bluuebunny/crossref_metadata_2025 huggingface dataset:
Teacher candidates’ reflective teaching and learning in a hospital setting – changing the pattern of practical training: a challenge to growing into teacherhood
Authors: Hyrkäs Kristiina , Tarkka Marja‐Terttu , Paunonen‐Ilmonen Marita
Published: March 2003

Teacher candidates’ reflective teaching and learning in a hospital setting – changing the pattern of practical training: a challenge to growing into teacherhood

Aims of the project. The main goal of the ‘teacher candidates’ reflective teaching and learning’ project was to integrate theories of reflection in education and nursing practice. This was realised through teacher candidates’ practical training in a hospital setting providing them with personal experiences of reflection in different forms and contexts. In this paper one teacher candidate pair’s experiences of developing documentation in one operating theatre are described.

Background. The power of reflection is acknowledged in health care education and, on the other hand, also in nursing practice. Reflection, however, is not spontaneous but it requires active contribution. The key persons in this respect seem to be healthcare teachers. The challenges for today are that, for example, the theoretical background of reflection is multi‐fold and that the concept of reflection is popularised in common use.

Design of the project. The project (1995–1998) was accomplished in one of the biggest university hospitals in Finland. On the collaborating wards, systematic team supervision was in progress. Teacher candidates planned and implemented in‐service‐training modules for teams based on educational needs raised during team supervision sessions.

Findings. The contribution of the project can be assessed as important to health care teacher education, but also to nursing practice. Practical training in a hospital setting enhanced teacher candidates’ ability to work as teachers in a hospital organisation as well as a nursing college/polytechnic by providing them with a new viewpoint. They learned valuable lessons from applying theory, as planning in‐service‐training required continuous reflective discussion with the nursing staff but also theoretical reflection. Improvements in nursing practice were also promoted as staff educational needs were met.

Conclusions. Shifting the teacher candidates’ practical training into a hospital setting and emphasising reflection seemed to promote their professional development towards teacherhood and improve nursing practice.
Constructions of sexuality for midlife women living with chronic illness
Authors: Kralik Debbie , Koch Tina , Telford Kerry
Published: March 2003

Constructions of sexuality for midlife women living with chronic illness

Aim. In this paper, we reveal constructions of sexuality that were articulated by women who participated in an inquiry which aimed to understand the experiences of midlife women who live with chronic illness. The aim of this paper is to illuminate sexuality as an important health issue for women living with chronic illness and to offer ways that nurses may acknowledge and facilitate sexuality issues for women.

Background. The first author, as part of her doctoral study, corresponded with 81 women living with chronic illness. The participatory inquiry was framed by feminist principles and enabled women to anonymously share their experiences and collaborate in the direction of the research. During the analysis phase of the research, it became evident that illness had altered the way in which women conceptualized sexuality.

Design. The three authors performed secondary analysis of the original data set in order to re‐examine the impact that chronic illness had on the sexuality of midlife women who live with chronic illness. Whilst we acknowledge that sexuality has multiple meanings, in this paper we describe the way in which women themselves have constructed and articulated their sexuality.

Findings. We found that sexuality incorporated women’s desires, appearance, sexual feelings and expression and imposed on aspects of their lives that they had not needed to acknowledge before illness intruded. Three concerns are discussed; the changing body, meeting the needs of others and communicating sexuality.

Conclusions. This paper reveals that issues of sexuality are an important health concern for women who live with long‐term illness and should be acknowledged in sensitive and responsive health practices. The paper concludes that it is important for nurses to provide women opportunity for open and genuine communications about sexuality. In this way, a foundation of acceptance for the whole person is established which provides women permission to ask questions and seek assistance with sexuality issues.
Concept analysis: abuse of ageing caregivers by elderly care recipients
Authors: Ayres Martha M. , Woodtli Anne
Published: March 2003

Concept analysis: abuse of ageing caregivers by elderly care recipients

Purpose. The purpose of this article is to clarify the concept of abuse within the context of ageing women who are at risk for or experiencing physical or emotional injury inflicted by elderly family members for whom they provide care.

Background. The study of abuse of ageing individuals in family caregiving situations has traditionally focused on abuse of the dependent care receiver. However, evidence supports the health risks related to abuse of ageing caregivers as well. Women, usually spouses, daughters, or daughters‐in‐law, most frequently assume the caregiver role.

