bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovation in the assessment of nursing theory and its evaluation: a team approach
Authors: Dean Janet M. , Mountford Brenda
Published: March 2003

In response to recent national changes in United Kingdom (UK) nurse education (e.g. devolution of assessment, moves to higher education, revision of the aims) and to local concerns (e.g. fairness to students, validity and reliability of written assessments, helping staff with less experience of assessment, student learning) an initiative has been developed at Southampton based on a team approach to marking and moderating. A five‐stage evaluation was designed to accompany implementation of the initiative. The evaluation, carried out by a lecturer and an independent educational evaluator, involved both tutors/lecturers and students. Interviews, questionnaires and observation methods were used. Benefits of the initiative and of the particular model of evaluation included: increased knowledge and confidence in the validity and reliability of the marking and moderating process undertaken by tutor‐teams; increased fairness to students; in‐service tutor training related to student assessment; knowledge that assessment‐promoted learning was taking place. A review of the total assessment programme was an unexpected outcome, including a review of the frequency and timing of assessments and of the written guidelines. The five‐stage evaluation developed a feeling of involvement and heightened self‐knowledge. Curricular understanding also increased; this helped to achieve the initiative as designed and intended. We recommend this model of evaluation; it promotes involvement of all concerned, students as well as staff, and generates valuable process‐knowledge. It can be used in pre‐ and post‐registration nurse education.
Continuing care: developing a policy analysis for nursing
Authors: Maslin‐Prothero Sian , Masterson Abigail
Published: March 2003

Many authors have commented on the invisibility of nursing in policy development, implementation and analysis. Some of this invisibility may be attributed to the lack of an easily accessible framework to assist analysis of policy from a nursing perspective. In this paper we offer a framework for nursing policy analysis based on the domain concepts of nursing. We use continuing care for older people, a topical policy issue and fundamental nursing speciality, as a case study to demonstrate the utility and potential of such a framework in action. The resulting analysis helps identify areas of potential policy interest to nurses, raises questions for further policy analysis and offers a coherent position statement for action.
The mental health of hospital nurses in Tasmania as measured by the 12‐item General Health Questionnaire
Authors: Farrell Gerald A.
Published: March 2003

The mental health of hospital nurses in Tasmania as measured by the 12‐item General Health Questionnaire Among a sample of 270 nurses who completed the General Health Questionnaire a third had scores to indicate ‘caseness’. Using principal component analysis three dimensions emerged which accounted for 64% of the variance. Preliminary findings indicate that nurses working in medical, psychiatric, surgical and pool/on call settings, in that order, had much higher rates of ‘caseness’ compared to their colleagues in other work settings.
Analgesia and anaesthesia in childbirth: obscurantism and obfuscation
Authors: Mander Rosemary
Published: March 2003

The terms ‘analgesia’ and ‘anaesthesia’ have been defined by emphasizing differing aspects of their effects. The distinction between these interventions has not been clarified by their definitions. The historical remedies for pain were similarly unclear. This lack of clarity is apparent in the introduction of chloroform in childbirth, which has much in common with the introduction and effects of epidural analgesia. The reasons for and benefits of this lack of clarity are examined.
Is caring a virtue?
Authors: Allmark Peter
Published: March 2003

The significance of the question ‘Is caring a virtue?’ lies in the fact that both the ethics of virtue and the ethics of care have been proposed as alternatives to what may be termed ‘bioethics’. The ethics of care has been of particular interest to nursing theorists, especially those who want to say that there is a body of distinctively nursing ethical theory which is different from bioethics. In answering the main question there are three supplementary aims: first, to explore the relationship between virtue ethics and the ethics of care, it is suggested that caring is not a virtue, but that the virtues involve caring correctly; second, to give a broad outline of what is meant by an ethics of virtue, including what it means to care correctly; and third, to examine implications of the theory for nursing.
Nursing care of older people: a personal construct theory perspective
Authors: Ellis Julie M.
Published: March 2003

Nursing care of older people: a personal construct theory perspective¶ This paper outlines the use of the repertory grid technique, with nurses caring for elderly residents, and residents of a nursing home. The method focuses on the individuality of each person’s attempt at making sense of her/his caring world. Previous papers have focused on a discussion of the repertory grid technique as a research method and tool for psychiatric nurses, an overview of studies using this technique with nurses and social workers, and applications of personal construct theory (from which the technique is derived) to nursing research. A paper by Rawlinson described content analysis of the role constructs elicited from the nurses. In this study, content analysis of caring constructs elicited by nurses and residents was also undertaken, and the results are presented. Additionally, principal component analysis of the repertory grids was carried out, and three examples are presented. This combined analysis provides an in‐depth insight into nurses’ perceptions of caring for others; perceptions which guide their caring behaviours. This information can be used by individual nurses to review their caring practice.
Burnout and AIDS care‐related factors in HIV community Clinical Nurse Specialists in the North of England
Authors: Hayter Mark
Published: March 2003

