nurses’ perceptions of ethical problems.

Rationale. Ethical problems are a source of tension for health professionals. Misunderstandings or conflicts may result from differing perceptions of ethical problems. If true collaboration is to be achieved, it is important to understand the perspectives of others, particularly when difficult end‐of‐life decisions must be made.

Methods. In this qualitative study a total of seven doctors and 14 nurses working in acute care adult medical‐surgical areas, including intensive care, were asked to describe ethical problems that they frequently encounter in practice. Interviews were taped and transcribed. Thematic analysis followed.

Results. All participants experienced ethical problems around decision making at the end of life. The core problem for both doctors and nurses was witnessing suffering, which engendered a moral obligation to reduce that suffering. Uncertainty about the best course of action for the patient and family was a source of moral distress. Competing values, hierarchical processes, scarce resources, and communication emerged as common themes. The key difference between the groups was that doctors are responsible for making decisions and nurses must live with these decisions. Each group, therefore, asked different questions when encountering and interpreting sources of moral distress.

Conclusions. It was concluded that observed differences between doctors and nurses were a function of the professional role played by each rather than differences in ethical reasoning or moral motivation. Although this was a small qualitative study on one institution, and may not be generalizable, results suggest that doctors and nurses need to engage in moral discourse to understand and support the ethical burden carried by the other. Administrators should provide opportunities for discourse to help staff reduce moral distress and generate creative strategies for dealing with this.
Dilemmas in the provision of own‐home respite support for parents of young children with complex health care needs: evidence from an evaluation
Authors: Olsen Richard , Maslin‐Prothero Paul
Published: March 2003

Dilemmas in the provision of own‐home respite support for parents of young children with complex health care needs: evidence from an evaluation

Aims. The aim of this article is to present some of the results of a qualitative evaluation of a United Kingdom (UK) nurse‐led, home‐based, respite service for the families of children under the age of five with complex health care needs.

Background. Advances in neonatal medical and nursing care have contributed to a growth in the number of children who survive low birth weight, birth trauma, and various congenital anomalies. Many of these children are likely to have long‐term care needs which will require innovative nursing responses. Of particular importance is the need for parental respite, given the added demands of caring for very ill children at home.

Methods. A parent‐centred, follow‐up evaluation, using in‐depth qualitative interviews with parents in 18 families consecutively referred to the Children’s Outreach Service between April and December 1997.

Findings. This evaluation reveals the sometimes mixed reactions of parents to this innovative service, and the equivocal evidence about its role in contributing to family well‐being. We discuss, from the perspective of parents using the service, some of the dilemmas and problems in the provision of home‐based respite support to this client group. In particular, we explore the diverse ways in which families talk about their need for respite support and point to the need for flexibility in this kind of service provision if these support needs are to be met.

Conclusion. We conclude by discussing the practice implications of our evaluation for those planning similar services.
Using psychological insights to help people quit smoking
Authors: Ward Tony
Published: March 2003

Using psychological insights to help people quit smoking

Aims.  This paper sets out to evaluate the possibility that smoking cessation interventions which make use of current psychological theories and constructs can be more successful than programmes based largely on nicotine replacement therapy and will be more satisfying to participants.

Rationale.  Nicotine replacement therapy is currently the most widely used method for helping smokers give up the habit. Numerous studies have shown this to be a successful approach for many smokers, but the majority still fail to benefit. Typically three quarters of smokers given nicotine replacement are smoking again one year later. This study investigates whether nicotine replacement can be enhanced by the addition of psychological techniques.

Design.  Smokers recruited via publicity in the local media were randomly assigned to one of two treatment conditions. The first condition consisted of a series of group sessions in which volunteers were instructed in nicotine replacement, and a number of psychological techniques, the most important being cognitive counter conditioning. The second condition was identical to the first but without the cognitive counter conditioning. Finally background quit rate was determined using waiting list controls.

Results.  Both interventions were successful in helping smokers quit the habit, based upon an analysis at 6 months, compared with waiting list controls. The experimental condition incorporating cognitive counter conditioning produced a much higher quit rate than the condition based largely upon nicotine replacement, although the difference was not significant.

