bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre‐registration diploma students: a quantitative study of entry characteristics and course outcomes
Authors: Kevern Jennifer , Ricketts Chris , Webb Christine
Published: March 2003

Pre‐registration diploma students: a quantitative study of entry characteristics and course outcomes

Nurse education has been transformed over the last decade and continuing change is likely. Nurse educators are responsible for meeting the quality assurance standards of local stakeholders and student retention and progress are important aspects of this process. As part of a monitoring exercise, an enquiry was set up to review pre‐registration selection and recruitment strategies and to establish if there were any significant relationships between the characteristics of pre‐registration diploma entrants and their academic achievement or completion rates. A multi‐factorial tree‐based technique was used for this purpose. This is one of the first British studies to consider both academic performance and completion rates for pre‐registration diploma students. Four cohorts (N = 355) were studied. There was marked heterogeneity in student characteristics with a wide age distribution, a significant proportion of mature entrants with previous care experience, and considerable diversity in terms of education. Education and age were significant predictors of academic achievement: entrants with a minimum of two A levels and mature women with recent study experience did particularly well. Younger recruits with modest educational qualifications on entry performed less well in their assessments of theoretical knowledge. Younger students tended to leave more regularly, and well‐qualified entrants showed a greater tendency to complete, although these relationships were not statistically significant. Multi‐factorial analysis demonstrated that organisational and course characteristics have a conjoint influence on course outcomes. Although the study is concerned with Project 2000 in the United Kingdom, there are lessons to be drawn concerning the selection and support of non‐traditional recruits into nursing.
Transition of care: an evaluation of the role of the discharge liaison nurse in the Netherlands
Authors: Van Emden Dorothea M. Dukkers , Ros Wynand J.G. , Berns Mary P.H.
Published: March 2003

Transition of care: an evaluation of the role of the discharge liaison nurse in the Netherlands

Problems in the transition of care from hospital to the home situation have led to the introduction of the discharge liaison nurse role in the Netherlands. A nation‐wide hospital survey was carried out to gain insight into the role and function of discharge professionals. It was found that 56 of the 117 hospitals in the Netherlands (48%) have a special discharge professional. The discharge professional is a relatively new concept. On average it covers a full‐time position. The function differs greatly between hospitals. Three working profiles can be distinguished: the organizational type, the advisory type and the policy‐making type. In most cases the discharge professional is a nurse from a community agency based in the hospital and therefore best fits the description of a discharge liaison nurse. Of the 56 hospital‐based initiatives involving discharge professionals, 11 (20%) have been systematically evaluated. A critical review of these evaluation studies showed a positive outcome on some aspects of quality of care, but no results were given on efficiency aspects. There was general appreciation of the discharge liaison nurse and continuation of the function was widely recommended. The quality of the evaluation studies was rather poor, and it is suggested that more substantial research should be carried out on this relatively new function.
The role of nurses in AIDS care regarding voluntary euthanasia and assisted suicide: a call for further dialogue
Authors: Young Michael G. , Ogden Russel D.
Published: March 2003

The role of nurses in AIDS care regarding voluntary euthanasia and assisted suicide: a call for further dialogue

Because of the nature of their work, nurses are directly involved with terminally ill patients and the problems associated with the decision to hasten death through voluntary euthanasia or assisted suicide (VE/AS). An anonymous survey delivered to nurses working in HIV/AIDS settings in Canada was used to analyse nurses’ experiences and attitudes regarding VE/AS. An emergent analysis of 22 nurses’ responses to an open‐ended prompt appearing at the end of the survey reveals that nurses: support death‐hastening practices; believe that legislation for these practices needs to be established; are wary of the potential abuse of VE/AS; and believe that further discussion on end‐of‐life issues is imperative. Their caring role in the health care setting places nurses in key positions to stimulate discussion in this area.
Clinical supervision, death, Heidegger and Freud come ‘out of the sighs’
Authors: Yegdich Tania
Published: March 2003

Clinical supervision, death, Heidegger and Freud come ‘out of the sighs’