Methods. A modification of the strategies for concept analysis proposed by Walker and Avant (1995) is used to clarify the concept of caregiver abuse. Searches of the professional literature reveal that caregiver abuse is rarely addressed; therefore, the broader concept of elder abuse is reviewed and then placed within the general context of family caregiving. Audiotapes of the first session of a community based intervention research study entitled Intervention for the Abuse of Ageing Caregivers (Phillips et al., NIH Grant No. R01 DA‐AG11155‐01, 1996), in which ageing women caregivers described abusive caregiving situations, were analysed qualitatively using the principles of concept analysis. The audiotapes serve as a second source of data for the concept analysis process.

Findings. Antecedents, defining characteristics, and consequences of abuse of ageing caregivers were identified through the process of concept analysis. Model, contrary, and borderline cases are presented to illustrate the findings.

Conclusions. Findings supported the need for awareness that ageing caregivers can be placed at risk by verbally and physically abusive behaviours of the elders for whom they provide care. Use of the term ‘abuse’ by health care professionals has potentially negative consequences for identification and intervention in cases of potential or actual caregiver abuse.
Hermeneutic notions illuminate cross‐cultural nursing experiences
Authors: Spence Deborah G.
Published: March 2003

Hermeneutic notions illuminate cross‐cultural nursing experiences

Aim of paper. To articulate selected hermeneutic notions for the purpose of extending current understanding of cross‐cultural nursing practice.

Background. This paper builds upon the findings of a New Zealand project that explored the experience of nursing people from cultures other than one’s own (Spence 1999). The project asserted that the notions of prejudice, paradox and possibility portray a nursing view of this phenomenon.

Argument. The discussion is based on philosophical hermeneutics as interpreted from the works of Gadamer (1996), Taylor (1985a, 1985b, 1995) and Lampert (1997). However the emphasis in this paper, rather than being methodological, is on showing how specific hermeneutic notions contribute to deeper understanding of the nature of cross‐cultural practice. It is argued that contact with, and the capacity to explore, the play of conflicting prejudices and possibilities enhances understanding of the complex and paradoxical nature of cross‐cultural nursing.
Qualified nurses’ smoking prevalence: their reasons for smoking and desire to quit
Authors: McKenna Hugh , Slater Paul , McCance Tanya , Bunting Brendan , Spiers Arlene , McElwee Gerry
Published: March 2003

Qualified nurses’ smoking prevalence: their reasons for smoking and desire to quit

Aim and rationale. The preventable nature of smoking related diseases places a major responsibility for health promotion on all health professionals. This study used a questionnaire to survey qualified nurses in Northern Ireland as to smoking prevalence and their desire to quit the habit. It also explores their knowledge base relating to smoking related diseases and their motivation to act as health promoters with patients who smoke.

Methods. A random sample (n=1074) of qualified nurses employed by the Health and Social Services Trusts, private, and voluntary organizations in the province were surveyed.

Results. Results show that 25·8% were smokers, 19% were ex‐smokers and 55·2% were nonsmokers. Three quarters expressed a wish to stop within 6‐months. Almost all smokers and half of ex‐smokers had taken up the habit prior to commencing nursing. ‘Addiction’ and ‘enjoyment’ were given as the principle reasons for continued smoking. Health reasons were paramount in smokers’ desire to stop smoking.

Conclusions. These findings suggest that smoking prevalence among qualified nurses in no greater than that reported by females in the general Northern Ireland population. Results also indicate that those nurses who smoke were less willing to take on the role of a health promoter with patients who smoke. Implications and recommendations for practice, education and research are explored.
Factors influencing women’s decisions for choice of surgery for Stage I and Stage II breast cancer in Western Australia
Authors: Mastaglia Barbara , Kristjanson Linda J.
Published: March 2003

Factors influencing women’s decisions for choice of surgery for Stage I and Stage II breast cancer in Western Australia

Background. Internal and external factors have been reported to influence decision‐making by women for breast cancer surgery.

Aim of the study. The aim of the study was to describe the factors those women with Stage I or Stage II breast cancer, perceived to be important when selecting either modified radical mastectomy or breast conserving treatment.

Design/method. A descriptive correlational study was conducted. A consecutive sample of women with a diagnosis of breast cancer during a 6‐month period was selected from the Health Department of Western Australia Cancer Registry.