Conclusions.  This study is highly suggestive that nicotine replacement therapy can be enhanced by the inclusion of psychological techniques in group work, resulting in abstention rates higher than nicotine replacement alone and increasing participant satisfaction. Further work is needed with larger numbers to verify that this is indeed a significant gain and to investigate whether psychological techniques can give longer term benefits.
Group reminiscence among people with end‐stage chronic lung diseases
Authors: Jonsdottir Helga , Jonsdottir Gudrun , Steingrimsdottir Edda , Tryggvadottir Bjarney
Published: March 2003

Group reminiscence among people with end‐stage chronic lung diseases

Background. Reminiscence is a process of recalling long‐forgotten memorable experiences and events through verbal interaction between the person eliciting memories and one or more persons. Reminiscence is considered an effective treatment for various groups of people, particularly the elderly.

Aim. This paper describes an intervention study on group reminiscence intervention for people with end‐stage chronic lung diseases. The following hypotheses were proposed: (1) Depression in people with end‐stage chronic lung diseases will decrease after participating in a reminiscence group. (2) Self‐esteem in people with end‐stage chronic lung diseases will increase after participating in a reminiscence group. (3) People with end‐stage chronic lung diseases will report increased well‐being after participating in a reminiscence group.

Methods. The research design was quasi‐experimental, using Beck Depression Inventory and Rosenberg’s Self‐Esteem Survey pre‐ and posttreatment, in addition to conducting semistructured interviews after the treatment was finished and qualitatively evaluating outcomes of selected nursing diagnosis. A total of 12 patients participated, 10 women (mean age 70 years) and two men (mean age 86 years). The treatment was provided by two nurses to a group of patients dwelling at a long‐term unit for people with end‐stage lung diseases located in Iceland. A total of 13 group meetings were held, with 5–8 participants each time. Each group meeting had a preselected focus. It started with a short period of relaxation followed by a selected reading from a biography or from Icelandic literature and then the group discussion started, focusing on the topic of the day.

Results. The first two hypotheses were not supported. The following themes support the third hypothesis: (a) enjoyment, (b) feeling well and (c) closeness and affirmation of self and others.

Conclusions. The purpose of the study was partly achieved. Although hypotheses one and two were not supported, the third was supported by the qualitative results, which clearly demonstrated that participation in the intervention increased well‐being.
Perceptions of labour pain by mothers and their attending midwives
Authors: Baker Angela , Ferguson Sally A. , Roach Gregory D. , Dawson Drew
Published: March 2003

Perceptions of labour pain by mothers and their attending midwives

Aims. The aim of the current study was to examine the perception of pain by labouring women and their attendant midwife, from the onset of labour to delivery.

Rationale. Accurate measurement and appropriate management of pain is a significant problem for attendant medical and nursing personnel. Both the experience and perception of pain are regarded as subjective and are therefore difficult to measure objectively. Indeed, much of the literature reports that pain is often under‐ or over‐estimated by nursing staff who as a consequence consistently fail to administer adequate analgesia. Few studies have specifically examined the ability of midwives to assess the pain of labouring women.

Design. The short form McGill Pain Questionnaire (SF‐MPQ), routinely used to assess pain in obstetric environments, was used to determine pain perception. Thirteen labouring women and nine midwives completed the SF‐MPQ every 15 minutes beginning at the time of admittance to the delivery suite. Peak pain ratings for the preceding 15 minutes were obtained without reference to prior ratings or each other’s scores. Further, midwives in the maternity unit of The Queen Elizabeth Hospital (TQEH), Adelaide, South Australia completed a survey investigating the cues they use to assess pain during labour.

Results. On each measure of pain on the SF‐MPQ, the midwives scores correlated with the mothers’ scores across the entire pain range. Further analysis showed that mothers’ and midwives’ pain scores were similar at mild‐moderate pain levels, but midwives significantly underestimated pain intensity at levels that mothers described as severe. The survey responses indicated that midwives rely on both verbal and nonverbal cues to assess pain levels.

Conclusions. The cues used by midwives to differentiate pain intensities and qualities are similar to those used in other clinical settings, but may have limited discriminatory value as pain levels become severe.
Clarification of conceptualizations of empathy
Authors: Kunyk Diane , Olson Joanne K.
Published: March 2003

Clarification of conceptualizations of empathy

Background. If understanding our clients needs, emotions, and circumstances is fundamental to nursing practice, and empathy is the foundation of that understanding, then a conceptualization of empathy that can be used by nurses is of utmost importance to the profession. In 1992, Morse, Anderson, Bottorff, Yonge, O’Brien, Solberg and McIlveen analysed the concept of empathy in the psychological and nursing literature, and suggested the conceptualization of empathy was incomplete. Since that time, nurse authors have continued to publish conceptualizations and research on empathy.