In his recent paper on clinical supervision, ‘Out of the sighs’— an existential‐phenomenological method of clinical supervision: the contribution to palliative care’, in this journal, Jones weds psychoanalytical ideas with Heidegger’s existential‐phenomenological concepts to provide a theoretical framework for clinical supervision in palliative nursing. Although this is an interesting undertaking, theoretical diversity is not a simple matter of merely interchanging concepts. Rather, it is a complex process that must account for varying philosophical assumptions upon which any theory attempts to explain or understand reality. This paper examines the major themes identified by Jones. In particular, it focuses on the spirit of ontological hermeneutics and psychoanalysis, represented by their respective founders, Heidegger and Freud, and in general, refers to other thinkers and ideas mentioned by Jones — as for instance, Schön’s reflective practice, Polanyi’s personal commitment, Husserl’s lived experience, Schutz’s intersubjectivity and Yalom’s existential disidentification. Here, discussion concerns the subject‐object polarity. The paper argues that many of these philosophies are incompatible. In particular, psychoanalysis and existentialism imply inconsistent aims in that psychology does not equate with fundamental ontology — and Jones has not adequately distinguished between these in his supervision discourse. The implications of the accompanying conceptual problems for the practice of clinical supervision in palliative nursing are exemplified by Jones’s case study of Lindsey, a dying patient.
Determining chest pain patients’ suitability for transfer to a general ward following admission to a cardiac care unit
Authors: Quinn Tom , Thompson David R. , Boyle Roger M.
Published: March 2003

Determining chest pain patients’ suitability for transfer to a general ward following admission to a cardiac care unit

The objective of this study was to assess the performance of a consensus‐derived decision algorithm in determining chest pain patients’ suitability for early transfer to a lower dependency ward by predicting complications. The sample comprised 516 patients with chest pain presumed to be cardiac in origin, admitted to a cardiac care unit (CCU) in northern England from the community or from the accident and emergency department. A decision algorithm was designed following a review of the literature and amended to take into account a clinical consensus of consultant physicians. Patients were assessed on admission by CCU nurses using the algorithm, and ‘triage’ decisions recorded (keep on CCU or suitable for early transfer to a general ward). Admission ECGs (electrocardiographs) and baseline clinical data were recorded independently by a researcher ‘blinded’ to actual clinical course, and applied to the algorithm using statistical software. On discharge or death, patients’ case notes were retrieved and the hospital course examined for death or severe complications. Performance of the algorithm and CCU nurses were compared for sensitivity, specificity, positive predictive value and negative predictive value. The main outcome measures were death or severe complications occurring during hospitalization, and during the first 2 days following CCU admission. While sensitivity of both the algorithm (0·98) and CCU nurses (0·95) was high, specificity was low in both groups (0·11 and 0·21, respectively), making it unlikely that the algorithm would prove useful in clinical practice. Further studies are required to develop the optimal triage tool for the assessment of patients with acute chest pain.
The discursive construction of identity by community psychiatric nurses and family members caring for people with dementia
Authors: Adams Trevor
Published: March 2003

The discursive construction of identity by community psychiatric nurses and family members caring for people with dementia

This paper examines the discursive work undertaken by family members caring for people with dementia when interacting with community psychiatric nurses. The paper outlines the theoretical basis of this approach and brings it to bear upon data taken from a study of home visits to family carers by community psychiatric nurses. The paper provides insights into the way family carers and welfare agencies manage their interface through the use of language. In particular, the paper illuminates how these interactions construct the identity of people with dementia and their carers and locates them in a specific socio‐political context. The paper has important implications regarding the future development of dementia care nursing and also the future development of policy relating to dementia care.
Exploration of the concept of hope in the Dominican Republic
Authors: Holt Jeanie
Published: March 2003

Exploration of the concept of hope in the Dominican Republic

An ethnonursing study explored What is the meaning of hope (esperanza/esperar) to the Dominican people? What is the importance of the concept of hope to the people of the Dominican Republic? What are the universals and diversities in the meaning of hope for this cultural group and United States’ (US) mainstream culture? Hope has been considered universal and recent research has demonstrated the effect of levels of hope or hopelessness on health. Nurse researchers have explored the meaning of hope to patients in the US and have developed instruments to measure levels of hope. However, little research has explored whether hope has different attributes in various cultural groups. From data gathered in a rural Dominican village, a definition of hope and its attributes were developed: ‘Hope is an essential but dynamic life force that grows out of faith in God, is supported by relationships, resources and work, and results in the energy necessary to work for a desired future. Hope gives meaning and happiness’. This definition and its attributes were compared with definitions developed from research among mainstream US populations to propose universals and diversities of hope.
Psychometric evaluation of the Demands of Immigration Scale with Taiwanese–Chinese immigrants: a pilot study
Authors: Tsai Jenny Hsin‐Chun
Published: March 2003

Background.

 Each year thousands of people move across national borders and become immigrants of another country. They face several demands and sources of distress during resettlement. The Demands of Immigration (DI) Scale developed by Aroian
et al . (1998), is the only instrument available to nurses (and other clinicians and researchers) to measure immigration‐specific distresses. This scale, however, is written in English and has only been tested with former Soviet immigrants in the Boston area of United States of America (USA) for psychometrics.

