bluuebunny/crossref_metadata_2025 huggingface dataset:
Specific determinants of intrinsic work motivation, burnout and turnover intentions: a study among nurses
Authors: Janssen Peter P.M. , De Jonge Jan , Bakker Arnold B.
Published: March 2003

Specific determinants of intrinsic work motivation, burnout and turnover intentions: a study among nurses

This study of 156 Dutch general hospital nurses tested a theoretically derived model of specific relationships between work stressors and stress reactions. The model proposes four central domains of the work situation, namely work content, working conditions, social and labour relations, and conditions of employment. In addition, the model proposes three important stress reactions, namely a diminished intrinsic work motivation, occupational burnout and an inclination to leave the job. More specifically, it was hypothesized that (i) intrinsic work motivation is primarily determined by work content variables, (ii) burnout is primarily determined by both work load and limited social support, and (iii) propensity to leave is primarily determined by conditions of employment. All these relationships were simultaneously tested using a structural equations modelling technique. The results of a series of LISREL analyses indicate that the postulated model fits well to the data. The present study used conceptually integrated measures that cover the area of work stress and stress reactions, and provides directions for interventions aimed at preventing or reducing specific negative outcomes of work‐related stress in general hospitals.
Review of nursing documentation in nursing home wards — changes after intervention for individualized care
Authors: Hansebo Görels , Kihlgren Mona , Ljunggren Gunnar
Published: March 2003

Review of nursing documentation in nursing home wards — changes after intervention for individualized care

Using standardized assessment instruments may help staff identify needs, problems and resources which could be a basis for nursing care, and facilitate and improve the quality of documentation. The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) especially developed for the care of elderly people, was used as a basis for individualized and documented nursing care. This study was carried out to compare nursing documentation in three nursing home wards in Sweden, before and after a one‐year period of supervised intervention. The review of documentation focused on structure and content in both nursing care plans and daily notes. The greatest change seen after intervention was the writing of care plans for the individual patients. Daily notes increased both in total and within parts of the nursing process used, but reflected mostly temporary situations. Even though the documentation of nursing care increased the most, it was the theme medical treatment which was the most extensive overall. A difference was seen between computer‐triggered Resident Assessment Protocol (RAP) items, obtained from the RAI/MDS assessments, and items in the nursing care plans; the former could be regarded as a means of quality assurance and of making staff aware of the need for further discussions. The RAI/MDS instrument seems to be a useful tool for the dynamic process in nursing care delivered and as a basis for documentation. The documentation should communicate a patient’s situation and progress, and if staff are to be able to use it in their everyday nursing care activity, it must be well‐structured and freely available. The importance of continuing education and supervision in nursing documentation for development of a reliable source of information was confirmed by the present study.
A conceptual framework for evaluating the nurse practitioner role in acute care settings
Authors: Sidani Souraya , Irvine Diane
Published: March 2003

A conceptual framework for evaluating the nurse practitioner role in acute care settings

The conceptualization and enactment of the ACNP role varies across settings, potentially leading to variability in outcome achievement. A conceptual framework for evaluating the ACNP role is proposed. The framework is an adaptation of the Nursing Role Effectiveness Model which was developed to facilitate the identification and investigation of nursing‐sensitive outcomes. The framework represents the complex system of interrelated factors that are present in the ACNP practice situation and that affect role effectiveness. It includes three components: (i) structure — encompassing patient, ACNP and organizational variables; (ii) process — consisting of the ACNP role components (clinician, educator, researcher and administrator) and the ways in which the role is enacted; and (iii) outcomes — including patient‐ and cost‐related outcomes. The framework proposes specific relationships among the structure, process and outcomes components. Empirical support for the framework propositions is provided, based on a review of pertinent literature. Implications for future ACNP impact studies are discussed.
The contingent nature of advanced nursing practice
Authors: Woods Leslie P.
Published: March 2003