Purpose. The purpose of our analysis was to describe empathy as presented in the nursing literature between 1992 and 2000.

Method. A concept clarification methodology of concept analysis was used because of the many definitions, the rich descriptions, and the application of empathy as a research variable in the reviewed literature.

Findings. Five conceptualizations of empathy were revealed: empathy as human trait, empathy as a professional state, empathy as a communication process, empathy as caring, and empathy as a special relationship.

Conclusions. The literature reviewed contained evidence that the concept is developing more depth and breadth. Nurse authors are approaching empathy from a variety of perspectives, time frames, measurements, and outcomes. While all are important to the development of the concept, further enrichment of the conceptual work on empathy is needed before a fully mature concept emerges that is fully useful in nursing practice, research, and education.
Effects of using videotaped vignettes on enhancing students’ critical thinking ability in a baccalaureate nursing programme
Authors: Chau J.P.C. , Chang A.M. , Lee I.F.K. , Ip W.Y. , Lee D.T.F. , Wootton Y.
Published: March 2003

Effects of using videotaped vignettes on enhancing students’ critical thinking ability in a baccalaureate nursing programme

Aim. The aim of this study was to determine the effects of using videotaped vignettes in promoting nursing students’ critical thinking abilities in managing different clinical situations.

Background. The impetus for undertaking this study came from recognition of the need to develop the level of students’ critical thinking within clinical nursing practice. Eight videotaped vignettes that simulated clinical situations were developed to promote baccalaureate nursing students’ critical thinking abilities in managing clinical situations. Guidelines were also developed to stimulate students’ discussion.

Design/Methods. A pre‐test/post‐test design was employed to determine the effectiveness of videotaped vignettes in promoting critical thinking skills among these students. A final sample of 83 students completed all the pre‐test and post‐test questionnaires on critical thinking skills and nursing knowledge test specific to a vignette.

Results/Findings. The findings indicate that students’ post‐test knowledge scores were significantly higher than the pre‐test knowledge scores. While the post‐test critical thinking skill test scores were slightly higher than those of the pre‐test for the students, the difference was not significant. One reason for such findings may be the limited exposure students had to these new types of videotaped vignettes. After the course had been completed both students and teachers were asked to reflect and to indicate their level of satisfaction with the new approach. There was overall satisfaction with the new approach to teaching clinical skills as reflected in the interview data from both teachers and students.

Conclusions. While there were positive outcomes in terms of helping students to relate nursing principles to clinical situations, more time for students to learn using videotaped vignette in tutorial hours remains a challenge for teachers in planning the lectures.
Valuing people as individuals: development of an instrument through a survey of person‐centredness in secondary care
Authors: Coyle Joanne , Williams Brian
Published: March 2003

Valuing people as individuals: development of an instrument through a survey of person‐centredness in secondary care

Background. Person‐centred care is regarded as the optimum way of delivering health care and is defined as valuing people as individuals (Winefield et al. 1996). So how can practitioners find out if their service ‘values people as individuals’? Serious doubts have been expressed about the validity of the concept of patient satisfaction and the ability of instruments to measure patients’ views of care. However, qualitative research among people who had experienced problems with their health care has identified an alternative concept better able to articulate patient’s complex experiences (Coyle 1997). The study found that that patients’ identity was threatened by experiences perceived as dehumanizing, objectifying, disempowering and devaluing. Thus the concept of ‘personal identity threat’ showed the extent to which people felt valued (or not) as individuals.

Aim of the study. The aim of the research reported in this paper is to build upon the earlier qualitative work and to identify the frequency and distribution of inpatients’ experiences of ‘personal identity threat’.

Design/Methods. The study adopted a cross‐sectional survey design. Ninety‐seven patients from general medical, surgical and otolaryngology wards completed a questionnaire developed from the qualitative study containing items on dehumanization, objectification, disempowerment and devaluation.

Findings. Although many patients expressed positive sentiments about their care, problems were highlighted around power/control, involvement in care, and the approachability and availability of staff. The findings also revealed that women were more at risk than men of ‘threats to identity’ in health care settings.