Aim.  This instrumentation pilot study is designed to evaluate the readability and psychometric properties of the Chinese version of the DI Scale.

Instrument.  This selected scale is a 23‐item, 6‐point Liket type scale. Six dimensions are included: loss, novelty, occupation adjustment, language accommodation, discriminations, and not feeling at home. High scores indicate high levels of distress related to the demands of immigration.

Methods.  The study uses a descriptive, cross‐sectional design with a multimethod approach. Seventy‐three Taiwanese–Chinese immigrants (≥18 years) in the USA responded to the scale and a demographic questionnaire. Eighteen of them contributed to the interview data that were collected for assessing content validity of the scale. Observations during the interviews and participants' questions were also documented for the evaluation. Scale format, wording of items, distribution of responses, internal consistency, test–retest reliability, content validity, and construct validity are examined.

Findings and conclusion.  Analyses suggest that the Chinese version is easy to read and understand. The internal consistency and test–retest reliability are satisfactory. This scale could be used with Taiwanese–Chinese immigrants as a generic measure of immigration‐related distress. Nonetheless, three main problems with its use with Taiwanese–Chinese immigrants and Chinese immigrants at large are revealed in the study. Each problem is discussed. Suggestions for further development of the Chinese DI Scale are addressed.
Antecedents to engrossment in Noddings’ theory of care
Authors: Crigger Nancy
Published: March 2003

Antecedents to engrossment in Noddings’ theory of care

Background. Nel Noddings theorized caring as a universal social process comprised of three phases: engrossment or mental attentiveness, affective engagement or empathy and a mental imperative to act on behalf of another. If Noddings’ theory is correct, caring is a learned process.

Aim. The goal of this research was to understand the process, particularly engrossment, and to facilitate students’ development of caring relationships.

Design. This qualitative study of 13 baccalaureate nursing students uncovered six antecedents that facilitated student’s engrossment and extends Noddings’ theory.

Conclusion. Further research, to deepen and synthesize understanding of antecedents and their influence on facilitating or inhibiting the caring process, is advocated.
Nursing staff members’ intentions to use physical restraints with older people: testing the theory of reasoned action
Authors: Werner Perla , Mendelsson Gady
Published: March 2003

Nursing staff members’ intentions to use physical restraints with older people: testing the theory of reasoned action

Aim of the study. To examine nursing staff members’ attitudes, subjective norms, moral obligations and intentions to use physical restraints, using the Theory of Reasoned Action (TRA).

Rationale. During the last two decades an extensive body of research has examined nurses’ attitudes as one of the main factors affecting the decision to use or not to use physical restraints with older persons. However, no studies have examined empirically the antecedents to nurses’ intentions to use physical restraints within a theoretically based framework.

Method. A correlational design was used with 303 nursing staff members from an 800‐bed elder care hospital in central Israel. Participants completed a questionnaire including questions based on the TRA as well as socio‐demographic and professional characteristics.

Results. Regression analyses found attitudes, subjective norms and moral considerations to be significantly associated to intention to use physical restraints with older people. The TRA explained 48% of the variance in nurses’ intentions.

Conclusions. The TRA proved to be a useful framework for examining nurses’ intentions to use physical restraints. Nurses’ attitudes, beliefs and expectations of significant others should be examined before implementing educational programmes regarding the use of physical restraints.
Empirical validation of a teaching course on spiritual care in Taiwan
Authors: Shih Fu‐Jin , Gau Meei‐Ling , Mao Hsin‐Chun , Chen Ching‐Huey , Kao Lo Chi‐Hui
Published: March 2003

Empirical validation of a teaching course on spiritual care in Taiwan

Aim(s) of study. The aims of this study were threefold: (a) to develop the first spiritual care program for master of science in nursing degree students (MSNDS) in Taiwan, since most of these students are or will be nursing leaders in clinical practice, education, administration, or research; (b) to facilitate the MSNDS in applying the contents of this program to care of their clients; and (c) to understand the MSNDS’ appraisals of the usefulness of the program in helping them provide spiritual care in clinical settings.

Background. The World Health Organization (WHO) (1998) proclaimed that health needs should include spiritual well‐being in addition to physical, mental, and social domains. Nevertheless, many dominant medical educational systems have not yet encompassed spiritual care as part of their comprehensive or core curricula.

Design/methods. The methodological triangulation research design used in this project included various strategies of developing a novice course entitled ‘Spirituality in Nursing Practice’ which was given to the subjects over 18 weeks from September 1998 to February 1999. The course included classroom lectures, field trips, clinical implications, and presentation‐appraisal. A convenience sample of 22 female MSNDS who were or had the potential to be nursing leaders from two schools of nursing in northern Taiwan was obtained.

