bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of tacit knowledge in the work context of nursing
Authors: Herbig Britta , Büssing André , Ewert Thomas
Published: March 2003

The role of tacit knowledge in the work context of nursing

Aims of the study. Previous research on the role of tacit knowledge is ambiguous. Some studies show the superiority of expertise, while other studies found experts would not be better than laymen. This paper aims at clarifying the contribution of tacit knowledge to expertise in the domain of nursing.

Background. Two important concepts for dealing with critical situations are outlined – tacit knowledge and experience‐guided working. The framework of tacit knowledge and experience‐guided working can contribute to an explanation of the ambiguous results. Tacit knowledge is acquired implicitly in the course of working and is therefore not subject to reflection. For this reason it can contain erroneous or problematic contents.

Methods. A method for the explication of tacit knowledge was developed and a laboratory study with 16 experienced nurses conducted. In the laboratory study the nurses had to deal with a critical nursing situation that was developed in co‐operation with nursing experts. The explicit knowledge of the nurses was tested before the laboratory study.

Results. No systematic differences in explicit knowledge could be observed, i.e. differences in performance could not be attributed to this knowledge mode. Results from multidimensional scaling procedures illustrate differences in the tacit knowledge of nurses who successfully accomplished the critical situation and those who did not.

Conclusions. The findings are in line with the assumption that experience‐guided working is of the utmost importance for dealing with critical situations. Consequences of these results for nursing and person‐related services in general are discussed and the aim of future research is outlined.
The adrenaline rush: nursing students’ experiences with the Northern Ireland Ambulance Service
Authors: Melby Vidar
Published: March 2003

The adrenaline rush: nursing students’ experiences with the Northern Ireland Ambulance Service

Aim.  The aim of this project was to explore nursing students’ experiences whilst on placement with the Northern Ireland Ambulance Service.

Background.  The literature suggests that experiential learning can enhance understanding, knowledge and skills and has the potential for reducing the theory–practice gap.

Design.  A qualitative approach was utilized, employing diaries and focus group interviews to gather data. One hundred and fifty‐four nursing students submitted diaries, producing a response rate of 69%, while 190 students partook in interviews (86%).

Findings.  Content analysis indicated that the students gained a new appreciation of the concept of holistic care, and that increased interprofessional understanding provides the foundation for improved quality of patient care.
Health‐related quality of life after myocardial infarction: an interview study
Authors: Roebuck Alun , Furze Gill , Thompson David R.
Published: March 2003

Health‐related quality of life after myocardial infarction: an interview study

Aim.  The aim of this qualitative study was to explore and gain insights into the effects of myocardial infarction on health‐related quality of life.

Background.  The study was undertaken as part of a larger on‐going project to develop and validate a disease‐specific health‐related quality of life instrument suitable for use with patients after myocardial infarction.

Methods.  A consecutive sample of 31 patients admitted to a district general hospital in the North of England was recruited and interviewed at home. Semi‐structured interviews were conducted based on a guide developed from a review of the literature pertaining to quality of life and expert opinion. Interviews were audio‐taperecorded and transcribed verbatim. Transcripts were subjected to latent and manifest content analysis and inter‐rater reliability was confirmed by a researcher not involved with the interview process.

Findings.  Analysis of the data revealed seven major categories: physical activity/symptoms; insecurity; emotional reactions; dependency; lifestyle modification; concern over medication; and side‐effects. Breathlessness, insecurity and feelings of over‐protection were major problems, as was dissatisfaction with information and support.

Conclusion.  Myocardial infarction resulted in a variety of health‐related problems which affected quality of life. Systematic monitoring and evaluation of health status should be performed routinely. This is likely to be aided by the development and use of a health‐related quality of life instrument for this patient group.
The effects of unit morale and interpersonal relations on conflict in the nursing unit
Authors: Cox Kathleen B.
Published: March 2003

The effects of unit morale and interpersonal relations on conflict in the nursing unit

Background. Health care organizations face major changes, and these changes are likely to increase conflict in organizations. Although numerous studies have focused on conflict management, few have considered causes and effect of conflict in nursing units.

Methods. The investigation tested a structural equation that examined the relationships among individual and contextual variables and intragroup conflict, job satisfaction, team performance effectiveness, and anticipated turnover. The nonrandom sample consisted of 141 nurses employed on 13 inpatient units at a state‐supported, 597‐bed academic medical centre in a southeastern city.

Results. Intragroup conflict was higher on smaller units with a higher ratio of RNs to total staff. Intragroup conflict was not associated with satisfaction with pay or anticipated turnover. In the final model, the unit morale and interpersonal relations dimension of team performance effectiveness was negatively associated with intragroup conflict and anticipated turnover, and positively associated with satisfaction with pay. High perceptions of unit morale and interpersonal relations buffered the effect of unit size and skill mix on intragroup conflict. Goodness of fit statistics indicated a good fit of the model to data.