Conclusions. Improvements are suggested to help promote a service that truly values people as individuals. These include improving health practitioners’ understanding of the impact of illness on everyday life, promoting practitioners’ listening and enquiring skills, and increasing the ‘visibility’ and availability of staff. Further research should also explore gender and age differences in perceptions of the lay–practitioner relationship.
What they talk about: conversations between child health centre nurses and parents
Authors: Baggens Christina
Published: March 2003

What they talk about: conversations between child health centre nurses and parents

Background. The voluntary child health promotion programme reaches virtually all children in Sweden and each child will visit the child health centre about 20 times until it has reached school age. The practical responsibility for the tasks at the child health centre resides mainly with the nurse. The nurse’s talk is the main instrument used to carry out health examinations, detect health problems and developmental deviations, pass on information and give individual advice and support to families.

Aim. The aim of the study is to explore the content of the conversations and analyse its relationship to both the child health promotion programme and the question of which party decides what is talked about in these encounters.

Methods. The empirical study, approved by the Committee for Ethics in Medical Investigation, was conducted at three child health centres in medium‐sized towns in Sweden. Data collection consisted of audiotapes of 44 visits to these child health centres. The tape‐recorded conversations were transcribed verbatim and constitute the material. The analysis was content‐orientated and was performed in four steps: coding and generating topics, categorization of topics, identifying the initiator and searching for regularities.

Results/Conclusion. The results showed that the most common issues discussed concerned the child’s development (mainly physical aspects), situational matters and questions about procedures and routines. The nurses initiated most of the topics discussed and her dominance was established with the help of the official child health promotion programme. The findings evoke ideas about what possibilities the parents have of making their voices heard during the conversations. The conclusion is that the findings indicate a need for further research on nurse‐parent/child communication during visits to the child health centre to acquire knowledge about the interactional consequences in the conversation when some topics are discussed but others are not.
Occupational therapy in accident and emergency departments: a randomized controlled trial
Authors: Hendriksen Hazel , Harrison Roger A.
Published: March 2003

Occupational therapy in accident and emergency departments: a randomized controlled trial

Background. The National Service Framework for Older People published in 2001 requires action to improve the discharge process of older people from hospital. Currently, many older people released from accident and emergency departments are unable to perform basic activities of daily living. This could delay recovery and increase demand for emergency primary care services.

Aims. To evaluate the potential for an occupational therapist in an accident and emergency department to reduce unmet functional needs after releasing patients aged 75 years or more with a primary diagnosis of limb, rib or back trauma.

Methods. A randomized controlled trial was employed, with the intervention group receiving an occupational therapy assessment and given, or arrangements made, for appropriate treatments and equipment before release. Controls received routine care. All patients were reassessed at home, 7 days later.

Results. Of 72 patients, 39 were recruited with 19 randomized to the intervention group and 20 to the control group. The median age was 81 years (75–92 years) and 31 (79%) were female. At baseline, 20 (51·2%) patients had problems in performing one or more of four basic activities assessed. At the follow‐up assessment, in the intervention group the proportion of patients having no problems with these activities increased by 54% over and above the change in the control group, compared with that at baseline (P < 0·001). No effect on anxiety or demand for primary care was observed.

Conclusions. In our local hospital, over 50% of older patients with limb, rib or back trauma would have left the accident and emergency department unable to perform basic activities of daily living. This might be overcome by employing occupational therapists to assess and meet the functional needs of these patients before sending them home. These results need confirming in a larger study.
Developing culturally competent researchers
Authors: Papadopoulos Irena , Lees Shelley
Published: March 2003

Developing culturally competent researchers

Background. Whilst we live in multicultural societies most health researchers tend to take the cultural perspective of the majority ethnic group at the expense of the perspective of minority ethnic groups.

Aim. This paper discusses the need for the development of culturally competent health researchers in all areas of research and proposes a model for the achievement of this.

Design. A snapshot review of research textbooks used in nursing curricula was conducted to identify whether culturally competent research was being promoted.

Results. The review found that whilst a few textbooks touched on ethnicity, race and culture, none of them addressed the issue of cultural competence. Subsequently the authors adapted their existing model of culturally competent health care practice, and in this paper they propose it as a model for the development of culturally competent researchers.

Discussion. The model put forward by the authors consists of four concepts: cultural awareness, cultural knowledge, cultural sensitivity and cultural competence. A culturally competent researcher is one who is able to apply the related skills and knowledge in project design, data collection, analysis, report writing and dissemination. Furthermore, the authors identify two layers of cultural competence, those of culture‐generic (knowledge and skills that are applicable across ethnic groups) and culture‐specific competence (knowledge and skills that relate to a particular ethnic group). The relationship between these two layers is a dynamic and spiralling process as illustrated by the model.