Burnout and AIDS case‐related factors in HIV community Clinical Nurse Specialists in the North of England¶Burnout in Acquired Immune Deficiency Syndrome (AIDS) care nursing is well described in the literature from a hospital based perspective. No studies into the effects of AIDS care and burnout have been carried out within the community setting. A two‐stage, mixed method study was carried out. In Stage one 30 Clinical Nurse Specialists in human immunodeficiency virus (HIV)/AIDS from the North of England completed the Maslach Burnout Inventory (MBI) and the AIDS Impact Scale. For Stage two five practitioners were selected randomly for semi‐structured interview. Burnout morbidity was significant. Sixty‐six per cent of informants scored as moderate or high burnout cases on the emotional Exhaustion and Personal Accomplishment subscales of the MBI. Only three per cent scored as cases on the depersonalization subscale. Links between the close involvement of practitioners with clients, death of clients, isolation, stigma and discrimination and the availability of support and supervision were identified as significant factors in AIDS care within this population that contributed to stress and burnout. Paradoxically, informants found the close relationships with clients, the autonomy of isolation and the exclusive nature of AIDS care positive aspects of their practice. The role of support and supervision in facilitating the continuance of a close empathic and therapeutic relationship and the prevention of an over‐involved, isolated and stressful relationship is proposed as a way forward.
Perceptions of care and services by the clients and families: a personal experience
Authors: Wallace Thérèse , Robertson Erica , Millar Carmen , Frisch Sara R.
Published: March 2003

Perceptions of care and services by the clients and families: a personal experience

This study was initiated in response to a provincial mental health policy emphasizing the primacy of the person and the hospital's decision to adopt total quality management. The objective of the project was to learn more about how clients and families viewed the care and services received during a psychiatric admission. Their perceptions were elicited through seven focus groups including multiple admission (3) clients and families of single and multiple admission clients (2 each). Group sessions were tape‐recorded, transcribed and analysed for themes. Three major themes were identified: quantity and quality of care, individuality and partnership. Both positive and negative comments were made within each of these themes, but two major areas for improvement were continuity of care and the environment. The findings are being used to change practices within the Department of Psychiatry.
An evaluation of the nurse practitioner role in a major rural emergency department
Authors: Chang Esther , Daly John , Hawkins Anne , McGirr Joe , Fielding Kerin , Hemmings Lynne , O’Donoghue Anne , Dennis Margaret
Published: March 2003

An evaluation of the nurse practitioner role in a major rural emergency department

The purpose of this pilot study was to investigate whether nurse practitioners are able to provide a level of primary health service applicable to remote/isolated settings in wound management and treatment of blunt limb trauma. It was hypothesized that there would be no significant difference in the quality of care, or the level of client satisfaction, provided by the medical officers and the nurse practitioners in the study. Two groups participated in the study, nurse practitioners and medical officers. The study used a randomized trial design. Data were collected using quantitative and qualitative methods. Two hundred and thirty‐two clients participated in the study. Of this number 63 were supervized cases in the pilot trial. In the randomized trial participants were distributed between nurse practitioners and medical officers (n = 169), of which 91 were randomized to medical officers and 78 to nurse practitioners. Telephone interviews were conducted to evaluate client satisfaction. The majority of study participants were surveyed for client satisfaction (n = 132). This represents approximately 78% of the randomized sample and multivariate analysis was carried out on the data. Study results indicate that there were no significant differences between the two groups in relation to client satisfaction. Very positive outcomes of treatment were consistent across groups in the study. The study also found that there was strong support for the role of the nurse practitioner in the rural emergency setting. Recommendations include further research to measure the efficacy of nurse practitioners utilizing the selected competencies in remote/isolated settings.
Family members’ experience of familial amyloidotic polyneuropathy disease — an infernal struggle and a fact of life
Authors: Jonsén Elisabeth , Athlin Elsy , Suhr Ole B.
Published: March 2003

Family members’ experience of familial amyloidotic polyneuropathy disease — an infernal struggle and a fact of life

Familial amyloidotic polyneuropathy is a fatal, hereditary, systemic, progressive amyloidosis. No previous qualitative study of the family members’ experience of the disease has been published. The purpose of this phenomenological study was to understand the lived experience of family members whose nearest and dearest suffered from familial amyloidotic polyneuropathy. In‐depth interviews were conducted with six family members. The analysis of the data was inspired by Colaizzi’s method. Two major theme categories, difficult to accept and forced to accept, emerged from the interviews. Implications for nursing practice, such as genetic counselling and support, are discussed.
Identifying the factors influencing minority language use in health care education settings: a European perspective
Authors: Roberts Gwerfyl Wyn , Paden Liz
Published: March 2003