The contingent nature of advanced nursing practice

This paper examines the issues faced by advanced nurse practitioners in the United Kingdom as they attempt to implement a new role in practice. The discussion draws on evidence gathered during a longitudinal study of a small number of graduates from a Master’s degree programme who subsequently took up posts as advanced nurse practitioners. The paper focuses on one of the key findings to emerge from the inquiry, that of the identification of the contingent nature of advanced nursing practice. The data for the study were collected over a 2‐year period via interviews, observation of clinical practice and self‐report role development diaries. Following analysis it was revealed that, whilst the passage from experienced nurse to advanced nurse practitioner can be considered to be highly individual and complex, practitioners appear to move through three discrete stages during the transitional process. The first of the three stages is represented by a state of ‘idealism’ on the part of advanced practitioners. During the second phase, termed ‘organizational governance’, practitioners discover that, in contrast to their initial optimism, the orientation, goal and delivery of their role is controlled by key stakeholders within the organization. The final stage, ‘resolution’, is only reached when practitioners have been in post for more than 1 year and can be summarized as a state of acquiescence and compromise. A conceptual model is presented which illustrates the contingent nature of advanced nursing practice.
The quality of mothers’ solutions to child‐rearing problems: what difference does setting internal or external to the family make?
Authors: Pridham Karen F. , Pascoe John
Published: March 2003

The quality of mothers’ solutions to child‐rearing problems: what difference does setting internal or external to the family make?

In this study we examined the difference the setting of a child‐rearing problem, either internal or external to the family, made for mothers’ generation of solutions likely to assist a child’s development of problem‐solving competencies. In addition, the direct effect of a mother’s personal resources (age, education, number of children parented, and verbal ability) and the direct and mediating effect of the extent to which a mother took the child’s perspective on her generation of assistive solutions were explored. Adult mothers (n = 128) of children ranging in age from 1 month to 18 years were interviewed by telephone concerning eight hypothetical child‐rearing problems. Mothers generated a greater proportion of assistive solutions and took the child’s perspective more often for external problems than for internal problems. For internal problems, a mother’s verbal ability made a significant contribution to the proportion of assistive solutions generated. For external problems, number of children made a significant negative contribution. For external problems, perspective taking had a mediating effect on the relationship of number of children with the proportion of assistive solutions generated. The nature of a mother’s perspective taking and the function that it has in solution generation for child‐rearing problems merit exploration.
Recovering from stroke: a qualitative investigation of the role of goal setting in late stroke recovery
Authors: Lawler John , Dowswell George , Hearn Jeff , Forster Anne , Young John
Published: March 2003

Recovering from stroke: a qualitative investigation of the role of goal setting in late stroke recovery

This article examines the role of goal setting in the continuing relationship between specialist nurse and patients recovering from stroke. The nurse intervention was intended to ease the patient through the stages of recovery from stroke, focusing on emotional and social recovery rather than physical function. Literature on the use of goals in the nursing process is discussed. The article uses data from contemporary nurse records and from interviews with nurses and with patients and caregivers. The data from each of these elements were subjected to content analysis and were then synthesized using a grounded theory approach to interpret their significance. The perspective of patients and caregivers provides an additional insight into the use and limitations of goal setting which is largely developed in the literature from a nursing perspective. Nurses were found to have different interpretations of the use of goal setting. Some used it explicitly in their relationships with patients, whilst others used the concept to inform their actions whilst being less explicit and more informal. In all cases they demonstrate the tension between establishing and supporting progress towards realistic recovery goals and recognizing the limitations now placed on stroke victims.
Chinese elderly patients’ perceptions of their rehabilitation needs following a stroke
Authors: Lui May H.L. , Mackenzie Ann E.
Published: March 2003

Chinese elderly patients’ perceptions of their rehabilitation needs following a stroke

Stroke is the third leading cause of death and disability among Chinese elderly patients in Hong Kong and yet the rehabilitation needs of these patients are rarely explored. The aim of this study was to identify the rehabilitation needs of Chinese elderly patients following a stroke. The study adopted an ethnographic approach, information being gathered by the researcher through interviews with 15 key informants selected by purposive sampling. The perceptions of patients as to their own needs were sought at three stages of recovery — in the acute and rehabilitation settings and at 1 month following discharge.

Ethical approval was gained from the Chinese University Faculty of Medicine ethical committee and access agreed by the hospital authorities. Verbal approval was gained from the patients before each interview, following confirmation of the voluntary nature of participation and assurance of confidentiality and anonymity. The researcher’s role was also clearly stated.