Conclusion. Current health policy in many developed countries focuses on inequalities of health and managing diversity, including ethnicity. Thus the authors conclude that the development of culturally competent researchers will lead to both valid research and culturally competent practice by health care professionals.
Feminist poststructuralism: a methodological paradigm for examining clinical decision‐making
Authors: Arslanian‐Engoren Cynthia
Published: March 2003

Feminist poststructuralism: a methodological paradigm for examining clinical decision‐making

Aim.  To present the philosophical framework of feminist poststructuralism, discuss its use as an innovative research approach and its implications for nursing knowledge development and practice.

Background.  This perspective examines the construction of meaning, power relationships, and the importance of language as it affects contemporary healthcare decisions. It seeks to identify and expose biases that marginalize the healthcare needs of women and contribute to healthcare disparities for this population. Additionally, a feminist poststructuralist perspective seeks to develop new knowledge for understanding gender differences.

Nursing application.  A feminist poststructuralist perspective represents an alternative paradigm for studying the phenomenon of clinical decision‐making. An empirical application example of a feminist poststructuralist perspective is provided. This exemplar investigated emergency department registered nurses’ triage decisions for men and women with symptoms suggestive of coronary heart disease.
Getting evidence into practice: the meaning of `context'
Authors: McCormack Brendan , Kitson Alison , Harvey Gill , Rycroft‐Malone Jo , Titchen Angie , Seers Kate
Published: March 2003

Getting evidence into practice: the meaning of `context'

Aim of paper. This paper presents the findings of a concept analysis of `context' in relation to the successful implementation of evidence into practice.

Background. In 1998, a conceptual framework was developed that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice [Kitson A., Harvey G. & McCormack B. (1998)Quality in Health Care7, 149]. One of the key elements of the framework was `context', that is, the setting in which evidence is implemented. It was proposed that key factors in the context of health care practice had a significant impact on the implementation and uptake of evidence. As part of the on‐going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide some theoretical and conceptual rigour to its content.

Methods.  Morse's [Morse J.M. (1995)Advances in Nursing Science17, 31; Morse J.M., Hupcey J.E. & Mitcham C. (1996)Scholarly Inquiry for Nursing Practice. An International Journal10, 253] approach to concept analysis was used as a framework to review semi‐nal texts critically and the supporting research literature in order to establish the conceptual clarity and maturity of `context' in relation to its importance in the implementation of evidence‐based practice.

Findings: Characteristics of the concept of context in terms of organizational culture, leadership and measurement are outlined. A main finding is that context specifically means `the setting in which practice takes place', but that the term itself does little to reflect the complexity of the concept. Whilst the themes of culture and leadership are central characteristics of the concept, the theme of `measurement' is better articulated through the broader term of `evaluation'.

Conclusions. There is inconsistency in the use of the term and this has an impact on claims of its importance. The concept of context lacks clarity because of the many issues that impact on the way it is characterized. Additionally, there is limited understanding of the consequences of working with different contexts. Thus, the implications of using context as a variable in research studies exploring research implementation are as yet largely unknown. The concept of context is partially developed but in need of further delineation and comparison.
Impact of a nurse‐led counselling service on quality of life in patients with inflammatory bowel disease
Authors: Smith Graeme D. , Watson Roger , Roger Derek , McRorie Euan , Hurst Nigel , Luman Widjaja , Palmer Kelvin R.
Published: March 2003

Impact of a nurse‐led counselling service upon quality of life in patients with inflammatory bowel disease

Aim. Health related quality of life is impaired in patients suffering from inflammatory bowel disease. Although counselling directed towards physical and psychological morbidity is assumed to improve health related quality of life, this has never been demonstrated.

Methods. Physical and psychological well‐being were assessed using questionnaires administered to 100 out‐patients in the United Kingdom suffering from inflammatory bowel disease, 50 subjects not suffering from inflammatory bowel disease and a disease control group comprising 28 patients with psoriatic arthritis. A specific nurse led counselling package was given to half the inflammatory bowel disease group and health related quality of life was assessed at baseline, 6 and 12 months.