Identifying the factors influencing minority language use in health care education settings: a European perspective

The recent enhanced status of many minority languages across the European Community has led to increasing demands for their use within the public sector. This is particularly evident in health care, where, in circumstances of stress and vulnerability, denying opportunities for clients to communicate in their preferred language may place them at a personal disadvantage and compromise their health chances. In view of the exclusion of many minority languages from the public domain over the years, their re‐introduction demands adaptations to health care education programmes in order to promote language sensitivity in practice. Before embarking on developments which establish such languages within the professional sphere, valuable insight may be gained by examining their current use in practice education. Furthermore, comparing their use across language communities enables the sharing of common experiences and furthers opportunities for developing networks across Europe. This paper describes an ethnographic study of the use, within midwifery education, of the Welsh language in north Wales, the Catalan language in Barcelona and the Irish language in Western Ireland. Semi‐structured interviews were conducted with key lecturers, clinical mentors and students across the three communities in order to determine patterns of language use within a range of learning environments. Focus groups were also held in order to confirm the findings. The data reveal many commonalties in terms of language use across the three settings and important factors are identified which support the use of minority languages in practice education. The findings are invaluable for guiding future bilingual initiatives across health care education programmes.
Priority‐setting for nursing research in the Republic of China
Authors: Yin Teresa J.C. , Hsu Nanly , Tsai Sing Ling , Wang Bette Wei , Shaw Fu Ling , Shih Fu Jin , Chang Wen‐Yin , Henry Beverly
Published: March 2003

Priority‐setting for nursing research in the Republic of China

The question of how public funds for research should be allocated has led to participatory priority‐setting in prosperous democracies like Taiwan, Republic of China. Useful criteria for research priorities are scientific merit, social benefit and feasibility. Taking a health needs approach and using these criteria, nearly 200 nurses from service and education in a national forum participated in describing research priorities. Through the group method of idea‐writing, for clinical nursing, of high priority were assessing quality, care of the elderly, and preventing infectious disease. For nursing education, research addressing advanced role preparation and bridging nursing education and practice were priorities. For nursing management, research of highest priority pertained to economic evaluation, personnel administration, and effectiveness. These suggestions from the deliberation of a committed group of nurses can help shape future national decisions about research funding and training.
A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands
Authors: Meijer Astrid , Van Campen Crétien , Kerkstra Ada
Published: March 2003

A comparative study of the financing, provision and quality of care in nursing homes. The approach of four European countries: Belgium, Denmark, Germany and the Netherlands

As result of an increase in the numbers of frail elderly people, most European countries are facing problems with the financing and provision of services by nursing homes. At the same time, the expectations of quality of these services continue to rise. The main question investigated in this study was that of how countries approach the problems of financing and service provision by nursing homes and, at the same time, attempt to increase the quality levels in these institutions. The study was conducted in Belgium, Denmark, Germany and the Netherlands. A study was made of the relevant literature and questionnaires were sent to experts in each country. The four countries are addressing the problems of financing and sufficient service provision by controlling the use of nursing home services. In addition, financial problems are approached by extending co‐payments, encouraging cheaper forms of care and putting pressure on nursing homes to operate at lower costs. Problems in the provision of care are addressed by applying more selective admission criteria and offering alternative forms of care outside the nursing home. As a result nursing home beds are used for those with the greatest care‐dependency. Nursing home services are adjusted to rising quality expectations by offering a greater range of provision, decreasing the number of residents per room, improving comfort and improving the training of nursing staff. Another way to increase the quality of care is to separate the housing and service functions. Many nursing homes nowadays collaborate intensively with other facilities for the elderly to cope with all these problems and changes. The workload for nursing home staff has increased because of the increasing care‐dependency of residents, the demand for higher quality of services and the financial problems.
The nursing education programme in Lithuania: voices of student nurses
Authors: Kapborg Inez
Published: March 2003