Analysis of the interview data produced five categories of patient need at the three stages of recovery, namely informational, physical, psychological, social and spiritual. The most frequently stated, but largely unmet, need in all settings was the need for information, particularly information about the reasons for stroke and about the activities that promote recovery. In the acute and rehabilitation settings patients’ responses indicated a need to be respected as individuals, to be addressed by name and to be provided with privacy. Although the Barthel Index administered during interviews charted recovery at different rates, nurses did not always make links between the level of functional ability and the help needed with physical tasks. They also failed to recognize the relationship between physical and psychological needs and the equal importance of both in recovery from stroke. As Chinese elderly patients tend to take a passive role in seeking help and information, nurses play a significant role in the identification of individual rehabilitation needs. Implications for nursing practice are discussed.
Acute care nurses’ experiences of moral certainty
Authors: Wurzbach Mary Ellen
Published: March 2003

Acute care nurses’ experiences of moral certainty

Moral certainty is a common, vivid experience for many nurses, but it may be a mixed blessing. From one perspective moral certainty provides comfort for the ethical decision‐maker and may prompt necessary action which would have been impossible without it. From another perspective, moral certainty stifles dialogue and in‐depth discussion of moral issues. Despite the fact that moral certainty is ubiquitous in health care, few research studies have explored both the positive and negative aspects of this complex and sometimes troubling concept. A qualitative design was used to describe the experiences of 20 acute care nurses with moral certainty. They were interviewed and the interviews analysed using Colaizzi’s method for qualitative data analysis. These nurses’ primary responses to moral certainty were ‘speaking up’, ‘standing up’ and ‘refusing to participate’. Their experiences with moral certainty, responses to it, reasons for responding as they did, and clinical prompts are described. The author concluded that moral certainty may have positive and negative aspects. Making an effort to hear alternative views is suggested.
Individuals’ perception of their quality of life following a liver transplant: an exploratory study
Authors: Robertson Gillian
Published: March 2003

Individuals’ perception of their quality of life following a liver transplant: an exploratory study

This study explores individuals’ perceptions of the effect of a liver transplant on their quality of life, focusing on the progression from dependence to independence physically, socially and psychologically. A phenomenological design using taped semi‐structured interviews was used. The sample consisted of five patients attending the out‐patients clinic at least 1 year following a liver transplant for chronic liver disease. The data were analysed using cluster analysis of transcribed interviews. Categories were identified as physical, social and psychological factors affecting their progression from dependence to independence pre‐ and post‐transplant and specific factors were identified as significant in overcoming the stressors affecting this progression. The findings reflected Maslow’s Hierarchy of Needs. Pre‐transplant their physical problems prevented them fulfilling personal goals and addressing psychological issues, e.g. dying. Post‐transplant any physical problems identified were insignificant to the participant. They were keen to socially integrate and be treated as normal; however, family and friends restricted their independence by continuing to ‘wrap them in cotton wool’ as they had before their transplant. Personality, incentives and Unit support were identified as imperative in their progression from dependence to independence. The findings demonstrate a need to impress on family and friends of patients following a liver transplant, their role in assisting the patient’s progression from dependence to independence.
Incontinence and sexuality: findings from a qualitative perspective
Authors: Roe Brenda , May Carl
Published: March 2003

Incontinence and sexuality: findings from a qualitative perspective

Incontinence remains a taboo where myths and misconceptions abound. The objectives of this study were to explore the impact of incontinence on an individual’s sexuality and to identify the impact of health interventions for the management of incontinence on sexuality. A quota sample of subjects whose incontinence was regarded as being either successfully managed (n=14) or unsuccessfully managed (n=12) by continence advisers, community nurses and health visitors from two National Health Service Trusts were interviewed. A further subject whose incontinence was not classified was also interviewed, bringing the total number of interviews to 27. One Trust had an established continence advisory service of some 19 years, while the other Trust did not have a specific continence advisory service and relied upon members of the primary health care team to meet the needs of individuals suffering from incontinence. The qualitative data from this study were analysed using the constant comparative technique and were grouped into themes relating to clothing and appearance, intimacy and caring, management techniques and relationships and life trajectory. This is the first study to have examined management techniques for incontinence and their relationship to an individual’s sexuality and therefore has important implications for clinical practice. It has also set the findings of incontinence and sexuality in the context of chronic conditions and their related patient careers and life trajectory.
Gender, adolescence and the management of diabetes
Authors: Williams Clare
Published: March 2003