Results. Four types of help were identified: (a) help in clarifying the theoretical concepts of spiritual care (100%); (b) help in providing a culturally bonded spiritual care plan (100%); (c) help in self‐disclosure of the nurse’s personal value systems and spiritual needs (91%); and (d) help in clarifying the symbolic meaning and the impact of religious rituals (86%). The explicit spiritual care plans and an empirical example of spiritual care were provided.

Conclusions. This study presented the first spiritual care program for MSNDS in Taiwan. All subjects considered the course helpful in providing spiritual care for their clients in various clinical settings. The concept of spirituality is arousing great interest in the world, and this is evident in the spiritual care courses appearing in nursing curricula for nursing leaders in Taiwan.
The psychometric properties of the Chinese Dialysis Quality of Life Scale for Hong Kong dialysis patients
Authors: Suet‐Ching Weety Luk
Published: March 2003

The psychometric properties of the Chinese Dialysis Quality of Life Scale for Hong Kong dialysis patients

Aims. This paper describes the process by which the Chinese Dialysis Quality of Life Scale was developed, and the preliminary testing and psychometric evaluation of the scale in a sample of dialysis patients.

Background. Quality of life as a specific outcome variable has not been systematically and satisfactorily studied in Chinese dialysis patients in Hong Kong. A single global quality of life measure that is both reliable and valid for dialysis patients has yet to be developed. Without measurement tools, it is impossible to judge progress towards this goal.

Design. A list of key issues was first derived from an in‐depth literature review, then verified by semi‐structured interview on seven patients. The initial list of 87 items was then further refined through two rounds of content analysis. The remaining 50 items were finalized by pilot test on seven patients. Of the refined 40 items, face validity was assessed by a team including one professor and ten patients.  The 40‐item scale was further evaluated by stability, internal consistency and criterion validity with a convenience sample of 164 patients. The scale demonstrated high internal consistency and good test–retest reliability and criterion validity when used.

Conclusions. The psychometric evaluations suggest that the instrument is worthy of further development. Continued validation of this scale on larger sample and Chinese population living outside Hong Kong has the potential to provide nurses with a valid assessment and treatment guide, and researchers with a valid measurement tool.
Near death experience: a concept analysis as applied to nursing
Authors: Simpson Suzanne M.
Published: March 2003

Near death experience: a concept analysis as applied to nursing

Background. A concept is a thought or complicated mental illustration of a phenomenon. Concepts are essential in research development as they are described as the building blocks of theory. The occurrence of near death experiences (NDEs) is not an innovative subject. Parallels have existed as early as the Bible and Plato’s Republic. The NDE was given further consideration in 1975 by Dr Raymond Moody who initiated an interest from the general public and researchers alike, with his book Life after Life.

Method. This paper will use the strategy of concept analysis to find a working definition for the concept of the NDE and the implications it has for nursing.

Conclusion. This paper will attest that the number of people who have claimed to have a NDE is phenomenal and overwhelming. In addition, it claims that the numbers of those who have experienced this phenomenon may be underestimated because of the persons’ feeling of insecurity in talking with others about their paranormal incident. Therefore, it is vital that nurses become aware of the NDE and how to support the client who has had the experience. The following paper will summarize the different stages of a NDE, the consequences that one experiences, both positive and negative, and nursing implications.
Expert supervisors' views of clinical supervision: a study of factors promoting and inhibiting the achievements of multiprofessional team supervision
Authors: Hyrkäs Kristiina , Appelqvist‐Schmidlechner Kaija , Paunonen‐Ilmonen Marita
Published: March 2003

Expert supervisors' views of clinical supervision: a study of factors promoting and inhibiting the achievements of multiprofessional team supervision

Background. Only a few studies are available of team supervision and its challenges to supervisors. A multiprofessional team supervision project was accomplished in 1995–1998 in one university hospital in Finland. Eighty‐two practitioners from five wards participated in the project and 10 experienced supervisors implemented their team supervision.

Aim. The aim of this qualitative study is to describe the experiences of five supervisor pairs (n=10) of multiprofessional team supervision.

Methods. Data were collected by semi‐structured interviews from the supervisor pairs. The interviewing style was open and followed that of a guided conversation between supervisors and researcher. Interview data were analysed using thematic content analysis.

Findings. The factors that influenced team supervision were as follows: advanced knowledge of supervision and confidence in supervisors, commitment and motivation, interaction and collaborative relationships and the arrangements of team supervision. The positive effects of team supervision as identified by the supervisors were as follows: influence on interaction and human relationships in the work community, supervisees' strengthened professional identity and the development of multiprofessional practice.