The nursing education programme in Lithuania: voices of student nurses

The nursing education programme in Lithuania has passed through many changes. The latest change has been carried out with support from Denmark. Ten female student nurses have been interviewed with the assistance of an interpreter. The purpose of this paper is to describe how student nurses perceived their preregistration training. The most outstanding feature of the nursing education programme in Lithuania was lack of adequate textbooks and students found this disadvantage caused a heavy workload. Students were spending the whole day in school, then studying during the evening. They were constantly tired. Although students were encouraged to be independent and to think actively during lectures, in reality this was difficult because of their workload. Students as a group were satisfied with their education, but they were doubtful about how to manage work as an independent nurse. Nowadays, many nurses in Lithuania view their work professionally and have taken over responsibility for some tasks that were carried out previously by physicians. Nurses trained previously may cause problems for newly graduated nurses because these nurses still work in a traditional manner. It will be impossible to evaluate the usefulness of the new nursing education programme in Lithuania until further investigations show how students qualify and manage their work as nurses.
The development of an instrument to measure the compliance of adolescents with a chronic disease
Authors: Kyngäs Helvi A. , Skaar‐Chandler Carrie A. , Duffy Mary E.
Published: March 2003

The development of an instrument to measure the compliance of adolescents with a chronic disease

The purpose of this paper was to describe the process of developing an instrument for measuring the compliance of adolescents with a chronic disease. The aim was to develop an instrument that could be used in a clinical setting to evaluate the compliance of young people with a chronic disease and to test a theoretical model of compliance, which had been developed along with the instrument. The instrument was originally developed to measure the compliance of adolescents with diabetes and later adjusted to measure the compliance of adolescents with asthma, rheumatoid arthritis and epilepsy. To test and develop the instrument, face and criterion validity, factor analyses, linear structural relations (LISREL) analyses, correlation coefficients and Cronbach’s α were used. The instrument has 13 background questions and 41 items to measure compliance and factors connected to it.
Women’s anxieties surrounding breast disorders: a systematic review of the literature
Authors: Woodward Val , Webb Christine
Published: March 2003

Women’s anxieties surrounding breast disorders: a systematic review of the literature

A systematic review of the research literature published in English between 1990 and 1999 was carried out to discover whether women with benign breast disorders suffer similar amounts of anxiety to women with breast cancer in the time between discovery of the problem and receiving a diagnosis, to include the immediate postdiagnosis phase. The study was limited to primary research papers with explicit methodology applicable to hospital specialist breast clinics where the main focus of the papers was anxiety and/or psychological distress. Studies focusing exclusively on routine breast screening or exclusively on women with previously diagnosed breast cancer were omitted. A protocol for the review was agreed at the outset, addressing selection criteria, search procedures, methods of data extraction and analysis, and dissemination. Search terms were refined as the study progressed. A data extraction tool was constructed based on Benton and Cormack’s framework (Benton & Cormack 1996, pp. 80–81). An initial search revealed 89 papers. Fourteen papers were found to meet the criteria for inclusion. The main findings were that women with benign breast disorders and those with breast cancer suffered from similar levels of anxiety and psychological distress in the period from first being aware of the problem up to the time of receiving a diagnosis. Anxiety levels were found to fall more quickly in women with benign disorders postdiagnosis. Methodological flaws were detracted from the rigour of many of the studies. Implications for practice are discussed.
Equal opportunities policies and nursing employment within the British National Health Service
Authors: Culley Lorraine
Published: March 2003

Equal opportunities policies and nursing employment within the British National Health Service

Aims. The National Health Service (NHS) is the largest employer in Western Europe and the largest employer of minority ethnic workers in Britain. This paper is concerned primarily with an examination of the experiences of nurses from minority ethnic groups.

Background. Recent research evidence suggests that many minority ethnic nurses face racial harassment from patients and colleagues and that there are continuing problems in recruitment and promotion. The Macpherson Report on the enquiry into the murder of black teenager Stephen Lawrence has stimulated a wide ranging discussion of institutional racism throughout the public sector in the UK, including the NHS.

Discussion. This paper discusses the continuing failure of equal opportunities policies to have a sustained impact on the experiences of minority ethnic nurses and discusses a number of reasons for the lack of progress of such policies. It examines the reasons why health care organizations might adopt equal opportunities policies and the pragmatic reasons why implementation has been both slow and patchy. It goes on to consider the concepts of managing diversity and ethnic managerialism as new tools to theorize equal opportunities and considers some of the continuing problems inherent in current strategies.
The effects of clinical supervision on the quality of care: examining the results of team supervision
Authors: Hyrkäs Kristiina , Paunonen‐Ilmonen Marita
Published: March 2003

The effects of clinical supervision on the quality of care: examining the results of team supervision

Aim(s) of the study. This study is part of a larger research project (1995–1998) aiming at quality improvement by means of clinical supervision (CS). The purpose of the study is to ascertain the conceptions of five ward teams having CS of its effects on the quality of care.

Background. The quality of nursing care has been debated since at least the 1980s. An extensive literature and research reports describe a variety of interventions and methods to improve the quality of care. One of the interventions is CS. However, the amount of empirical research exploring the effects of CS especially on the quality of care is limited.