Conclusion. The findings have implications for nursing educators and administrators, and provide direction for future research.
Decision making for health care professionals: use of decision trees within the community mental health setting
Authors: Bonner Gwen
Published: March 2003

Decision making for health care professionals: use of decision trees within the community mental health setting

Aim of the paper. To examine the application of the decision tree approach to collaborative clinical decision‐making in mental health care in the United Kingdom (UK).

Background. While this approach to decision‐making has been examined in the acute care setting, there is little published evidence of its use in clinical decision‐making within the mental health setting. The complexities of dual diagnosis (schizophrenia and substance misuse in this case example) and the varied viewpoints of different professionals often hamper the decision‐making process. This paper highlights how the approach was used successfully as a multiprofessional collaborative approach to decision‐making in the context of British community mental health care.

Design. A selective review of the relevant literature and a case study application of the decision tree framework.

Conclusions. The process of applying the decision tree framework to clinical decision‐making in mental health practice can be time consuming and client inclusion within the process is not always appropriate. The approach offers a method of assigning numerical values to support complex multiprofessional decision‐making as well as considering underpinning literature to inform the final decision. Use of the decision tree offers a common framework that can assist professionals to examine the options available to them in depth, while considering the complex variables that influence decision‐making in collaborative mental health practice. Use of the decision tree warrants further consideration in mental health care in terms of practice and education.
Triangulation using a meta‐matrix1
Authors: Wendler M. Cecilia
Published: March 2003

Triangulation using a meta‐matrix

Background and significance.  Quantitative and qualitative data analysis are often undertaken as separate enterprises, as they emerge from differing philosophies of science and methodologies for data collection, management and analysis. Quantitative data analysis is sometimes seen in philosophic and methodologic conflict with a naturalistic, human science perspective of science. Researchers interested in data from both realms often rely on triangulation procedures, in which each is considered from its representative lens. Results are then projected out into a common area where data are melded and discussed. The purpose of this paper is to introduce the meta‐matrix as a tool for triangulation in nursing research and to demonstrate its usefulness in an exemplar case.

Design/methods.  The exploratory nature of a recent study led to the decision to manage triangulation using an emerging methodology, thereby allowing consideration of all data simultaneously through the use of a meta‐matrix. Discussion of the meta‐matrix as a method is presented.

Findings.  Use of the meta‐matrix facilitated data analysis and allowed pattern recognition across data sets. Discovery of several unexpected relationships deepened understanding of the results and assisted in identifying questions for further research.

Conclusions/implications.  The meta‐matrix method provides a useful alternative approach for secondary‐level data analysis in mixed‐methods research.
Midwives’ attitudes to the use of the cardiotocograph machine
Authors: Sinclair Marlene
Published: March 2003

Midwives’ attitudes to the use of the cardiotocograph machine

Background. The literature would suggest that midwives’ attitudes towards the use of birth technology are mainly focused around issues of ‘trust and dependence’ yet there has been no published research to refute or substantiate these beliefs.

Aim. This paper reports on an empirical study that aimed to identify midwives’ attitudes to technology usage in the labour ward and specifically the use of the cardiotocograph machine (CTG) for electronic foetal monitoring.

Design. A postal survey was conducted and the questionnaire included a 25‐item attitude scale, which was designed to assess attitudes towards the use of the CTG machine. All midwives (1086) on the United Kingdom Central Council register for Northern Ireland were surveyed. The data were factor analysed and compared using several categorical groupings including age, perceived skill, prior training with computers and trust in the machines.

Results. The results indicate that midwives reject any notion of them being, or becoming, dependent on machines in their practice. However, midwives who trust machines are more disposed to their use and trust is affected by perceived competence.

Conclusion. The paper concludes with a recommendation for the future education of midwives to develop and maintain competence based craft skills in natural birth as well as high‐tech birth.
Psychiatric nurses’ attitudes towards patient autonomy in depot clinics
Authors: Svedberg Bodil , Lützén Kim
Published: March 2003

Psychiatric nurses’ attitudes towards patient autonomy in depot clinics

Aim. The aim of this qualitative study was to explore how psychiatric nurses experience patient autonomy in relation to their professional role in depot clinics.

Background. The administration of depot neuroleptics at outpatient clinics is a common task for psychiatric nurses in many countries. The procedure is characterized by brief contacts often allowing little opportunity for adequate monitoring of the treatment and a dialog between nurses and patients. As nurses have an important role in involving patients in decision‐making, there is a need to analyse the nurses’ attitudes towards giving depot neuroleptics from the perspective of autonomy.