Conclusions. Several factors can promote or inhibit the achievements of team supervision. Regardless of all the difficulties related to team supervision, its effects on a work community are positive. For the supervisors, team supervision is a demanding and challenging but also a rewarding process.
A review of symptoms of coronary artery disease in women
Authors: Miller Christine L.
Published: March 2003

Background.  Research on heart disease has increasingly included information on women's experiences. A number of recent studies present frequencies and comparisons of symptoms between men and women and there appears to be some variability in the symptoms especially among women. Even with acute myocardial infarction (AMI) where anticipated symptoms are more clear‐cut, women can have vague or nonclassic symptoms.

Aim and method.  Selected medical and nursing research on cardiac symptoms is examined for information on the cardiac warning symptom experiences unique to women. A search of the literature between 1995 and 2000 was done using CINAHL and MEDLINE . Terms used for the search included: cardiac symptoms, women's symptoms and symptom perception. The findings from this review are used to suggest implications for clinical practice.

Findings.  Women experiencing AMI present with a variety of symptoms including chest pain. Less obvious symptoms include; fatigue, shortness of breath, back pain, oedema, and transient non‐specific chest discomfort. These less dramatic and non‐specific symptoms do not necessarily prompt further assessment for coronary disease in women.

Conclusion.  Cardiac screening of women who present with cardiac risk factors and careful attention to less anticipated symptoms are critical factors that can improve the rapid identification of coronary disease in women. The unique physiological and sociological differences between women and men make further study of women's symptom experiences and perceptions important for health care providers. Further study of gender and ethnic differences in symptom patterns and recognition will help to improve screening and earlier identification of cardiac problems in women patients especially those without chest pain as a prodromal symptom.
Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women, relatives and themselves
Authors: Ödling Gunvor , Norberg Astrid , Danielson Ella
Published: March 2003

Background.  In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives.

Aim.  To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward.

Methods.  Thirty‐one nurses from a surgical ward participated in semi‐structured interviews. The interviews were tape‐recorded and transcribed verbatim. Thereafter a step‐by‐step, qualitative content analysis was carried out.

Results.

 The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between
what
nurses described as important needs and
how these needs were provided for.

Conclusion.

 This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self‐experienced situations in the daily care
. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.
Uncovering the secret: giving voice to the experiences of nurses who misuse substances
Authors: Lillibridge Jennifer , Cox Marion , Cross Wendy
Published: March 2003

Aim of the study.  The aim of this study was to gain insight into the experience of being a nurse with a substance misuse problem.

Rationale.  Several members of the research team work in a withdrawal programme specifically designed for nurses by nurses. Gaining insight into nurses' experiences will contribute to the development of appropriate guidelines to assist with prevention, identification and intervention strategies.

Background.  Published research is almost exclusively from North America. Much of it represents work completed in the 1980s, with very few research‐based accounts from the perspective of nurses, highlighting that this is a poorly researched and understood problem in Australia.

Research methods.  This phenomenological study used in‐depth, unstructured interviews either face to face or via the telephone with a purposive sample of 12 nurses who had experienced problem substance use.

Findings.  Five major themes were identified: nurses' justification for using substances, the fear surrounding being ‘discovered’, the personal meaning for nurses, the professional impact and the turning point in their road to recovery.

Discussion.  The five themes derived from the data are inextricably linked to the nature of nursing and of the nursing workplace. Information about potential risk factors and the experiences of nurses with substance misuse problems is critical to the development of prevention and treatment strategies.

Conclusions.  Issues of occupational health and safety are raised due to the increasingly demanding and often traumatic nursing work environment. Fears about stigma and loss of their nursing identity highlight nurses' perceptions that treatment programmes are often punitive in nature. Guidelines for the workplace addressing issues such as confidentiality, stress reduction and strategies for handling situations where a colleague is suspected of having a problem are beginning steps that will help address the problem of substance misuse in the nursing profession.
Applying a phenomenological method of analysis derived from Giorgi to a psychiatric nursing study
Authors: Koivisto Kaisa , Janhonen Sirpa , Väisänen Leena
Published: March 2003

Background.  The experience of mental ill health is fundamentally disempowering. The processes of psychiatric hospital care and treatment may also add to the personal feeling of disempowerment. This disempowerment is partly due to the failure of others to afford a proper hearing to the person's story of his/her experiences and problems in life. Hence, there is a need to investigate patients' experiences of being mentally ill with psychosis and being helped in a psychiatric hospital.

Aim.  This paper describes the application of a phenomenological method of analysis derived from Amadeo Giorgi to an investigation of psychiatric patients' experiences about being mentally ill with psychosis and being helped in a psychiatric hospital ward in Northern Finland.