Method. Data were collected using group interviews and analysed using the method of phenomenography.

Findings. The following categories describing the conceptions related to CS and to the quality of care emerged: knowledge, change and ‘I and we as providers of quality’. Conceptions of the effects varied between and within the teams and sometimes contradicted each other. The importance of knowledge was underlined on three of the five wards. The patient’s point of view emerged only on one ward.

Conclusions. It can be concluded that CS has effects on the quality of care and it can be considered a quality improving intervention in nursing practice. However, the knowledge of the different conceptions produced in this study also gives proof that team supervision is a challenge for supervisors.
Feminist conceptualizations of women’s madness: a review of the literature
Authors: Wright Nicola , Owen Sara
Published: March 2003

Feminist conceptualizations of women’s madness: a review of the literature

Background. Gender is one aspect of an individual’s identity that has been widely debated and discussed in relation to many different aspects of social life. The literature review explores how gender stereotypes affect women and their experience of mental illness. The aim is to demonstrate how a feminist perspective provides a useful lens through which women’s experience of mental illness can be viewed.

Methods. The papers were identified by a computerized search of the CINAHL, Medline, BIDS ISI and Mental Health Nursing Collection databases and a hand search. All papers were screened and subjected to critical review.

Results. A theoretical framework was developed that reflected two key themes to emerge from the feminist literature on women and mental illness, namely psychiatry as a method of socially controlling women and the medicalization of women’s unhappiness. In addition the complexities and contradictions in the feminist arguments are highlighted.

Conclusion. The paper concludes by considering the implications of the issues raised for nursing practice by drawing attention to the current debates on the need to focus on gender relations rather than just on women’s issues.
‘Breaking bad news’ within a paediatric setting: an evaluation report of a collaborative education workshop to support health professionals
Authors: Farrell Mike , Ryan Steve , Langrick Brian
Published: March 2003

‘Breaking bad news’ within a paediatric setting: an evaluation report of a collaborative education workshop to support health professionals

Aims of Project. To evaluate a workshop to prepare health professionals for breaking bad news in the paediatric setting.

Background. Breaking bad news can be difficult for health professionals, and it seems that few receive specific training for undertaking this challenging task. Latterly, however, there have been reports of training programmes being developed to prepare health professionals for breaking bad news, although most focus upon meeting needs of medical staff only. While doctors have a uniquely important role in breaking bad news it is evident that other health professionals, most frequently nurses, can be equally involved in this encounter. Accordingly, nurses and other professionals need training to recognize the contribution that they can make in ensuring sensitive and effective bad news disclosure.

Design. A one‐day, multi‐professional, experiential training workshop.

Method. Forty‐five participants, mainly nurses (34, 76%) and doctors (10, 22%), attended one of five breaking bad news workshops set up for staff working in a range of paediatric settings including Accident and Emergency and Intensive Care. Each of the workshops was facilitated by three facilitators from varied backgrounds. Using an experiential design, participants were supported to explore and reflect upon breaking bad news issues, which also included engagement with actors to act out realistic bad news scenarios. Debriefing, using a positive learner‐centred model of feedback, provided the main platform for promoting learning. Following the workshop, participants completed an evaluation questionnaire, seeking their perceptions of the effectiveness of the workshop in enhancing knowledge and communication skills.

Data Analysis. Atlas.ti, a qualitative computer data analysis software program was used to explore the evaluation comments made by participants, resulting in the generation of common themes.

Findings. Seven themes, including development of practice, the value of sharing, benefit of feedback, and team work, emerged from responses. All responses indicated that the workshop had been beneficial and an effective training method, with most participants (40 of 89%) indicating that they would strongly recommend their colleagues to attend a similar workshop.

Conclusion. The educational approach reported is considered by participants to be beneficial in preparing health professionals for breaking bad news in a collaborative way.
The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial
Authors: Hattan Jennifer , King Lindy , Griffiths Peter
Published: March 2003

The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial

Background. Because of the widely presumed association between heart disease and psychological wellbeing, the use of so‐called ‘complementary’ therapies as adjuncts to conventional treatment modalities have been the subject of considerable debate. The present study arose from an attempt to identify a safe and effective therapeutic intervention to promote wellbe ing, which could be practicably delivered by nurses to patients in the postoperative recovery period following coronary artery bypass graft (CABG) surgery.

Aim. To investigate the impact of foot massage and guided relaxation on the wellbeing of patients who had undergone CABG surgery.

Method. Twenty‐five subjects were randomly assigned to either a control or one of two intervention groups. Psychological and physical variables were measured immediately before and after the intervention. A discharge questionnaire was also administered.