Results. Women who had breast conserving treatment rated the surgeon’s preference as a more important factor in decision‐making than women who had modified radical mastectomy. The lack of difference in long‐term survival between the types of surgery was also a more important influence on decision‐making for the breast conserving treatment group compared with women who had received modified radical mastectomy. Women in rural areas tended to choose modified radical mastectomy rather than breast conserving treatment. The surgeon, family and general practitioner were important sources of information. A significant association was found between women’s involvement in decision‐making and their use of a general practitioner as an information source. Many women wanted the decision about surgery to be entirely their own; the breast conserving treatment group preferred a more active role in decision‐making compared with those who chose modified radical mastectomy. Most women had participated in the decision‐making process as much as they wished, had enough time in which to make their decisions and had received sufficient information. A correlation between adequacy of information and sufficient time for decision‐making was found.

Conclusion. Findings may be useful to nurses and other health professionals who endeavour to provide adequate information and support to women during their initial treatment decision‐making experience.
A comparative study of work characteristics and reactions between general and mental health nurses: a multi‐sample analysis
Authors: Tummers Gladys E.R. , Janssen Peter P.M. , Landeweerd Ab , Houkes Inge
Published: March 2003

A comparative study of work characteristics and reactions between general and mental health nurses: a multi‐sample analysis

Aim of the study. The first aim of this study was to examine differences in work characteristics (autonomy, social support and workload) and work reactions (emotional exhaustion and job involvement) between general and mental health nurses. The second aim was to validate whether a specific pattern of relationships between work characteristics and reactions was the same for mental health and general nurses.

Background. Nurses are generally being considered as an above risk group regarding work stress. However, health care is a diverse sector and literature suggests important differences regarding the work of different categories of nursing, such as general and mental health nurses. In addition, little empirical evidence exists about these differences. In order to improve their work situation, more insight is needed regarding differences and similarities in the work of general and mental health nurses. The demand‐control‐support (DCS) model was used as a research framework. We hypothesized that autonomy, job involvement, and emotional exhaustion are higher in mental health nursing, whereas social support is expected to be lower. Next, in line with the propositions of this model and several recent studies, we hypothesized that emotional exhaustion is primarily predicted by workload and social support, whereas job involvement is primarily predicted by autonomy. In addition, we investigated whether this pattern of relationships was similar in both groups.

Design/methods. Questionnaires were distributed to nurses working in a general and a psychiatric hospital in the Netherlands. We used MANOVA and MSA (by means of LISREL) to analyse the data.

Results and conclusions. Regarding the differences in work characteristics and work reactions between mental health and general nurses, our hypotheses were confirmed, except for social support and job involvement. Autonomy and emotional exhaustion were higher among mental health nurses, whereas their job involvement proved to be significantly lower. Emotional exhaustion was primarily predicted by workload and lack of social support. Contrary to our expectations, the relationship between autonomy and job involvement was not significant in both samples. Finally, we found that the proposed pattern of relationships appeared to be invariant across the two samples.
Undergraduate student nurses’ expectations and their self‐reported preparedness for the graduate year role
Authors: Heslop Liza , McIntyre Meredith , Ives Glenice
Published: March 2003

Undergraduate student nurses’ expectations and their self‐reported preparedness for the graduate year role

Aims of the study. The study identifies third‐year nurses’ expectations of the graduate nurse role and ascertains how prepared they feel to fulfil this role.

Background. The literature substantiates that the university‐workplace transition is marked by differences between students’ expectations of the graduate year and the realities of practice they encounter in the workforce setting. Nursing professionals and health service employers continue to debate the expectations required of the new nurse graduate. Yet there is little assessment of graduate nurses’ expectations of the workplace. This study describes student nurses’ expectations of the graduate year and the extent to which they regard themselves as well‐ or ill‐prepared.

Design. Third‐year student nurses (n=105) from a 3‐year Bachelor of Nursing (BN) course at a large Metropolitan University in Australia were surveyed. A group of nursing academics and their senior colleagues in the clinical setting designed a questionnaire in light of common themes derived from literature on the graduate year role. Responses were examined and analysed using descriptive statistics.

Results. Responses revealed that student nurses tended to favour large public hospitals, and sought a good graduate programme with associated opportunities for guidance and support. Most expected to achieve good working relationships with both professional colleagues and patients. Final year students expressed some apprehension about meeting the performance expectations of the workplace, given their self‐perceived lack of clinical experience.