Results. Inflammatory bowel disease and psoriatic arthritic patients had a range of physical disease activity, although none were severely ill during the course of the study. Medical therapy was similar in both groups throughout the duration of the trial. The mean Short Form 36 (SF‐36) scores for mental health were low in inflammatory bowel disease patients; 62·9 ± 9·1 (SD) in ulcerative colitis, 60 ± 9·8 (SD) in Crohn's disease, compared with 72·4 ± 7·2 (SD) in healthy controls (P < 0·05). Mean SF‐36 scores for social function were also reduced in Crohn's disease patients; 68·4 ± 10·1 (SD) in Crohn's disease, compared with 87 ± 10·1 (SD) in healthy controls (P < 0·05). As expected, the mean SF‐36 scores in psoriatic arthritic patients were significantly low 61·9 ± 1·5 (SD) compared with 82·4 ± 14 (SD) in healthy controls (P < 0·05).

Crohn's disease patients were significantly more anxious than the other groups, mean HAD score was 10 ± 3·7 (SD) in Crohn's disease patients and 6·86 ± 3·5 (SD) in healthy volunteers (P < 0·05), although mean HAD scores for depression were similar in all groups. Maladaptive coping mechanisms were present in a significant proportion of Crohn's disease patients. At follow‐up all aspects of psychological morbidity returned to the normal range in the Crohn's disease patients without significant change in the mean physical disease index.

Conclusion. Health related quality of life can be improved over 6 months by provision of a nurse led counselling service but the effects are not sustained for 12 months.
A risk assessment scale for the prediction of pressure sore development: reliability and validity
Authors: Lindgren Margareta , Unosson Mitra , Krantz Ann‐Margret , Ek Anna‐Christina
Published: March 2003

A risk assessment scale for the prediction of pressure sore development: reliability and validity

Background. The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice.

Aim. To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale.

Methods. The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re‐modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value.

Results. Two variables were excluded as a result of low item–item and item–total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0·83, respectively. The factor analysis gave three factors, with a total variance explained of 65·1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards.

Conclusions. The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.
Dealing with uncertainty: parental assessment of pain in their children with profound special needs
Authors: Carter Bernie , McArthur Elizabeth , Cunliffe Mary
Published: March 2003

Dealing with uncertainty: parental assessment of pain in their children with profound special needs

Background. Despite advances in the assessment and management of children's pain, children with profound special needs are especially vulnerable to poor pain management. Their underpinning condition often severely compromises their ability to express pain through the usual verbal and behavioural routes. The lack of any appropriate framework for assessment results in a suboptimum and inaccurate approach to an important aspect of their care.

Purpose. The purpose of the study was to explore the ways in which parents of children with profound special needs assess and manage their children's pain.

Methods. Qualitative case study design underpinned the study using guided interviews with the 15 parents/carers (of 12 children aged 5–16 years with profound special needs).

Ethical approval. Ethics Committee approval was gained.

Findings. A number of themes emerged from the data including learning to live with pain, dealing with uncertainty, expression of pain and making decisions.

Conclusions. Parents felt that their child had learned to live with significant levels of chronic and acute pain. Assessment of pain was an uncertain and complex process requiring parents to draw on skills and knowledge developed over a number of years. Parents used different strategies for both the assessment and management of pain based on an intimate knowledge of their child's usual nonpain state. Even with a limited repertoire of behaviours available to them, children were able to express pain. Parents often felt isolated in relation to pain management and under‐used as a resource by health professionals.
Older Swedish women's experiences of living with symptoms related to Parkinson's disease
Authors: Caap‐Ahlgren Marianne , Lena Lannerheim PhD RN  , Ove Dehlin MD PhD
Published: March 2003

Background.  Approximately 1% of the population over 65 years of age is afflicted with Parkinson's disease (PD). The number of patients with the disease will most probably increase in the future because of the increased longevity of the population. There is no curative therapy for the disease.

Aim.  To explore women's experiences of living with symptoms related to PD, and to analyse how the symptoms influence their quality of life.

Methods.  A phenomenological‐hermeneutic method, inspired by the philosophy of Ricoeur was used. The study focuses on eight women between 63 and 80 years of age who have been diagnosed with PD for 5–15 years. The women all lived at home, were moderately to severely disabled and cognitively intact.