Results. No significant differences between physiological parameters were found. There was a significant effect of the intervention on the calm scores (ANOVA, P=0·014). Dunnett’s multiple comparison showed that this was attributable to increased calm among the massage group. Although not significant the guided relaxation group also reported substantially higher levels of calm than control. There was a clear (nonsignificant) trend across all psychological variables for both foot massage and, to a lesser extent, guided relaxation to improve psychological wellbeing. Both interventions were well received by the subjects.

Conclusions. These interventions appear to be effective, noninvasive techniques for promoting psychological wellbeing in this patient group. Further investigation is indicated.
Nursing diagnosis taxonomy across the Atlantic Ocean: congruence between nurses' charting and the NANDA taxonomy
Authors: Thoroddsen Asta , Thorsteinsson Hrund Sch.
Published: March 2003

Nursing diagnosis taxonomy across the Atlantic Ocean: congruence between nurses' charting and the NANDA taxonomy

Purpose and aims. The purpose of this study was to analyse expressions or terms used by nurses in Iceland to describe patient problems. The classification of NANDA was used as reference. The research questions were: (a) Does NANDA terminology represent patient problems documented by Icelandic nurses? (b) If so, what kind of nursing diagnoses does it represent? (c) What kind of patient problems are not represented by NANDA terminology? (d) What are the most frequent nursing diagnoses used?

Methods. A retrospective chart review was conducted in a 400 bed acute care hospital in Iceland. The sample was defined as nursing diagnosis statements in charts of patients hospitalized in two 6‐month periods in two separate years. The data were analysed according to a predefined grading system based on the PES format or Problem – (A)aetiology – Signs and symptoms.

Results. A total of 1217 charts were used for the study, which yielded 2171 nursing diagnoses statements for analysis. Charts with at least one nursing diagnosis documented were 60·1% and the number of diagnoses per patient ranged from 0 to 10, with 65% of charts with three diagnoses or less. The number of diagnoses correlated with patients' length of stay, but not with increased age of the patients. The average number of statements per patient was 3·28. Almost 60% of the diagnoses were according to NANDA terminology, another 20% were stated as procedures, medical diagnoses or risks for complications. The 20 most frequently used nursing diagnoses accounted for 80% of all diagnoses documented. Discrepancy between nurses' documentation on emotional problems and availability of diagnosis in the NANDA taxonomy was evident.

Conclusion. It can be concluded that the NANDA taxonomy seems to be culturally relevant for nurses in different cultures.
Managing adverse drug reactions: an orphan task
Authors: Jordan Sue
Published: March 2003

Managing adverse drug reactions: an orphan task

Background. Nurse prescribing initiatives have potential to impact on medication management for long‐term conditions. Over time, the adverse effects of medications become increasingly onerous. This `side‐effect burden' is particularly heavy for users of antipsychotic medication. Although consensus exists that strategies are needed to alleviate these problems, currently, they are not clearly the responsibility of any one professional group.

Aim. This paper explores the introduction of nurse‐administered evaluation checklists, in relation to nurse prescribing initiatives and division of professional responsibilities for medication management.

Methods. This was an observation study, with a quasi‐experimental comparator group design, undertaken with clients receiving long‐term antipsychotic medication. In both intervention and comparator groups, before and after introduction of evaluation checklists in the intervention group, 20 nurse–client interactions were observed. Problems actioned by the nurses, with and without the checklists, were compared. Stakeholders' views were sought concurrently.

Findings. Implementation of evaluation checklists increased the numbers of adverse effects detected and actioned by nurses. They also served to apportion aspects of medication management between nurses and medical prescribers. Most actions taken by nurses to alleviate adverse effects concerned clients' physical health and advice on health‐promotion. However, the nurses' interventions would have been more effective had they been able to supply clients with certain medicines either by prescribing from the Nurse Prescribers' Formulary or issuing under Patient Group Directions. For some clients, ameliorating the adverse effects of medication would have involved changes to prescribed antipsychotic medication; here decisions were more equivocal.

Implications. The identification of previously unattended problems, together with the views of service users, suggests that empowering nurses to address the `care gaps' in medication management may benefit service users. The `checklist evaluation' approach warrants further investigation, ideally in conjunction with nurse prescribing initiatives.
Implied consent prior to nursing care procedures
Authors: Aveyard Helen
Published: March 2003

The aim of the paperis to demonstrate the nurses should be wary of relying on the concept of implied consent prior to nursing care procedures.

Rationale. The difference between a patient who implies consent and who merely complies with a procedure is almost undetectable.

Methods. An exploratory study, incorporating use of focus groups and critical incident technique to examine the way in which nurses obtain consent prior to nursing care procedures.