Conclusions. When asked about their initial expectations of the workplace, third year student nurses expressed little apprehension and reported high levels on scales of organizational commitment and professionalism. The research literature suggests that divisions exist between students’ expectations of the graduate year and the actual work experience. The expectations of the graduate year described in this study offer a student‐centred perspective that contributes to future planning and policy directions of undergraduate curricula, graduate year programmes and nurse retention.
The relationship between maternal needs and priorities in a neonatal intensive care environment
Authors: Bialoskurski M.M. , Cox C.L. , Wiggins R.D.
Published: March 2003

The relationship between maternal needs and priorities in a neonatal intensive care environment

Aim. The aim of this study was to investigate the nature and organization of maternal needs and priorities in a neonatal unit.

Background. The relationship between maternal needs and priorities appears to be an under studied area in neonatal nursing.

Methods. A quantitative survey was carried out based on 209 mothers with premature infants. Two self‐assessment schedules were used: critical care maternal needs inventory (J. Leske, Heart and Lung15, 27–42) and a ranking scale. The data were analysed with multivariate analysis.

Findings. Data analysis revealed clear priorities in maternal needs. In particular the need for accurate infant related information was a priority for 93% of the mothers. Good communication practices with professionals were also valued. The mothers displayed altruistic behaviour, and self‐related needs took second place. It is proposed that maternal needs demonstrate a hierarchical organization.

Conclusion. It is important for nurses to consider the individual needs of the mothers, simply because the satisfaction of these needs is essential for maternal well‐being.
Intravascular administration sets are accurate and in appropriate condition after 7 days of continuous use: an  in vitro study
Authors: Rickard Claire M. , Wallis Steven C. , Courtney Mary , Lipman Jeff , Daley Peter J.P.
Published: March 2003

Intravascular administration sets are accurate and in appropriate condition after 7 days of continuous use: an

in vitro study

Background. The ideal duration of intravascular administration set use is unknown. Studies have compared the infective implications of 1–7 days of use. The Centers for Disease Control recommend at least 3 days usage. No previous study has evaluated the accuracy of volume delivery or integrity of administration sets after prolonged use.

Aim. To evaluate the accuracy and condition of intravascular administration sets used continuously for 7 days.

Design. Prospective, randomized, experimental study in the laboratory setting.

Methods. Four administration sets were randomly assigned to deliver 2 mL/hour (IMED® syringe set 2280–0000), 20, 50 or 100 mL/hour (IMED® infusion sets 2210–0500) of crystalloid solution continuously for 7 days through an IMED® Gemini® four channel infusion pump (PC4). At study commencement and daily for 7 days, a 4‐hour volume measurement and an inspection for leaks/erosion of administration sets occurred for each administration set (total measurements = 32).

Results. Mean volume outputs over 4 hours were 7·84 mL (2 mL/hour), 80·66 mL (20 mL/hour), 205·35 (50 mL/hour) and 406·37 (100 mL/hour). These differed significantly from the programmed volumes (P=0·00–0·01). Usage duration did not influence performance (F=0·866, P=0·55). Accuracy of volume delivery differed significantly with pump speed (F=106·933, P < 0·001) exhibiting increased volume to 50 mL/hour then a reduction at 100 mL/hour. Differences were within manufacturer specifications (±5%) and were clinically acceptable. All administration sets remained in appropriate condition displaying no leakage or erosion.

Conclusion. There were small inaccuracies found between programmed and delivered volumes, however, there was no deterioration in performance over time. This suggests that inaccuracies were because of normal pump performance rather than the administration sets. Administration sets retain acceptable accuracy and condition after 7 days continuous use. Further research should assess the infective and other impacts of prolonged usage.
Using chaos theory: the implications for nursing
Authors: Haigh Carol
Published: March 2003

Using chaos theory: the implications for nursing

Aims of the paper. The purpose of this paper is to review chaos theory and to examine the role that it may have in the discipline of nursing.

Background. In this paper, the fundamental ingredients of chaotic thinking are outlined. The earlier days of chaos thinking were characterized by an almost exclusively physiological focus. By the 21st century, nurse theorists were applying its principles to the organization and evaluation of care delivery with varying levels of success. Whilst the biological use of chaos has focused on pragmatic approaches to knowledge enhancement, nursing has often focused on the mystical aspects of chaos as a concept.