Method. Nine experienced psychiatric nurses were interviewed using open‐ended questions. The steps of a phenomenological descriptive method guided the data analysis.

Findings. The structure describes how benevolent attitudes towards patient autonomy motivated the nurses’ interventions in relation to how they experienced their own professional authority. The structure consists of four variations: (1) Beneficent interventions used with patients perceived as co‐operative when the nurses experienced a high degree of professional authority. (2) Paternalistic interventions used with patients perceived as ambiguous towards medication when the nurses experienced an arbitrary professional authority in collaboration with team members. (3) Weak paternalistic interventions used with patients perceived as unwilling when the nurses experienced having sufficient professional authority in the treatment situation. (4) Nonmaleficent interventions used with patients perceived as being resigned when the nurses experienced a low degree of professional authority within the team.

Conclusions. The findings indicate that psychiatric nurses’ experience of their professional authority is closely related to the organization of the depot treatment and that brief contacts do not favour the establishment of collaborative relationships with patients. When injection‐giving nurses, as patients’ key workers, have overall responsibility for co‐ordinating the patients’ treatment they can encourage patient autonomy by helping patients understand the meaning of depot medication and its benefits. Further clinical research regarding the involvement of nurses in the treatment as well as patients’ experiences of treatment with depot neuroleptics is needed to allow suggestions about improvements of the organization of the treatment.
Identification of priorities for nursing research in Spain: a Delphi study*
Authors: Moreno‐Casbas Teresa , Martín‐Arribas Concepción , Orts‐Cortés Isabel , Comet‐Cortés Pilar
Published: March 2003

Identification of priorities for nursing research in Spain: a Delphi study

Aim. The aim of this work was to identify priorities for nursing research in Spain. The Co‐ordination and Development of Nursing Research Centre (Investén‐isciii group) carried out the study using the Delphi technique during the period April 1998 to January 1999.

Methods. Study subjects were professionals involved in different nursing activities. From 1250 eligible professionals initially contacted, 452 (38%) responded in round 1 and 258 (57%) in round 2. But only 189 filled out correctly the questionnaires from both rounds of data collection (overall response rate was 21·6%).

Results. The participants identified priorities related to continuity and co‐ordination of nursing care, quality of nursing care, impact of invasive techniques and treatments on the quality of life of patients, needs of the primary care givers, quality of life among elders, satisfaction of customers and needs of terminal patients and their families.
Chronic illness: reflections on a community‐based action research programme
Authors: Koch Tina , Kralik Debbie
Published: March 2003

Chronic illness: reflections on a community‐based action research programme

Aim. The purpose of this paper is to describe the birth of a research culture in a community nursing service, and the development and implementation of an action research programme that focuses on understanding the experiences of living with chronic illness.

Background. Approximately 70% of the clients of our community nursing practice in South Australia live with chronic illness. Our research interest has focused on how community nurses can assist people living with chronic conditions to live ‘well’. In this paper we describe the way in which we have applied the principles of participatory action research (PAR) when working with women who live with multiple sclerosis (MS) and urinary incontinence. We then draw on elements of PAR research with men who live with MS and men and women who live with type 2 diabetes. In total, we have convened eight PAR groups researching with people who live in the community with chronic illness and this work constitutes our chronic illness research programme.

Design. The PAR philosophy is based on the principles of democratic, equitable, liberating and life enhancing relations within a research process, and is operationalized in cycles of: look, think and act. In these collaborative inquiries the researchers have facilitated participants to reflect on how illness affects their lives, to tell their own story, make connections, plan action and help them negotiate the rites of passage. We select two areas for discussion: methodological issues in the application of PAR principles and our tentative findings from the chronic illness research programme.

Findings. We assert that the facilitator’s skill in managing group dynamics is crucial to the life and outcome of the project. Change can occur as a result of action at an individual level, with improved self‐management of chronic illness, or at a collective level where the PAR group instigates larger reform strategies. In terms of tentative findings, men and women living with a chronic illness appear to be involved in an ongoing process of transition toward incorporating the illness into their lives. Although we have not yet identified specific events, we have noted that there are critical turning points in the illness transition experience. Participants feel validated in telling their story of living with a chronic illness. Story telling may be the turning point that enhances the lives of all those who participate.

Conclusion. If health care professionals can understand the process that facilitates people to move toward incorporating chronic illness into their lives, we can make a substantial contribution to enhance their chronic disease self care management.
Recruitment of frail older people to research: lessons learnt through experience
Authors: Harris Ruth , Dyson Elizabeth
Published: March 2003

Recruitment of frail older people to research: lessons learnt through experience

Background. With the emphasis on the need for clinical governance and evidence‐based practice in the healthcare industry there is increasing pressure on researchers to provide tangible research evidence of the effectiveness of new treatments, interventions and services. Recruiting an adequate size of sample is an important factor in the success or otherwise of a study to answer the research question. Difficulty in the recruitment of older people to research is widely acknowledged. However, much can be achieved to maximize the success of this process.