Findings.  In the analysis, four themes emerged: (1) wish for a stable body image; (2) wish to keep traditional female competence; (3) need to feel accepted for the person she is; and (4) perceived stigmatization. All themes showed that trying to adapt to unpredictable fluctuations in physical and psychosocial competence has a great impact on the females' lives. It became clear that fluctuations in competence and not knowing when to expect impaired mobility are connected with frustration and social withdrawal.

Conclusion.  The experience of PD from eight disabled female patients has revealed that the disease affects quality of life not only for the person who has it, but also for her family. Thus, it is equally urgent that patients, relatives, nurses and caregivers gain better knowledge and more understanding of PD, so as to ease the impact of the disease on the patient's daily life.
Issues in educating health professionals to meet the diverse needs of patients and other service users from ethnic minority groups
Authors: Chevannes Mel
Published: March 2003

Aim.  The main aim of the study was to undertake training needs analysis among a multi‐professional group for the purpose of improving care for ethnic minority patients and other service users.

Background.  Evidence from the literature identifies that some of the explanations advanced for the failure of health professionals to meet the needs of ethnic minorities include lack of understanding of cultural diversities, racism, racial stereotyping, lack of knowledge, exclusiveness, and ethnocentrism. While these issues have been addressed in different countries, little work has been carried out to examine these from the perspective of health professionals caring for ethnic minorities. This study is therefore an attempt to find out what health professionals know about caring for patients and other service users from minority ethnic groups and their perception of training needs in this area of work.

Methods.

 A pre‐ and post‐training design phase structured the qualitative approach. A purposive sample of individuals working across five health service organizations located in a multi‐racial city yielded a multi‐professional group of participants. Views of 22 participants were obtained by semi‐structured interviews at a pretraining phase. Training needs of health professionals drew on
Walklin's (1992 ) six stages used to structure data collection, data analysis and delivery of training. The post‐training phase used questionnaires to evaluate immediate learning that based on a 4‐week period of reflection and applied to practice. The questionnaires were complemented by a facilitator‐lead focus group.

Results.  The majority of the participants confirmed that no attention was given in their initial education to the health care needs of minority ethnic groups. Instead, participants engaged in self‐initiated learning to improve their knowledge and understanding. The issue of communication was viewed with dissatisfaction and seen as affecting the sufficiency of caring for these patients. All participants rated meeting the needs of ethnic minorities as very important and believed that they had gained a better understanding of the concepts of ethnicity and race and resources available in local communities as a result of the training. They also reported changes in thinking about ethnic minorities and had started to acquire greater confidence to engage with colleagues about different cultural values and practices and the implications of these for caring. While a quarter of the participants had transferred some learning to practice, the majority were not able to bring about any change. This majority response challenged the sustainability of learning about ethnic minorities when training takes place away from the context in which professionals practise.

Conclusion.  Training embedded in clinical and nonclinical environment where patients and other service users and professionals interact is offered as a major finding.
The efficacy of acupressure to prevent nausea and vomiting in post‐operative patients
Authors: Ming Jin‐Lain , Kuo Benjamin Ing‐Tiau , Lin Jaung‐Geng , Lin Li‐Chan
Published: March 2003

Background.  Post‐operative nausea and vomiting is a common complication following general anaesthesia. Traditional Chinese medicine indicates that acupressure therapy may reduce nausea and vomiting in certain ailments.

Aim(s) of the study.  The aim of this study was to examine the effect of stimulating two acupressure points on prevention of post‐operative nausea and vomiting.

Design and methods.  A randomized block experimental design was used. The Rhodes Index of Nausea, Vomiting and Retching (INVR) questionnaire was used as a tool to measure incidence. To control the motion sickness variable, the subjects who underwent functional endoscopic sinus surgery (FESS) under general anaesthesia were randomly assigned to a finger‐pressing group, a wrist‐band group, and a control group. There were 150 subjects in total with each group consisting of 50 subjects. The acupoints and treatment times were similar in the finger‐pressing group and wrist‐band pressing group, whereas only conversation was employed in the control group.

Results.  Significant differences in the incidence of the post‐operative nausea and vomiting were found between the acupressure, wrist‐band, and control groups, with a reduction in the incidence rate of nausea from 73·0% to 43·2% and vomiting incidence rate from 90·5% to 42·9% in the former. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the former group.

Conclusion.  In view of the total absence of side‐effects in acupressure, its application is worthy of use. This study confirmed the effectiveness of acupressure in preventing post‐operative nausea and vomiting.