Conclusions. The contention that chaos theory has yet to find a niche within nursing theory and practice is examined. The application of chaotic thinking across nursing practice, nursing research and statistical modelling is reviewed. The use of chaos theory as a way of identifying the attractor state of specific systems is considered and the suggestion is made that it is within statistical modelling of services that chaos theory is most effective.
Measurement of outpatients' views of service quality in a Finnish university hospital
Authors: Hiidenhovi Hannele , Nojonen Kaija , Laippala Pekka
Published: March 2003

Measurement of outpatients' views of service quality in a Finnish university hospital

Aims of the study. To describe the development of service quality in the surgical and medical outpatient departments of a university hospital.

Rationale. Measurement and documentation of service quality and the use of these data as a basis for improvement are prerequisites for service improvement.

Methods. A survey conducted over a 3‐week period using a 12‐item questionnaire measuring service quality on a rating scale from 4 to 10 (extremely poor – excellent quality). Nineteen outpatient departments participated at a Finnish university hospital, 7679 voluntary patients visiting the outpatient departments between 1997 and 1999 completed the questionnaires.

Results. The questionnaire, which has not been described in use previously, proved to be a good tool enabling systematic access to patient feedback on service quality in outpatient departments. The instrument allowed the detection of strengths of the service provided by a large organization and long‐term trends from patients' perspective. Patient evaluations were mainly good and the results improved year by year, although the instrument was built on questions concerning issues that were rated poorest by patients. The poorest ratings were related to access to information and adherence to appointment times.

Conclusions. The service quality instrument offers a means to generate information to be used for service quality improvement in outpatient departments.
Nursing staffs' perceptions of persons suffering from mania in acute psychiatric care
Authors: Hummelvoll Jan Kåre , Severinsson Elisabeth
Published: March 2003

Nursing staffs' perceptions of persons suffering from mania in acute psychiatric care

Aim. The aim of this study was to illuminate nursing staff perceptions of persons suffering from mania and how this influences the provision of nursing care.

Background. Nursing staffs' experiential knowledge in relation to their work with persons with manic illness is explored, guided by a theoretical framework of mania as suffering.

Methods. The study was carried out with a participatory inquiry design, and focus group interviews were employed for the collection of data. The data analysis followed the qualitative content analysis procedure.

Findings. Four main themes emerged from the analysis: staff views of patients' self‐image, needs and desires, a united stance, nursing strategies, and ethical dilemmas. Nursing staff discern the `disease suffering' based on what is typical in the patient's behaviour, apprehend the existential suffering through the uniqueness of the patient's situation, and finally, realize the various ways in which patients can experience suffering as a consequence of nursing care and treatment. The findings further revealed that one of the greatest challenges of working with persons suffering from mania is that they are often admitted against their will and do not perceive themselves as being ill or in need of help.

Conclusions. In conclusion, the findings from this study are theoretically transferable to similar contexts. We suggest that the themes identified above could be used by nursing staff to reflect on their perceptions of and encounters with persons suffering from mania. Furthermore, value‐based psychiatric nursing practice, focusing on patients' experiential knowledge, is needed in order to assess the influence of suffering on a person's life and their experiences of treatment and care.
A path model of factors influencing the academic performance of nursing students
Authors: Ofori Richard , Charlton John P.
Published: March 2003

A path model of factors influencing the academic performance of nursing students

Aims. The aim of this study was to build and test a model describing some of the psychological processes underlying nursing students' academic performance. The model hypothesized that age and entry qualifications influence students' academic motivation (locus of control, academic worries, self‐efficacy, and expectations), and that this in turn affects their decisions to seek support, which subsequently influences their academic performance.

Rationale and background. A literature search showed that previous academic motivation research is piecemeal. The present work sought to integrate previous findings into a coherent framework as a way of advancing our understanding of the complex interactive nature of the factors influencing student performance.

Method. Path analysis was performed on data obtained from questionnaires and university records for 315 students undertaking a preregistration diploma course in nursing at a university in the Northwest of England.

Results. Support‐seeking was more predictive of student performance than entry qualifications. Support‐seeking also mediated the age–performance relationship: greater willingness to seek support led to the better academic performance of older students. Other features of the accepted model suggested that students who judged their self‐efficacy to be higher expected higher grades and that these highly optimistic expectations led to less support‐seeking. Academic worries and internal control beliefs were also found to have positive influences on support‐seeking. The model developed accounted for 24% of the variance in students' academic performance.