Method.  This phenomenological study was conducted with nine voluntary adult patients recovering from psychosis. In 1998, patients were interviewed regarding their experiences of psychosis and being helped. The verbatim transcripts of these interviews were analysed using Giorgi's phenomenological method. Giorgi's method of analysis aims to uncover the meaning of a phenomenon as experienced by a human through the identification of essential themes. Patients' experiences of psychosis and being helped were clustered into a specific description of situated structure and a general description of situated structure.

Findings.  The Giorgian method of phenomenological analysis was a clear‐cut process, which gave a structure to the analyses and justified the decisions made while analysing the data. A phenomenological study of this kind encourages psychiatric nurses to focus on patients' experiences.

Conclusion.  Phenomenological study and Giorgi's method of analysis are applicable while investigating psychiatric patients' experiences and give new knowledge of the experiences of patients and new views of how to meet patients' needs.
Tobacco use and baccalaureate nursing students: a study of their attitudes, beliefs and personal behaviours
Authors: Chalmers Karen , Seguire Marilyn , Brown Judy
Published: March 2003

Aim.  To report findings about student nurses' attitudes, beliefs and personal behaviour in relation to tobacco issues.

Rationale.  Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. However, a review of the literature suggests that this is not happening. Further understanding of nursing students' attitudes, beliefs and behaviours regarding tobacco use is needed in order to develop strategies which can positively impact on their future health promotion role.

Methods.  A cross‐sectional survey of the total population of baccalaureate nursing students in one Canadian province was employed. Students were asked to complete a self‐administered questionnaire, which included questions related to their smoking history; stage of behavioural change, and beliefs and attitudes towards tobacco. Students also completed the Health Promotion Lifestyle Profile (HPLP) and the Fagerström Nicotine Tolerance Scale.

Findings.  Two hundred and seventy‐two students (61·9%) responded. Sixty (22·1%) indicated that they smoked daily or in social situations. These smokers were found to have a fairly low level of nicotine dependence and although 91·4% said they wanted to quit, few were actively engaged in the quitting process (16·9%). When comparing the beliefs and attitudes of smoking and non‐smoking students, proportionally more of the non‐smokers agreed that smokers will need close family/friends to help them quit; that the health of society should be protected by laws against smoking; and that nurses should set a non‐smoking example. Non‐smokers indicated more health promoting behaviours on items in the HPLP especially on the variables of physical activity, nutrition and stress management.

Conclusions.  Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. Developing future nurses with the knowledge and skill to do so needs to be an important emphasis of nursing curricula.
Caring as a slave morality: Nietzschean themes in nursing ethics
Authors: Paley John
Published: March 2003

Background. Sceptical arguments about ‘caring’ can be divided into three categories. First, it is suggested that, while caring is no doubt an admirable thing in itself, it is just one ideal among others. Secondly, it is claimed that caring is not really a virtue at all, and that it should be regarded as more of a vice, because it promotes favouritism, injustice, and self‐deception. Thirdly, there is a worry that caring is not politically realistic, and that its advocates underestimate the powerful organizational and social structures which conspire to subvert nursing.

Aim. This paper outlines a fourth, and more radical, type of scepticism, which explains why caring is subject to these drawbacks. In doing so, it considers the relation between caring, phenomenology and holism in nursing discourse, and the way in which all three fit together to form the ‘caring paradigm’.

Methods. The paper adopts a genealogical approach, borrowed directly from Nietzsche'sGenealogy of Morality. That book argues that the values associated with caring are the expression of a profound resentment, harboured by the slaves (weak, powerless, timorous) against the nobles (strong, powerful, self‐confident). Caring represents an inversion, a sort of ‘fantasy revenge’, in which the nobles can be portrayed as ‘evil’, while the slaves portray their own weakness as ‘good’. Taking its cue from Nietzsche, the paper shows that theGenealogynarrative can be transposed into a modern health care context, with nurses as the ‘slaves’ and the medical profession as the ‘nobles’.

Conclusions. The ideology of caring is, in theGenealogy'sterms, a slave morality. It represents an attack on the ‘medical‐scientific model’, motivated by resentment, and designed to establish nursing's superiority. Its effects have been debilitating, and it has prevented nursing from becoming a ‘noble’ (that is, a properly scientific) discipline.
Confusing rhetoric with reality: achieving a balanced skill mix of nurses working with children
Authors: Smith Joanna , Long Tony
Published: March 2003

Background and rationale. The option of separate registration in children's nursing has been a feature of nursing in the United Kingdom since 1919, but this is currently under review. The recently superseded governing body of nursing, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, has suggested that generic nurse registration with later specialization would be a more appropriate structure. Polarized views tend to dominate the debate over whether or not children's nursing should remain a discrete branch of nursing rather than simply another postregistration speciality. A long series of reports is often referred to in the debate, but the recommendations of these are often misconstrued and misrepresented.