Aims of the paper. This paper describes and explores our experience of recruiting frail, older people to research, with particular emphasis on ensuring quality in the process of research related to ethical practice.

Conclusions. Recruitment of frail older people to research can be a complex process in which the awareness and integrity of the researcher is key in upholding the principle of nonexploitation. It is important not to underestimate this difficulty and to ensure that the data collection period is sufficient to recruit adequate numbers. There is a need to continue to develop and refine recruitment skills and strategies to maximize the involvement of frail older people to research while protecting their right to refuse.
Professional and organizational obstacles to establishing a new specialist service in primary care: case study of an epilepsy specialist nurse
Authors: Mills Nicola , Campbell Rona , Bachmann Max O.
Published: March 2003

Professional and organizational obstacles to establishing a new specialist service in primary care: case study of an epilepsy specialist nurse

Background. Few evaluations of the effectiveness of specialist nurse‐led services explore the nurse’s experiences, attitudes and qualities. This can help us to understand why a service has the effects it does and to inform new specialist nurses of potential difficulties.

Aim. To explore the experiences, feelings and perceived problems of providing a new specialist nurse service from the nurse’s perspective.

Methods. This was a case study nested within a controlled trial that assessed the effectiveness of an epilepsy specialist nurse‐led service on the quality of patient care. In‐depth interviews were conducted with the specialist nurse at the end of the first and second year of the new service. Interviews were audio‐tape recorded and transcribed verbatim. Transcribed text was methodically coded and themes were identified. A descriptive account, summarizing the findings of both interviews, was written based on the thematic coding of text.

Results. Overall, the epilepsy nurse felt a sense of achievement and believed that the service had had a beneficial impact on both patients and health care professionals in the locality. However, she experienced many operational problems, especially adapting to a primary care setting, difficulties in meeting practice staff and in motivating them, and contending with a heavy workload. These problems were partly attributable to her lack of community work experience and more generally to the structure of the service.

Conclusions. Findings indicate that specialist nurses responsible for providing primary care services would benefit from having theoretical knowledge and practical experience of working in the community prior to starting in post. The aims of a service need to be consistent with the available resources. Accounts of other specialist nurse’s experiences of providing a primary care service could help to reduce set up time. Finally, support in the form of a coherent team is important to avoid feelings of professional isolation and to maximize effective use of specialist skills.
The short‐term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects
Authors: Delaney Joseph P.A. , Leong King Sun , Watkins Alan , Brodie David
Published: March 2003

The short‐term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects

Aim of the study. To investigate the effects of myofascial trigger‐point massage therapy to the head, neck and shoulder areas on cardiac autonomic tone.

Background. No studies have reported on the effect of back massage on autonomic tone as measured by heart rate variability. This is especially relevant to the nursing profession, as massage is increasingly available as a therapy complementary to conventional nursing practice.

Design/Methods. An experimental study in which subjects were initially placed in age‐ and sex‐matched groups and then randomized to treatment or control by alternate allocation. The study involved 30 healthy subjects (16 female and 14 male, aged 32·47 ± 1·55 years, mean ± standard error). A 5‐minute cardiac interbeat interval recording, systolic and diastolic blood pressure and subjective self‐evaluations of muscle tension and emotional state were taken before and after intervention. Autonomic function was measured using time and frequency domain analysis of heart rate variability.

Results. Following myofascial trigger‐point massage therapy there was a significant decrease in heart rate (P < 0·01), systolic blood pressure (P=0·02) and diastolic blood pressure (P < 0·01). Analysis of heart rate variability revealed a significant increase in parasympathetic activity (P < 0·01) following myofascial trigger‐point massage therapy. Additionally both muscle tension and emotional state, showed significant improvement (P < 0·01).

Conclusions. In normal healthy subjects myofascial trigger‐point massage therapy to the head, neck and shoulder areas is effective in increasing cardiac parasympathetic activity and improving measures of relaxation.
Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan
Authors: Chang Mei‐Yueh , Wang Shing‐Yaw , Chen Chung‐Hey
Published: March 2003

Effects of massage on pain and anxiety during labour: a randomized controlled trial in Taiwan

Aims. To investigate the effects of massage on pain reaction and anxiety during labour.

Background. Labour pain is a challenging issue for nurses designing intervention protocols. Massage is an ancient technique that has been widely employed during labour, however, relatively little study has been undertaken examining the effects of massage on women in labour.