Gender, adolescence and the management of diabetes

Health professionals view adolescence as a difficult time in which to manage diabetes. Adherence to treatment may be a problem, and there is also an expectation that young people should become independent in self‐care. Drawing on data from a qualitative study which interviewed teenagers with diabetes and their mothers, this paper focuses on the ways in which gender and adolescence interact to affect how young people live with diabetes. Key themes explored include: the gendered meanings of diabetes; gendered management strategies; gendered dependencies; and adherence to treatment regimes. Gender was found to have a major impact on how young people managed diabetes. Gender also impacted on the involvement of mothers, with the mothers of sons much more likely to be involved in helping their sons than the mothers of daughters. In discussing some of the implications for health policy, it is suggested that in their ways of managing diabetes, young people should be seen as acting rationally within the confines of their gendered identities. Therefore, a uniform policy which promotes the independence of young people may not always be an appropriate way of working with young people or their families.
A description of health care professionals’ experiences of encounters with patients in clinical settings
Authors: Takman Christina A.S. , Severinsson Elisabeth I.
Published: March 2003

A description of health care professionals’ experiences of encounters with patients in clinical settings

The aim of this study was to describe health care professionals’ way of experiencing their encounters with in‐ or outpatients, while working in acute medical care hospitals. One main question was addressed: What are the experiences which health care professionals have of their encounters with in‐ or outpatients in clinical settings? Eleven health care professionals (physicians, registered nurses and enrolled nurses) were interviewed and a phenomenographic approach was used, where data were analysed qualitatively. The results indicate that the health care professionals’ way of experiencing their encounters with patients in acute medical care hospitals could be separated into three categories of description: a gain in personal knowledge and understanding of the patients’ different ‘ways’ of communicating experienced suffering; making the patient feel confident and; focusing on the medical problems, not understanding the patient’s different ‘ways’ of communicating their experienced suffering. The first two categories of description showed encounters where the health care professionals felt that they could understand the patients’ expressions of suffering. The third showed encounters where the health care professionals experienced difficulty in understanding the patients’ expressions of suffering. There is a need therefore to support health care professionals in improving their understanding of patients’ suffering.
The biopsychosocial impact of end‐stage renal disease: the experience of dialysis patients and their partners
Authors: White Yvonne , Grenyer Brin F.S.
Published: March 2003

The biopsychosocial impact of end‐stage renal disease: the experience of dialysis patients and their partners

This phenomenological study was conducted to investigate the biopsychosocial impact of end‐stage renal disease on dialysis patients and their partners. Forty‐four participants were interviewed separately (22 patients and their partners) by way of two open‐ended questions, and multiple themes were identified from verbatim transcripts. Both the patients and partners viewed their relationship very positively, and both were overwhelmed by the impact of dialysis on their lives. Anger, depression and hopelessness were evident in the patients, whilst a pervasive sadness, resentment, guilt and loss were prevalent in the partners. This study gives a unique perspective on the negative impact which dialysis can have on couples, yet it also suggests that some are able to cope in a positive way despite the many life‐style adjustments required by dialysis. The results of this study indicate that nurses need to recognize and respond to the tremendous emotional impact that chronic illness and its treatment can have on families in an era where it is possible to sustain life for years with the use of life support technology.
Perceptions of research utilization: comparisons between health care professionals, nursing students and a reference group of nurse clinicians
Authors: Kajermo Kerstin Nilsson , Nordström Gun , Krusebrant Åsa , Björvell Hjördis
Published: March 2003

Perceptions of research utilization: comparisons between health care professionals, nursing students and a reference group of nurse clinicians

The study reported in this paper was carried out to investigate a group of nursing teachers’ (n=37), nursing students’ (n=166), nursing administrators’ (n=33) and physicians’ (n=127) perceptions of barriers to and facilitators of nurses’ use of research findings in clinical practice. The results were compared with the corresponding figures for a reference group of nurse clinicians (n=237). The Barriers Scale and a questionnaire for the demographic issues were used for data collection. The organization and the communication of research were seen as barriers to research utilization by the nursing teachers, students and administrators in agreement with the nurse clinicians. The nurses’ research‐related competence and awareness were seen as barriers by the nursing teachers, students and administrators to a greater extent than by the nurse clinicians themselves. The physicians perceived barriers to a lesser extent than the other groups did. The students’ perceptions were closest to the nurse clinicians, while the physicians’ perceptions differed most. Education to increase the nurses’ knowledge of research and to develop their competence to evaluate research results, increased resources for education, more staff, support from the administration and research presented in a user‐friendly way were the most frequently suggested facilitators. The nurses’ isolation from knowledgeable colleagues with whom to discuss the research was seen as a barrier by the majority of the participants. This indicates a need for positions in clinical practice for nursing researchers, in order to promote a research‐based, nursing practice.
Barriers to, and facilitators of, research utilization among nurses in Northern Ireland
Authors: Parahoo Kader
Published: March 2003