Findings. Many nurses administer care without seeking verbal or written consent, but claim that the patient's consent is implied. However, there is evidence that care is often administered in the absence of information‐giving and that this perceived implied consent should more realistically be called compliance. Implied consent is consent for which information is a crucial component. There is evidence that the term implied consent signifies different things to different nurses. Furthermore, even if there is agreement about what constitutes implied consent, in practice, implied consent may be indistinguishable from compliance. Nurses who assume that they have the patient's implied consent, when in reality only have compliance, risk carrying out care procedures without the patient's consent.

Conclusions. Nurses should be familiar with the principles of implied consent. They should be wary of relying on the use of implied consent prior to nursing care procedures because of the difficulty in distinguishing implied consent and compliance. Nurses should approach all aspects of care‐giving with the offer of information. In order to reduce the risk of misinterpretation of a patient's implied consent, they should seek the verbal affirmation of a patient prior to a nursing care procedure. Where nurses rely on the patient's implied consent, they should do so at their own discretion and with full understanding of the meaning of the term.
Help in times of crying: nurses' approach to parents with colicky infants
Authors: Helseth Sølvi
Published: March 2003

Background. Colic, a condition that is well known to parents and nurses working in child health centres, is characterized by excessive crying. However, the criteria for defining colic are vague, there is no agreed definition and no effective treatment exists. Even though there is no cure for colic, nurses in child health centres have to deal with the condition as parents bring their crying infants to them.

Aim. To develop an understanding of how nurses deal with infant colic/excessive crying, how the parents perceive nurses' contribution, and whether nursing makes a difference to the situation or not.

Ethical issues and approval. The project was reviewed and approved by the Research Ethics Committee in Norway where the study was carried out.

Methods.  The design is explorative, and data were collected through qualitative in‐depth interviews with nurses and parents of crying infants. The analysis follows the guidelines of Kvale, which imply a phenomenological/hermeneutical mode of understanding.

Findings. The primary aim of nursing is to assist parents in their efforts to cope with the challenges of infant colic. Nurses and parents differ to some extent in how they define the problems and the needs of the families. In addition, both parents and nurses question the nurses' knowledge and ability to help in this situation. A relationship with the parents based on trust is fundamental to enable the nurses to achieve their goals, but such a relationship is not always developed.

Conclusions. Even though nursing interventions do not cure infant colic, the amount of crying may be reduced and life made easier for the families if the parents are offered help in coping with the situation. Consequently, this should be the primary aim of nursing when approaching families with a colicky infant.
Gender influences beliefs about health and illness in diabetic subjects with severe foot lesions
Authors: Hjelm Katarina , Nyberg Per , Apelqvist Jan
Published: March 2003

Background.  No studies have been found regarding beliefs about health and illness in patients with diabetic foot ulcers investigated from a patient perspective. Beliefs might affect self‐care and health.

Aim.  To explore beliefs about health and illness among patients with severe diabetic foot lesions that might affect self‐care practice and care‐seeking behaviour.

Method.  The study design was explorative. A purposive sampling procedure was used. Focus group interviews were held, with 10 women and 11 men under 65 years (working age) and six women and 12 men over 65 years (range 23–83 years) with present or previous diabetic foot lesions managed at a specialized multidisciplinary diabetic foot clinic.

Findings.  Foot problems were perceived by participants as caused by both external and internal factors related to the individual. Self‐care was practised to restore health when ill and in daily foot care. When help was needed it was sought in the professional sector. Women were active in self‐care and preventive care, searched for information and tried to adapt to the situation. Men more often sought help for acute problems, discussed more foot‐related problems, had a pessimistic view of the future, showed a passive attitude, accepted information given and used more complementary care from the lay sector (wife) and/or the professional sector (district nurse, home care staff, podiatrist). Foot lesions caused deterioration of perceived health and quality of life due to decreased ability to be active.

Conclusion.  The present study emphasizes the need to take into account the existence of different beliefs about health and illness, especially regarding gender, in the prevention and management of the diabetic foot.
Swedish nursing students' attitudes to and awareness of research and development within nursing
Authors: Björkström Monica E. , Johansson Inger S. , Hamrin Elisabeth K. F. , Athlin Elsy E.
Published: March 2003

Background. Nurses' attitudes towards research have been illuminated in many studies. However, there is still a need for more knowledge about the attitudes and awareness of undergraduate nursing students.

Aim. To investigate Swedish undergraduate nursing students' attitudes towards and awareness of research and development within nursing, and to illuminate factors that may have an impact on their attitudes and awareness.

Methods. A questionnaire consisting of three parts: demographic data, attitude scale, and research awareness was used. Parametric and nonparametric statistics were used. Two hundred and one students participated in the study and the response rate was 77%. Cronbach's alpha test on the seven factors was between 0·52 and 0·80.