Methods. A randomized controlled study was conducted between September 1999 and January 2000. Sixty primiparous women expected to have a normal childbirth at a regional hospital in southern Taiwan were randomly assigned to either the experimental (n=30) or the control (n=30) group. The experimental group received massage intervention whereas the control group did not. The nurse‐rated present behavioural intensity (PBI) was used as a measure of labour pain. Anxiety was measured with the visual analogue scale for anxiety (VASA). The intensity of pain and anxiety between the two groups was compared in the latent phase (cervix dilated 3–4 cm), active phase (5–7 cm) and transitional phase (8–10 cm).

Results. In both groups, there was a relatively steady increase in pain intensity and anxiety level as labour progressed. A t‐test demonstrated that the experimental group had significantly lower pain reactions in the latent, active and transitional phases. Anxiety levels were only significantly different between the two groups in the latent phase. Twenty‐six of the 30 (87%) experimental group subjects reported that massage was helpful, providing pain relief and psychological support during labour.

Conclusions. Findings suggest that massage is a cost‐effective nursing intervention that can decrease pain and anxiety during labour, and partners' participation in massage can positively influence the quality of women's birth experiences.
Practice nurses and clinical guidelines in a changing primary care context: an empirical study
Authors: Harrison Stephen , Dowswell George , Wright John
Published: March 2003

Background.  Practice Nurses form an increasingly large proportion of the English National Health Service primary care workforce and the delegation to them of clinical work from General Practitioners has attracted some academic attention. Central to this process are clinical guidelines, which provide the interface between the movement towards ‘evidence‐based practice’ and a range of government‐driven policy developments in primary care.

Aims.  To identify the attitudes of practice nurses to clinical guidelines; to investigate the impact of guidelines on nurse/physician relationships; and to describe the impact of the changing primary care context on nurses.

Methods.  We interviewed a sample of 29 Practice Nurses three times during a 16‐month period to clarify their attitudes towards guidelines, their use of guidelines in practice and their assessment of guidelines' importance. We gathered further data on organizational culture and perceptions of national reforms of primary care structures.

Results.  We found that practice nurses are generally supportive of clinical guidelines. Moreover, nurses' role and influence within primary care is in a process of transition to one in which they may undertake responsibility for influencing General Practitioners' clinical behaviour so as to adhere to guidelines. Practice nurses themselves recognize and welcome this, though with some reservations.

Conclusions.  Our findings support the proposal that explicit codification of the scientific basis of the work of lower paid groups may enhance their relative professional status.
Pressure area care: an exploration of Greek nurses' knowledge and practice
Authors: Panagiotopoulou Kalliopi , Kerr Susan M.
Published: March 2003

Background. Despite a plethora of information on the prevention of pressure sores, they remain a significant problem in both hospital and community settings. The need to reduce the incidence of pressure sores has been well documented; unfortunately there is little evidence to suggest improvement. The reasons for this lack of improvement have been explored, but the picture remains unclear. While some studies have suggested that nurses have the appropriate knowledge to prevent pressure sores developing (but do not use their knowledge), others suggest that nurses' knowledge of preventive strategies is deficient. In Greece, similarly to the United Kingdom (UK), the incidence of pressure sores is high. There is currently no evidence on Greek nurses' knowledge and practice and therefore no baseline on which to build, in terms of improving practice.

Aim. The purpose of this study was to explore Greek nurses' knowledge of ‘risk factors’, ‘areas at risk’ and ‘recommended preventive strategies’ in relation to pressure area care. In addition, information was sought on nurses' ‘current preventive practice’ and any barriers to ‘good practice’.

Research methods. The study was exploratory and descriptive, adopting a cross‐sectional survey approach. The sample was drawn from the population of nurses working in a military hospital near Athens. The data were collected over a 4‐week period in June 2000, using a self‐completed questionnaire.

Results. Although the knowledge‐base of many of the nurses was good in relation to ‘risk factors’ and ‘areas at risk’, a significant proportion were unaware that methods such as ‘massage’ and ‘donuts’ are no longer recommended. This lack of knowledge influenced practice with these methods commonly being used. In relation to barriers to good practice, a significant proportion of nurses reported that they could not access, read or understand research findings. This has obvious implications for the implementation of evidence‐based practice.

Conclusion. The results of this study suggest that the knowledge and practice of participants could be improved. It is of particular concern that methods known to be detrimental were in common use. Finally, there is a need to improve the research skills of Greek nurses in order to provide them with the appropriate knowledge to use research findings.
Health promotion in palliative care: the patients' perception of therapeutic interaction with the palliative nurse in the primary care setting
Authors: Richardson Jane
Published: March 2003

Aims.  To identify and describe palliative patients' perception of factors within the interaction with the community palliative care nurse that enhance feelings of health and well‐being, and to begin to define health promotion in relation to palliative nursing in the primary care setting.