Aims. First, to provide a factual historical overview of the significant reports on the provision of child health care over the past 50 years, identifying the key principles of each, and to develop from this analysis reasoned conclusions regarding the priorities in skill mix for nursing children. Second, to propose an alternative framework for nursing skill mix that will ensure that children receive care appropriate to their needs, and that nurses are appropriately prepared for the level of service to be offered.

Conclusion: The problems associated with expectations of universal provision of registered children's nurses for all children requiring nursing intervention have resulted from misunderstandings of the recommendations of key historical reports. In the light of evidence presented for the drive for abolition of specialist registration, and the main arguments of the polar stances of genericism or specialization, it is vital that alternative strategies are developed and debated. The proposed framework, based on pragmatism and key principles established from major reports, is discussed in an attempt to address the real issues; namely that all children are cared for by nurses who have adequate preparation commensurate with their needs, and that there is a strong career trajectory for all nurses working in the field of child heath.
Nurses' perceptions of critical incidents
Authors: O'Connor Jillian , Jeavons Sue
Published: March 2003

Aims of the study.  To determine: (1) the types of clinical events nurses perceived as ‘critical’; and (2) whether nurses' experiences of critical incidents were associated with any demographic variables such as qualifications and current area of work.

Background.  A review of the literature revealed little research has investigated in detail which clinical events nurses perceived as ‘critical’, apart from two North American studies. Exploratory research of Australian nurses was undertaken to confirm and contrast their understandings and views with those of other work specialities and North American findings.

Design/methods.  Two hundred and twenty‐seven full‐time registered nurses at a metropolitan medical centre responded to a survey questionnaire designed for the study based on findings of earlier studies regarding critical incidents.

Results.  Respondents viewed the sexual abuse of a child and death of a child as the most critical of events listed on the questionnaire and an emergency situation as the most frequent and stressful incident in the previous year. Factor analysis indicated the existence of three types of critical incident represented by Grief, Emergency, and Risk Scales. Events on the Grief scale were most stressful for respondents. Although several significant relationships were found for demographics with the Grief and Risk Scales, findings were considered tentative because of disproportionate representation on many of the demographics.

Conclusion.  Further research is necessary to substantiate the findings of the study. However, the identification of the scales provided a concise way of conceptualizing the essential elements of critical incidents.
Preparing nurses to face the pandemic of diabetes mellitus: a literature review
Authors: Hjelm Katarina , Mufunda Esther , Nambozi Grace , Kemp Joan
Published: March 2003

hjelm k., mufunda e., nambozi g.&kemp j. (2003) Journal of Advanced Nursing 41(5), 424–434

 Preparing nurses to face the pandemic of diabetes mellitus: a literature review

Background. Diabetes constitutes a global public health problem. Today about 135 million people are affected and it is estimated that the number in 2025 will be 300 million.

Aims. By reviewing existing literature the aim is to raise awareness among nurses, nurse educators and nursing students of the global epidemic of diabetes mellitus, its multiple underlying causes, especially social ones, and how to fight it. A further aim is to discuss the implications for future curriculum content in nurse education programmes.

Findings. The main underlying causes of the disease are genetic and environmental factors, such as urbanization and industrialization, as well as increased longevity and changes in lifestyle from a traditional healthy and active life to a modern, sedentary, stressful life and over‐consumption of energy‐dense foods. This process, labelled ‘coca‐colonization’, is evident all over the world, although more so in developing countries. The prevalence of diabetes mellitus varies among populations due to differences in genetic susceptibility and social risk factors such as change in diet, obesity, physical inactivity and, possibly, factors relating to intrauterine development. Migrants are especially affected. Diabetes mellitus needs to be treated by a holistic approach through dietary adjustment, exercise, medication (if needed), education and self‐care measures. Type 2 diabetes mellitus is a preventable disease. The main implication for nurses and nursing curricula is to change the focus from the individual with diabetes mellitus and management to prevent deterioration of health (secondary prevention), to population‐based community‐intervention programmes. These need to focus on health promoting activities to raise awareness among healthy people of the risk factors for diabetes mellitus.