Barriers to, and facilitators of, research utilization among nurses in Northern Ireland

It is clear from the nursing literature that there are a number of factors which can impede or facilitate the use of research in practice. It is important that these are identified and addressed, both at local and national levels, if evidence‐based practice is to become a reality. This study surveyed nurses’ perceptions of barriers to, and facilitators of, research utilization. The Barriers Scale was administered to a convenience sample of 2600 nurses in 23 hospitals in Northern Ireland. The number of completed questionnaires was 1368 (52·6%). The results show that the top barrier was ‘The nurse does not feel she/he has enough authority to change patient procedures’ followed by ‘statistical analyses are not understandable’. Seven out of the top 10 barriers were related to ‘setting’. The implications of these and other findings are discussed.
Men’s lived experiences following transurethral prostatectomy for benign prostatic hypertrophy
Authors: Pateman Brian , Johnson Martin
Published: March 2003

Men’s lived experiences following transurethral prostatectomy for benign prostatic hypertrophy

The aim of this study was to illuminate the lived experience of prostatectomy recovery by means of semi‐structured interviews. Despite the commonality of prostatic enlargement and the corrective transurethral procedure, surprisingly little is known of the impact upon the men’s social and psychological well‐being. The interviews have produced very rich data, which illustrate the extent to which the men are initially very reluctant to identify ‘problems’ either with their hospital experience or their subsequent recovery period. However, once respondents appeared to feel more comfortable, we began to learn of their very substantial difficulties both before and after the operation.
Cultural challenges in end‐of‐life care: reflections from focus groups’ interviews with hospice staff in Stockholm
Authors: Ekblad  , Marttila  , Emilsson
Published: March 2003

Cultural challenges in end‐of‐life care: reflections from focus groups’ interviews with hospice staff in Stockholm

During the past few decades, Swedish society has changed from a society with a few ethnic groups to one with over a hundred groups of different ethnic backgrounds, languages and religions. As society is becoming increasingly multicultural, cultural issues are also becoming an important feature in health care, particularly in end‐of‐life care where the questions of existential nature are of great importance. However, cultural issues in health care, especially at hospices, have not been studied sufficiently in Sweden.

The purpose of this study was to gather reflections about cultural issues among hospice staff after a 3‐day seminar in multicultural end‐of‐life care, by using a qualitative focus groups method. The 19 participants (majority nurses) were divided into three groups, one per hospice unit. A discussion guide was developed with the following themes: 1) post‐training experiences of working with patients with multicultural background; 2) experiences gained by participating in the course of multicultural end‐of‐life care; 3) post‐training reflections about one’s own culture; 4) ideas or thoughts regarding work with patients from other cultures arising from the training; and 5) the need for further training in multicultural end‐of‐life care. One of the study’s main findings was that to better understand other cultures it is important to raise awareness about the staff’s own culture and to pay attention to culture especially in the context of the individual. The findings from focus groups provide insight regarding the need for planning flexible training in cultural issues to match the needs of the staff at the hospice units studied.
Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses
Authors: Healy Christine M. , McKay Michael F.
Published: March 2003

Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses

The study reported in this paper examined relationships between nursing work‐related stressors and coping strategies, and their impact upon nurses’ levels of job satisfaction and mood disturbance. It was proposed that higher levels of perceived work stress and use of avoidance coping would increase mood disturbance, while problem‐focused coping would be associated with less mood disturbance. The study also aimed to explore the possible ‘buffering effects’ of using humour in coping with stress, and the effect of job satisfaction on the stress–mood relationship. The sample consisted of 129 qualified Australian nurses who volunteered to complete standardized questionnaires, including the Nursing Stress Scale, Ways of Coping Questionnaire, the Coping Humour Scale, Job Satisfaction Scale of the Nurse Stress Index, and the shortened version of the Profile of Mood States. Results revealed a significant positive relationship between nursing stress and mood disturbance, and a significant negative relationship between nursing stress and job satisfaction. The use of avoidance coping and the perception of work overload were found to be significant predictors of mood disturbance. No evidence was found to indicate that the use of humour had a moderating effect on the stress–mood relationship but there was support for the influence of job satisfaction upon this relationship. These results provided some support for a transactional model of stress since situational factors were found to influence the nurses’ coping and perceptions of stress.
Women’s ‘inner‐balance’: a comparison of stressors, personality traits and health problems by age groups
Authors: Kenney Janet W.
Published: March 2003

Women’s ‘inner‐balance’: a comparison of stressors, personality traits and health problems by age groups

The purposes of this descriptive study were to identify differences in women’s stressors, personality mediating traits and symptoms of health problems by age groups, and to guide revisions for development of a shorter, reliable questionnaire to measure women’s health and risks for stress‐related illnesses. A convenience sample of 299 women aged between 18 and 66 years who resided in the south‐western United States and could read English completed a lengthy questionnaire. ANOVAs were used to compare women by three age groups. Young women (18–29 years) reported high stressors, less healthy personality traits, and significantly more physical and emotional symptoms of health problems than middle‐age and older women. Middle‐age women (30–45 years) had significantly more stressors than other women, but their healthy personality traits may have contributed to fewer health problems. Older women (46–66 years) had the fewest stressors, highest healthy personality traits, and fewest symptoms of problems compared to other age groups. In their roles and relationships as wives, mothers and employees, women experienced multiple stressors such as inadequate physical and emotional support from their spouse/partner, along with parenting and employee difficulties that contributed to their health problems. Young and middle‐aged women were more stressed, juggling the multiple responsibilities and demands of their spouse, children, ageing parents, and their occupation, while trying to maintain their own ‘inner balance’.
Education and training consortia: leading the way for the new British NHS
Authors: Burke Linda M.
Published: March 2003

Education and training consortia: leading the way for the new British NHS

In November 1997 The New NHS — Modern,Dependable was published, describing the British Labour government’s plans to introduce major changes to the NHS (National Health Service). Education and Training Consortia (ETCs) were only briefly referred to and no direct changes were proposed to them. It can be argued that this was because they had not fitted well within the Conservative government’s competitive culture of the NHS internal market. Education Consortia members share information, make plans collectively and work collaboratively, activities much more appropriate for the ‘New NHS’ which is underpinned by the concepts of partnership, openness and local ownership. In this paper it is argued that there are many valuable lessons that the key individuals involved in implementing the policies of the New NHS can learn from Education and Training Consortia. Data have been drawn from a qualitative study in which the aim was to explore the development, implementation and management of consortia and contracting for non‐medical education and training (NMET) from a stakeholder’s perspective. One of the unexpected themes that emerged from the analysis of the data, was that the development of ETCs could be utilized as a model for many of the innovations in the New NHS, particularly in relation to the formation of primary care groups.
Enabling young ‘ventilator‐dependent’ people to express their views and experiences of their care in hospital
Authors: Noyes Jane
Published: March 2003

Enabling young ‘ventilator‐dependent’ people to express their views and experiences of their care in hospital

Discussion in this paper is drawn from a phenomenological study carried out in England describing the views and experiences of young ‘ventilator‐dependent’ people aged 6–18 years, regarding their health and social care, education, and aspirations for the future. This study presented many methodological and ethical challenges in order to elicit and present their views in a meaningful way. Data were elicited through focused face‐to‐face interviews with 18 young people. Innovative methods of data collection were used with younger children and those who had a range of communication impairments. In addition, family members of 15 young people were interviewed. Presentation of findings is limited to views and experiences of the young people’s care in hospitals. Findings reveal that a significant number of Articles in the United Nations (UN) Convention on the Rights of the Child were not respected or upheld. Young ‘ventilator‐dependent’ people were discriminated against when trying to access health services because of their need for assisted ventilation. They were particularly excluded from making important decisions about their lives and were not always offered the full protection of the Children Act 1989 (England). Some young people were not able to maintain adequate contact with their families, first language, culture, nationality and religion. Almost all spent prolonged periods of time (in some cases years) in hospital when they no longer wanted or needed to be there. All those interviewed wanted to be discharged home far sooner. The generalizability of findings is unknown; however, important questions are posed in relation to nursing practice and research regarding the overall management of this group of young people. Issues include: respecting and upholding human rights; and challenging the boundaries of current nursing practice in order to move towards child‐centred, appropriate and effective models of care.
Researching children: issues arising from a phenomenological study with children who have diabetes mellitus
Authors: Miller Sue
Published: March 2003