Background.  Health promotion may seem to be of little relevance in palliative care and for patients within its remit, and there is no definition of health promotion in relation to palliative care, yet therapeutic ‘new’ nursing, and its core elements of holism, egalitarianism and a humanistic approach accord with the philosophy of palliative care and are recognised as health promoting nursing practice.

Design/methods.  A qualitative methodology was used. Information was obtained from 12 patients by a qualitative semi‐structured interview. Data were organised and analysed using recognised guidelines for phenomenological analysis.

Findings.  The patients identified two types of therapeutic interaction with the nurse, which enhanced feelings of health and well‐being in different ways. Psychological well‐being was enhanced by the humanistic and egalitarian personal interaction with the nurse, and the professional interaction focused on the disease and addressed physical problems. Although recognizing the nurses' role in the relief of physical symptoms, the patients' perception of ‘feeling better’ generally focussed on enhancement of psychological health and well‐being.

Conclusion.  For the patients, a combination of ‘new’ (therapeutic) nursing and a more traditional expert‐led approach resulted in the promotion of an enhanced sense of physical and psychological health and well‐being, and was an integral part of community palliative care nursing. Based on the study findings, the researcher offers a definition of health promotion relevant to palliative nursing in the primary care setting, which identifies that for the patients (but with caveats related to generalizability), the practice of holistically therapeutic palliative nursing is the ideal.
The work of district nurses: first assessment visits
Authors: Kennedy Catriona M.
Published: March 2003

Background.  District nurses are the largest group of community nurses in the United Kingdom and overall responsibility for assessing and planning how patients' and families' needs are met remains an essential element of their role.

Aim.  To explore the nature of the knowledge required by district nurses to carry out first assessment visits and the relationship of this to the decisions they make.

Methods.  An ethnographic design was used. The sample was 11 district nurses and the principal data collection methods were participant observation and two semi‐structured interviews. The first interview, which took place immediately after the visit, was designed to explore general areas in relation to assessment and particular issues from the visit (phase 1). Following analysis of the phase 1 interview and fieldnote data, questions for the second interview were generated to facilitate further exploration and clarification of important issues that had arisen (phase 2). The second interviews were conducted approximately 1 year later and data were collected during 1997 and 1998.

Findings.  The findings revealed a breadth and depth of community nursing knowledge that seemed to incorporate an amalgam of theoretical (knowing that) with practice‐based (knowing how) knowledge. The findings depict the range and scope of knowledge in use by district nurses and reflexive character of the assessment process, and challenge the use of theoretical models that remove knowledge from the context in which district nurse–patient interactions take place.

Conclusion.  The information search in assessment was paced to cope with the uncertainty that existed in many of the complex multifaceted situations encountered by the district nurses. Understanding assessment as a paced process was linked to making the best judgement at the time of the visit.
The changing division of labour between nurses and nursing assistants in New Brunswick
Authors: Rhéaume Ann
Published: March 2003

rhéaume a. (2003) Journal of Advanced Nursing 41(5), 435–443

 The changing division of labour between nurses and nursing assistants in New Brunswick

Background. In 1989, the professional nursing organization that represents nurses in New Brunswick adopted baccalaureate entry to practice in nursing. This decision coincided with a major restructuring of provincial health care. Consequently, there has been a reorganization of health care worker roles which affects nurses and nursing assistants.

Aim. This paper explores the changing division of labour between nurses and nursing assistants in the province of New Brunswick, Canada.

Methods. The study used archival material, from the period 1978–1990, of three nursing organizations that played a significant role in initiating baccalaureate entry to practice. Interviews with 19 key people involved in the decision to upgrade nurse education were conducted. Data from the archival material and interviews were analysed jointly.

Findings. There are ongoing tensions between nurses and nursing assistants. Although nurses would like a support worker, they remain ambiguous about the role of nursing assistants in health care and which tasks should be delegated to this group. Nursing leaders are concerned about the ease with which some patient‐related tasks are moved to nursing assistants. In the past, these concerns have led nursing leaders to attempt to limit nursing assistant responsibilities through both legislative means and ways of organizing nursing labour (primary nursing). As a result of health care reforms and baccalaureate entry to practice for nurses, nursing assistant responsibilities are currently expanding.

Conclusion. Upgrading nurse education, which came into effect in 1996 with the closure of diploma schools in New Brunswick, is likely to entrench the role of nursing assistants in health care because of the economic value of their work during a period of restructuring and rationalization of health care.
How can a pelagic seabird provision its chick when relying on a distant food resource? Cyclic attendance at the colony, foraging decision and body condition in sooty shearwaters
Authors: Weimerskirch Henri
Published: March 2003

1.  Sooty shearwaters are abundant in waters too distant from their colonies to account for the observed average frequency with which the chicks are fed. This, and the unexplained cyclic pattern of attendance at their colonies, have led to contradictory interpretations related to evolution of the extreme life histories of pelagic seabirds and their relationship with the marine environment.