Discussion. Implications for nurse education, and interventions that focus on improving students' academic motivation are discussed in the context of the `personal teacher' support framework.
Developing and supporting extended nursing roles: the challenges of NHS walk‐in centres
Authors: Rosen Rebecca , Mountford Lesley
Published: March 2003

Background.  National Health Service (NHS) walk‐in centres offer immediate access to nurse‐led primary care. Forty ‘pilot’ centres are now open, of which nine are in London. In providing clinical assessment, health information and a limited range of treatments to users, they exemplify new nursing roles that are emerging in primary care.

Aim.  To describe the emerging roles of walk‐in centre nurses, and explore thecauses of role stress and review arrangements for training, development and support.

Methods.  Semi‐structured interviews with 29 managers and nurses from the nine London walk‐in centres and with 10 stakeholders providing other primary care services near to three of the walk‐in centres.

Findings.  Walk‐in centre nurses are drawn from a wide range of clinical backgrounds. Emerging roles include diagnosing, developing clinical management plans, prescribing and discharging patients. Most find the roles challenging, but at times also stressful. There is no consensus on the most appropriate nursing skill mix for a walk‐in centre nor on the core competencies required by the nurses working there. As a result there is no standardization of induction, training or support for walk‐in centre nurses – particularly on the balance between taught and apprenticeship‐type training.

Conclusions.  Agreement is required on the competencies required for walk‐in centre nursing and on appropriate ways to develop and support nurses in their practice. Lessons could be learned from general practitioner training.
A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care
Authors: Lock Catherine A. , Kaner Eileen , Lamont Sharon , Bond Senga
Published: March 2003

Background.  Excessive alcohol consumption causes significant mortality, morbidity, economic and social problems in the United Kingdom (UK). Despite strong evidence for the effectiveness of brief intervention to reduce excessive drinking in primary health care, there is little indication that such intervention routinely occurs.

Aims.  This study aimed to explore primary health care nurses' attitudes and practices regarding brief alcohol intervention in order to understand why it is underexploited.

Methods.  The study design was qualitative, using a grounded theory approach to data collection and analysis. Semi‐structured in‐depth interviews were conducted with 24 nurses from practices that had previously been involved in a General Practitioner (GP) led brief alcohol intervention trial in the North‐east of England. A combination of convenience and purposive sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data‐analysis until data saturation occurred.

Results.  It was clear that although primary health care nurses have many opportunities to engage in alcohol intervention, most have received little or no preparation for this work. This has left nurses at a disadvantage as alcohol consumption is a confusing and emotive area for both health professionals and patients. An analysis of factors influencing nurse involvement in alcohol intervention outlined a requirement for clear health messages about alcohol, training in intervention skills, facilitation to enhance confidence regarding intervention and support to help deal with negative patient reactions.

Conclusions.  As current health policy is to encourage, sustain and extend the health promotion and public health role of primary care nurses, more attention should be given to providing them with better preparation and support to carry out such work.
Preparing for change in the secondary prevention of coronary heart disease: a qualitative evaluation of cardiac rehabilitation within a region of Scotland
Authors: Clark Alexander M. , Barbour Rosaline S. , McIntyre Paul D.
Published: March 2003

Background.  Secondary prevention of Coronary Heart Disease (CHD) is often poorly managed and its benefits attained in only a minority of those with CHD. Guidelines developed in the United Kingdom and North America suggest that in future cardiac rehabilitation programmes should provide services through individualized programmes that cater for a wide range of conditions associated with CHD. This will involve substantial and costly changes to current programmes that are mostly standardized and for postmyocardial infarction patients. Based on change theory, this study examined the dynamics, strengths and weaknesses of an existing programme in a Scottish region which was due to undergo the changes suggested by guidelines.

Aim.  To examine the perceived provision of secondary prevention services for CHD from the perspectives of health professionals within one region in the West of Scotland.

Methods.  A purposive sample of 14 health professionals (eight primary and six secondary care health professionals) was selected to cover a range of professional roles including both specialists and generalists. Separate focus group discussions (2) were held with primary care and secondary care professionals.