Conclusion. Nurses all over the world have an important role in fighting the diabetic pandemic by health promotion aimed to keep people healthy as long as possible.
Sustainability in changing clinical practice promotes evidence‐based nursing care
Authors: Wallin Lars , Boström Anne‐Marie , Wikblad Karin , Ewald Uwe
Published: March 2003

wallin l., boström a.‐m., wikblad k. &ewald u. (2003) Journal of Advanced Nursing 41(5), 509–518

 Sustainability in changing clinical practice promotes evidence‐based nursing care

Aim. To examine the relationship between sustained work with quality improvement (QI) and factors related to research utilization in a group of nurses.

Design. The study was designed as a comparative survey that included 220 nurses from various health care organizations in Sweden. These nurses had participated in uniformly designed 4‐day basic training courses to manage a method for QI.

Method. A validated questionnaire covering different aspects of research utilization was employed. The response rate was 70% (154 of 220). Nurses in managerial positions at the departmental level were excluded. Therefore, the final sample consisted of 119 respondents. Four years after the training courses, 39% were still involved in audit‐related activities, while 61% reported that they had discontinued the QI work (missing = 1).

Results. Most nurses (80–90%) had a positive attitude to research. Those who had continued the QI work over a 4‐year period reported more activity in searching research literature compared with those who had discontinued the QI work (P  = 0·005). The QI‐sustainable nurses also reported more frequent participation in research‐related activities, particularly in implementing specific research findings in practice (P  = 0·001). Some contextual differences were reported: the QI‐sustainable nurses were more likely to obtain support from their chief executive (P  = 0·001), consultation from a skilled researcher (P  = 0·005) and statistical support (P  = 0·001). Within the broader health care organization, the existence of a research committee and a research and development strategy, as well as access to research assistant staff, had a tendency to be more common for nurses who had continued the QI work.

Conclusion. Sustainability in QI work was significantly related to supportive leadership, facilitative human resources, increased activity in seeking new research and enhanced implementation of research findings in clinical practice. It appears that these factors constitute a necessary prerequisite for professional development and the establishment of evidence‐based practice.
Moving toward an unstable equilibrium: saddle nodes in population systems
Authors: Cushing  , Dennis Brian , Desharnais  , Costantino
Published: March 2003

1.  We identify an unstable equilibrium with a two‐dimensional stable manifold and a one‐dimensional unstable manifold in a three‐state variable (larva, pupa, adult) insect population growth model.

2.  The saddle node forecasts that the time series of some initial numbers of larvae, pupae and adults are drawn closely to the unstable equilibrium before approaching the asymptotic stable attractor (a two‐cycle), while the time series of other initial points are not.

3.  Using two quantitative indices, we examine time series from a Tribolium experiment for evidence of the predicted saddle node. We conclude that a saddle node accounts for the transient dynamics in these data and for the differences between the transient behaviour of different replicates of the same experiment.
Demographic consequences of sex‐biased dispersal in a population of brushtail possums
Authors: EFFORD MURRAY
Published: March 2003

1.  A population of brushtail possums (Trichosurus vulpecula) in the Orongorongo Valley, near Wellington, New Zealand was live‐trapped three times a year for 15 years. Almost all births occurred in a single autumn pulse, and many young were tagged while still with their mothers in spring before becoming independent in summer. Yearlings could be distinguished from adults until the following summer. An age‐structured mark–recapture analysis distinguished in situ recruitment from immigration.

2.  The sex ratio of young in June, soon after birth, was male‐biased (56·1%); by September, late in the pouch phase, the observed ratio was closer to parity (52·5%). Disappearance immediately after independence was not sex‐biased and did not coincide with noticeable immigration, so it is believed to be due almost entirely to mortality.

3.  Recurrent seasonal patterns of disappearance and immigration differed between sex and age classes. Adult disappearance was high in winter (June–September), particularly among males, and low through the rest of the year. The disappearance of yearlings, which seldom bred, showed the least sexual dimorphism in winter. Almost no immigration was detected for either age class over winter. Winter disappearance was therefore attributed to in situ mortality, made worse in adult males by their abrupt loss of condition during the autumn breeding season.

4.  The largest seasonal influx of immigrants was of nominally adult males in the intervals September to February and February to June. Many of these were young males in their second summer that could not be distinguished from adults by body size. It is inferred that the majority of natal dispersal was delayed until after their first winter of independence, which may have the effect of reducing dispersal‐related mortality.

5.  Immigration by males exceeded that by females in both adult and yearling age classes, and at all times of year. In total, 74% of immigrants were males. About three in four breeding males and one in five breeding females were immigrants.

6.  The inverse seasonal relationship between mortality and dispersal suggests that the proximate motivation for dispersal in brushtail possums is not related to weather or food shortage. Immigration probably exceeded emigration, indicating that dispersal was not a strategy to escape high densities. Dispersal appears to be an integral part of male development. The rules governing the settlement of dispersers remain unknown.