Results. Most of the students had positive attitudes towards nursing research. More than half (60%) of the students expected to make use of nursing research sometime in the future and about 25% had never read any of the scientific nursing journals. The majority (77%) of the students were acquainted with at least one Swedish researcher, but few had attended a doctoral dissertation. Students with an interest in some particular development or research area in nursing were significantly more positive and expected to make use of nursing research more frequently. Other variables that were found to have some impact upon attitudes were gender, age and additional academic studies.

Conclusion. Nursing students had an overall positive attitude towards nursing research and their interest in a particular development or research area was the most important variable for their attitudes and expected use of nursing research in the future. Therefore, it would seem to be important to encourage the students' interest in specific development/research areas of nursing during their education. In spite of the nursing students' positive attitudes to nursing research, the study demonstrates the theory–practice gap is still present to some degree.
Effects of habitat patchiness and connectivity on the spatial ecology of the root vole Microtus oeconomus
Authors: Bjørnstad Ottar N. , Andreassen Harry P. , Ims Rolf A.
Published: March 2003

1.  The effect of habitat patchiness and connectivity on dispersal distances and spatial aggregation of individuals is investigated in 12 enclosed populations of the root vole, Microtus oeconomus, employing a factorial experimental design with three different patch configurations and two distinct geographical root vole strains. The three patch configurations, all with an identical total area, were: two large patches, six small patches and six small patches connected by corridors.

2.  The populations were followed for three generations (13. weeks) using live‐trapping. Matrilineal relationships, time and place of birth, and weekly home ranges were established for the 1155 individuals in the study.

3.  Smaller patch sizes enhanced dispersal, but most for one of the strains. The strain difference is, tentatively, explained by inbreeding avoidance which is known to differ between the strains.

4.  The effect of habitat configuration on the dispersion pattern was similar for the two strains. Increased patchiness increased the aggregation of individuals. The two sexes diverged in their response, however, females being more aggregated than males.

5.  The spatial pattern of matrilinearity was used as an indication of the resulting effect of habitat configuration on the demic structure in space. Patchiness enhanced and connectivity decreased the substructuring.
Effects of size and fluctuating asymmetry on field fitness of the parasitoid Trichogramma carverae (Hymenoptera: Trichogrammatidae)
Authors: BENNETT  , HOFFMANN
Published: March 2003

1.  The effects of body size and asymmetry in morphological traits on field fitness were studied in the parasitoid Trichogramma carverae.

2.  Significant fluctuating asymmetry was detected in four bristle counts and two wing measurements made on forewings. There was no evidence for directional asymmetry in any of the traits. An estimate of field fitness was obtained in grapevines by collecting released wasps arriving at oviposition sites consisting of egg rafts of the tortricid Epiphyas postvittana.

3.  Comparisons of ovipositing and emergence samples indicated that wasps at oviposition sites were relatively larger and more variable in their size distribution. A non‐parametric analysis of the relationship between fitness and size indicated that extremely large wasps had the highest fitness and suggested that small as well as large wasps may have had a fitness advantage.

4.  For asymmetry, the only trait showing an association with field fitness was wing length. Wasps with a low length asymmetry were more likely to be collected at oviposition sites, although fitness curves indicated that wasps had a similar fitness once an intermediate length asymmetry was exceeded.

5.  Mother–daughter comparisons for wasps from a genetically heterogeneous stock provided no evidence that size measures or asymmetries were heritable when wasps were reared on a factitious host.

6.  These findings have implications for improving parasitism rates in inundative releases.
Mortality during dispersal and the cost of host‐specificity in parasites: how many aphids find hosts?
Authors: Ward S. A. , Leather S. R. , Pickup J. , Harrington R.
Published: March 2003

1. For a full assessment of explanations for the evolution of host‐specificity it is necessary to estimate the probability that a dispersing parasite finds a host. We develop a method of estimating this success rate from samples of dispersing parasites and populations resident on hosts.

2. Applying this method to data on the bird cherry‐oat aphid, Rhopalosiphum padi (L.), from southern Scotland in 1984–92, we estimate that 0·6% of the autumn migrants find hosts.

3. With such a low success rate, there should be selection for a broadening of host range, to include any host on which the colonist's fitness is more than about 0·6% of that on the normal hosts. We argue that neither nutrition nor the need for ‘enemy‐free space’ are sufficient explanations of the host‐specificity of this animal, and propose instead that it is the host's role as a rendezvous for mating that constrains the migrants to their costly host‐specificity.

4. We also discuss the implications of this low success rate for the hypothesis that aphids speciate sympatrically through the formation of host races.