Findings.  Whilst the health professionals were enthusiastic about CHD prevention and their involvement, they perceived barriers to the success of the existing service as being complex and multifactorial, including patient, social and service‐related factors. Although both groups identified motivation as the most influential personal factor, secondary care staff tended to focus on the importance of patient factors in influencing motivation to change, whereas the primary care staff referred more to the cumulative effects of social and cultural factors. Professionals highlighted weaknesses in the transition between hospital and community‐based services with regard to the information flow between primary and secondary care.

Conclusions.  Although the study has immediate relevance for the local area, it highlighted issues of more general relevance to cardiac rehabilitation programme development and intersectoral working, such as communications and role perceptions in multi‐professional working and the need to adapt services to local socio‐economic conditions.
Stress and stressors of myocardial infarction patients in the early period after discharge
Authors: Al‐Hassan Musa , Sagr Laila
Published: March 2003

Background.  The period immediately following discharge after hospitalization for a first‐time myocardial infarction (MI) is stressful. Recovery‐related stressors include anticipation of or actual difficulties in resuming social and physical activities, and adopting recommended health actions.

Rationale.  Stress level and sources of stress in the early discharge period need to be evaluated. Identifying patient charcteristics that contribute to high stress is essential to facilitate patients' adjustment.

Aims.  To evaluate stress level, identify sources of stress, and examine the significance of sociodemographics and health characteristics in predicting stress in MI patients in the early discharge period.

Methods.  In this cross‐sectional study, data were collected from 84 MI patients 2–16 weeks after discharge. The patients, aged 20–70 years, were attending cardiology clinics of four Jordanian public hospitals and had experienced myocarial infarction for the first time.

Instruments.  A structured interview guide including a stress discharge assessment tool was used to identify stress level and sources of stress experienced after discharge.

Findings.  Most patients experienced a moderate level of stress, with 20% reporting high stress levels. They perceived ‘having many persons to provide care to, worrying about having another heart attack, and my partner worries too much about me’ as their most important concerns. Age, gender, income, frequency of chest pain episodes, and physicians' recommendations to quit smoking were the most significant predictors of stress.

Conclusion.  The findings suggest that in the early discharge period MI patients worry about their social role, interpersonal relations and personal health, which can exacerbate symptoms and complicate their future care.
A personal and historical investigation of the career trends of UK graduate nurses qualifying between 1970 and 1989
Authors: Ring Nicola
Published: March 2003

Aim.  To explore from a personal and historical perspective key career trends of UK graduate nurses qualifying between 1970 and 1989.

Background.  During the 1970s and 1980s, graduate nurses qualifying from UK academic institutions with nursing and degree qualifications were a controversial minority. Concerns about their practical ability and role resulted in considerable quantitative research about graduate nurse careers. Whilst such research identified key graduate nurse career trends, these trends have yet to be explored from a qualitative perspective.

Design.  This descriptive study used a phased approach: first, a literature review of earlier studies to identify key career trends of UK graduate nurses qualifying between 1970 and 1989, and second, an exploration of these trends from the perspective of six graduate nurses qualifying during this period using semi‐structured interviews. Third, archival material was used to set career trends and interview data within their historical context.

Findings.  The literature indicated that most graduate nurses remained clinically based, especially in community and intensive care, with few in senior posts above charge nurse/health visitor level (G‐grade). Analysis of interview data revealed four major themes significantly influencing graduate nurse careers: wanting to be clinical nurses, the effect of organizational structures and systems, being a woman, and careers by accident not design.

Conclusion.  Graduate nurses interviewed aspired to clinical posts, yet this was not what some in nursing expected of them during the 1970s and 1980s. The ability of these graduate nurses to fulfil personal career aspirations and develop their careers depended on many factors, not fully acknowledged in earlier studies. For example, organizational structures and systems often delayed fulfilment of career aspirations. Significantly, gender issues embedded within nursing adversely affected career progression of those interviewed, even in the 1990s. In particular, although nurses can combine work and family commitments, for those interviewed this was often at the expense of their career development.
Living with persistent pain: experiences of older people receiving home care
Authors: Blomqvist Kerstin , Edberg Anna‐Karin
Published: March 2003

Background.  Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge.

Aim.  To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain.

Methods.  Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis.

Findings.  Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as ‘competent and proud’ and ‘confident and serene’, expressed satisfaction in spite of pain, while the groups ‘misunderstood and disappointed’ and ‘resigned and sad’ expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living.