2.  Study of the provisioning behaviour of individual parent sooty shearwaters indicates that they can rely on productive distant waters, probably 1550. km away, to build up their body reserves and to provision their chick. These long foraging trips on average last 11. days and account for 84% of the foraging time.

3.  Birds use this stored energy to cover the costs of performing several successive foraging trips of short duration in nearby less productive waters. These brief trips double the energy flow to the chick and take only 16% of the foraging time but are at the expense of adult body condition, i.e. there is a net energy loss. Foraging successively with short and long trips allows parents to increase by 20% the energy flow to the chick over what it would get if foraging was exclusively in distant waters.

4.  The results suggest that maximal fitness in this pelagic seabird is not achieved by maximization of foraging efficiency but is the result of a trade‐off system whereby at some stages birds forage with net energy losses. The decision to feed close to or far from the colonies, i.e. to allocate to the chick or to store body reserves, is not related to any endogenous rhythm, nor to the nutritional status of the chick, nor to the length of the previous foraging trip. Rather, it is under the sole control of adult body condition, with the possible existence of a threshold body mass around 750 g. Thus, adult body mass plays a central role in foraging decisions, linking foraging and allocation.

5.  The synchronized return of foraging birds every 2. weeks is not due to environmental factors. By modelling attendance patterns with an increasing variance in the foraging routine, it is shown that the periodicity of feeding times is retained throughout the chick rearing period, with a cyclicity of 14. days. This result indicates that cyclic attendance at the level of the whole colony is an emergent property of the two‐fold foraging strategy of individual adults.

6.  One main consequence of this system appears to be a reduction in competition close to the breeding grounds and this may help explain the existence of huge populations of sooty and short‐tailed shearwaters that rely on distant food resources.
Small mammals cycles in northern Europe: patterns and evidence for a maternal effect hypothesis
Authors: Inchausti Pablo , Ginzburg Lev R.
Published: March 2003

1.  Voles undergo pronounced oscillations over periods of 3–5 years in northern Europe. A latitudinal gradient of cycle periods and amplitudes has been reported for Fennoscandia, with periods and amplitudes increasing towards northern latitudes.

2.  This study formulates a discrete time model based on maternal effects to explain the density fluctuation patterns of microtine rodents. The phenotypic transmission of quality from mothers to offspring generates delayed density dependence, which produces cyclic behaviour in the model.

3.  The dynamic patterns predicted by the maternal effect model agree with data. We conclude that the maternal effect hypothesis is a plausible, parsimonious explanation for vole‐density cycles in northern Europe.
Explaining the latitudinal gradient anomaly in ichneumonid species richness: evidence from butterflies
Authors: SIME KAREN R. , BROWER ANDREW V. Z.
Published: March 2003

1.  Despite the profusion of Lepidoptera and other potential hosts in the tropics, the Ichneumonidae are not more species‐rich in the lowland tropics than in temperate communities. Alternate but partially complementary hypotheses emphasizing resource fragmentation, predation, or chemical defence have been proposed to explain this paradox.

2.  Because different diversity gradients occur in the various subgroups of the Ichneumonidae, as well as among their hosts, general explanations are unlikely to account for this ‘anomalous diversity.’ Hypotheses of ecological causation are best tested at the taxonomic level where the pattern of interest applies.

3.  Phylogenetic trends in the distribution, abundance, and palatability of butterflies (Papilionoidea), a group that increases dramatically in species richness towards the tropics, are presented as a case study for evaluating hypotheses of parasitoid species richness. Evidence is presented that supports the ‘nasty host hypothesis’ as an explanation for the lack of diversity of associated parasitoids.

4.  An examination of hypotheses and the approaches used to test them suggests that the nasty‐host hypothesis is best supported by the limited evidence available, while evidence in favour of other hypotheses is either lacking or ambiguous. In particular, use of the koinobiont/idiobiont dichotomy and parasitoid assemblage‐size comparisons may result in contradictory conclusions.
Regulation of food provisioning in the Antarctic petrel; the importance of parental body condition and chick body mass
Authors: Tveraa Torkild , Sether Bernt‐Erik , Aanes Ronny , Erikstad Kjell Einar
Published: March 2003

1. Two hypotheses may explain how long‐lived seabirds regulate the food provisioning to their chick. The fixed level of investment hypothesis states that the parents provide food for their chick according to an intrinsic rhythm, independent of their chick's need. The flexible investment hypothesis states that the parents adjust their food provisioning both according to their chick's and their own need.