Conclusion.  This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side‐effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side‐effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain.
Early support needs of Finnish families with small children
Authors: Häggman‐Laitila Arja
Published: March 2003

Aims. This study describes the early needs for support that families with small children have in the context of their own life situations. The study population consisted of Finnish families (n = 551) who participated in a project titled ‘Families with Children’ (1996–2001). The project supplemented the existing public services. The information provided by the study was utilized in supporting families and developing family work in seven experimental areas.

Methods. The data were collected between 1997 and 2000 using family service plans and client reports. The data were analysed with inductive content analysis and using the SPSS software (version 7·5).

Findings. The families needed support in the areas of parenthood, upbringing and child care, marital problems and social support networks. The need for early support was also connected to health problems of the children or the parents, problems with work or studies, unemployment, problems in economic or living conditions, or family crises. In addition to support, the families searched for help from family workers in disputes over child custody and visitation rights, intoxicant abuse and violence, and problems in adjusting to society. Each family had 4–5 needs for early support.

Conclusions. The results demonstrate that families with small children have many needs for which they seek help when there are available services supplementing the existing public services. The information provided by the study can be utilized in maternity and child welfare clinics, in social services and in family work provided by civic organizations to define the early needs of families for support and to develop services.
Density‐dependent population dynamics in clonal organisms: a modelling approach
Authors: Tanner Jason E.
Published: March 2003

1. Density dependence may act at several stages in an organisms life‐cycle (e.g. on mortality, fecundity, etc.), but not all density‐dependent processes necessarily regulate population size. In this paper I use a density manipulation experiment to determine the effects of density on the transition rates between different size classes of the clonal zoanthid Palythoa caesia Dana 1846. I then formulate a density‐dependent matrix model of population dynamics of Palythoa, and perform a series of sensitivity analyses on the model to determine at what stage in the life‐cycle regulation acts.

2. Seven of the 16 transition probabilities decreased with density, most of them being shrinkage (due to loss of tissue or fission) and stasis (the self–self transition) of medium and large colonies. The only probability to increase was for the stasis of large colonies. Recruitment was quadratically dependent on density, peaking at intermediate densities.

3. Equilibrium cover in the model was 84% and was reached in ≈40 years. To determine which density‐dependent transitions were involved in population regulation, the strength of density dependence was varied in each independently. This sensitivity analysis showed that only changes in the probabilities of large colonies remaining large and producing medium colonies, were regulating.

4. These results suggest that regulation is primarily acting on fission of large colonies to produce intermediate‐sized colonies, in combination with size specific growth rates. Fission rates decrease greatly with density, resulting in a greater proportion of large colonies at high densities and large colonies grow more slowly than small. Overall, this behaviour is very similar to that of clonal plants which have a phalanx type life history.
Barn swallows trade survival against offspring condition and immunocompetence
Authors: Saino Nicola , Calza Stefano , Ninni Paola , Møller Anders Pape
Published: March 2003

1. Organisms are continuously faced with the problem of making decisions about allocation of limiting resources to maintenance and reproduction. This paradigmatic principle leads to the prediction that each individual will have to trade competing activities affecting fitness, with natural selection favouring the evolution of optimal life‐history strategies.

2. In the present study we tested for the existence of a trade‐off between parental survival and progeny quality and number in the biparental barn swallow (Hirundo rustica, Linnaeus) by recording survival from one breeding season to the next of adults, whose first brood size had been either increased or reduced by one nestling.

3. Quality of offspring was expressed as body mass, body size and the ability to mount a T‐lymphocyte cell‐mediated immune response,in vivo, to a mitogenic stimulus, mimicking the reaction to an antigenic challenge to the immune system.

4. Both adult male and female barn swallows were less likely to survive when their offspring had greater immunocompetence. Adult females were also less likely to survive when offspring had larger body size but smaller body mass. Brood enlargement reduced survival of adult males and had a differentially larger negative effect on survival of double‐brooded than single‐brooded adult females. Double‐broodedness did not covary with adult male survival but had a differentially larger effect on survival of adult females with enlarged compared to reduced broods. Males with relatively long ornamental tail feathers were more likely to survive than those with short tails.

5. We conclude that parent barn swallows trade their own survival against features of nestlings that affect their probability of recruitment. Because immunity is one of the principal defences available to hosts against parasites, this study suggests that host–parasite interactions may have played a part in the evolution of optimal parental strategies.