2. We tested how the Antarctic petrels adjust the food‐provisioning according to their own body condition or to their chick's need. First, we selected parents in poor and good body condition. Then we gave all parents randomly a chick of different body mass, but of the same age. We then measured the chicks daily until they were fed for the first time after swapping.

3. Parents in good body condition at hatching were more likely to produce a chick that was still alive 9 days after hatching than parents in poor body condition. Chick body mass at day 9 and at the end of the guarding period was positively related to the mean body condition of the parents at hatching.

4. The meal size provided by parents in good body condition was larger than that provided by parents in poor body condition. Parents in good body condition delivered more food to small than to large chicks, whereas no such relationship was found among parents in poor body condition.

5. Our results suggest that the Antarctic petrel parents adjust the amount of food delivered to their chick according to both the chick's need and their own body condition, and that the ability to respond to the chick's need is dependent upon their own body condition.
The relative role of density‐dependent and density‐independent survival in the life cycle of Atlantic salmonSalmo salar
Authors: Jonsson N. , Jonsson B. , Hansen L. P.
Published: March 2003

1. Density‐dependent factors appeared important for the survival of juvenile Atlantic salmon in the River Imsa whilst density‐independent factors were more important for the older fish at sea. In fresh water, density dependence was indicated by a stock−recruitment relationship with increasing loss‐rates from eggs to smolts and from eggs to adults as egg density increased. 73% of the loss‐rates were explained by variation in egg density. At sea, density independence was indicated by the lack of a significant relationship between loss‐rates and smolt densities.

2.The relationship between smolt density and initial egg density was best described by an asymptotic ‘Cushing’ type relationship with a plateau at densities higher than approximately 60 000 eggs for the total river areas of 10 000 m2. The number of smolts developed from the eggs spawned varied between 350 and 2400.

3.The relationship between smolt biomass in wet mass (kg 10 000 m−2) or energy (kJ 10 000 m−2) and the amount of salmon eggs in the River Imsa increased asymptotically. Annual smolt biomass ranged from 13 to 88 kg 10 000 m−2, or 66 000 and 431 000 kJ 10 000 m−2. Variation in egg density accounted for approximately 45% of the variation in smolt biomass (mass or energy).

4.Total wet mass and energy of adults (kg 10 000 m−2and kJ 10 000 m−2) produced in relation to the amount of eggs at the start of the year‐class, were not significantly correlated, due to a high variation among years. The biomass of adults ranged from 73 kg 10 000 m−2to 655 kg 10 000 m−2and in energy from 370 000 kJ 10 000 m−2to 3 270 000 kJ 10 000 m−2.

5.Total adult biomass (adults caught at sea and in rivers) and the returning adults to the River Imsa in mass or energy were correlated with the size of the smolt cohort from which they originated. Yearly total adult biomass ranged between 240 and 3711 kg 10 000 m−2, when the number of smolts ranged from 397 to 2751, respectively. The biomass of adults returning to the River Imsa was between 59 and 614 kg, produced from between 672 and 1621 smolts.
Survival‐variation within and between functional categories of the African multimammate rat
Authors: Julliard Romain , Leirs Herwig , Stenseth Nils. Chr. , Yoccoz Nigel. G. , Prévot‐Julliard Anne‐Caroline , Verhagen Ron , Verheyen Walter
Published: March 2003

1.By identifying ecological factors specific to functional categories of individuals, it may be possible to understand the mechanisms underlying life‐history evolution and population dynamics. While empirical analyses within the field of population biology have focused on changes in population size, theoretical models assuming differential sensitivities of population growth rate or fitness to demographic parameters have mostly been untested, particularly against data on small mammals.

2.Statistical modelling of capture–mark–recapture data on the multimammate rat (Mastomys natalensis) from Tanzania shows that: (i) females survive slightly better than males and subadults survive much better than adults; (ii) temporal variation of survival of all individuals is similarly related to the rainfall of the month; (iii) subadults exhibit a strongly density‐dependent low persistence rate in the population immediately after their first capture; (iv) subadults survival in later months is, however, positively related to density; and (v) adult survival shows negative density‐dependence.

3.Both density‐dependent and density‐independent factors simultaneously determine stage‐dependent survival variation of the multimammate rat. Whereas environmental factors in this population seem to affect survival rates of all individuals in a similar manner, density‐dependent relationships are more complex.

4.The patterns of survival variation in small mammals may be different from those observed in large mammals.

5.Further studies of demography in small mammals should aim at understanding how much of the variability in population growth rate is accounted for by the variability of the demographic rates resulting from limiting (density‐independent) and regulating (density‐dependent) factors, respectively. This study emphasizes the use of robust and accurate statistical methods as well as stage‐ or age‐structured population modelling.