Researching children: issues arising from a phenomenological study with children who have diabetes mellitus

In Britain the incidence of diabetes mellitus in children is increasing. These children are health care consumers and will continue to be throughout their lives. It is important that their views are sought regarding their health care condition. A phenomenological study was undertaken with six children aged 7–12 years regarding their experience of living with diabetes. This research highlighted several issues regarding the conduct of research with children. Access to children required negotiation with the ethics committee and the parents. It was also important to seek the consent of the children via the signing of a consent form, as well as an on‐going process throughout the conduct of the research. In addition, appropriate communication methods had to be utilized, acknowledging the age and abilities of individual children. The use of both verbal and non‐verbal communication skills were important, but the use of non‐verbal skills appeared to be the most significant. Researchers should not be bound by the supposed abilities of children and should take care not to underestimate the awareness and maturity that some children possess when addressing issues of concern to themselves. When given the opportunity, children were keen to express their views and were very articulate in doing so. There is much scope for future research studies seeking children’s perceptions about their health care condition.
Pedagogical implications of approaches to study in distance learning: developing models through qualitative and quantitative analysis
Authors: Carnwell Ros
Published: March 2003

Pedagogical implications of approaches to study in distance learning: developing models through qualitative and quantitative analysis

The need for flexibility in the delivery of nurse education has been identified by various initiatives including: widening the entry gate; continuous professional development; and the specialist practitioner. Access to degree level programmes is creating the need to acquire academic credit through flexible learning. The aim of this study was to further develop relationships between the need for guidance, materials design and learning styles and strategies and how these impact upon the construction of meaning. The study is based on interviews of 20 female community nurses purposively selected from the 96 respondents who had previously completed a survey questionnaire. The interviews were underpinned by theories relating to learning styles and approaches to study. Of particular concern was how these variables are mediated by student context, personal factors and materials design, to influence the need for support and guidance. The interview transcripts were first analysed using open and axial coding. Three approaches to study emerged from the data — systematic waders, speedy‐focusers and global dippers — which were linked to other concepts and categories. Categories were then assigned numerical codes and subjected to logistical regression analysis. The attributes of the three approaches to study, arising from both qualitative and quantitative analysis, are explained in detail. The pedagogical implications of the three approaches to study are explained by their predicted relationships to other variables, such as support and guidance, organization of study, materials design and role of the tutor. The global dipper approach is discussed in more detail due to its association with a variety of predictor variables, not associated with the other two approaches to study. A feedback model is then developed to explore the impact of guidance on the global dipper approach. The paper makes recommendations for guidance to students using different approaches to study in distance learning.
A description of the nursing role in stroke rehabilitation
Authors: Burton Christopher R.
Published: March 2003

A description of the nursing role in stroke rehabilitation

A theoretical description of the nursing role in stroke rehabilitation remains elusive in the literature. The United Kingdom strategy for health service development will increasingly require nurses from all clinical specialities to collaborate with other health care professionals and stakeholders to evaluate the services they provide. In stroke rehabilitation, an understanding of the contribution that nursing makes is essential, if that collaboration is to be effective. This paper details a study undertaken to describe the nature of the nursing role in stroke rehabilitation, and the factors that shape this role. A reflective enquiry was used to enable the collection of data grounded in the realities of clinical practice. Study participants were qualified nursing staff (n=13) working in a rehabilitation unit in the north‐west of England. A total of 35 in‐depth reflections were obtained for analysis. Three role categories were identified in the data: the nurse as care giver, facilitator of personal recovery and care manager. Sub‐categories of nursing intervention were identified within each category, together with anticipated outcomes and contextual features that shaped the category. The results of the study were verified by a purposive sample of nursing staff from the rehabilitation unit.
The health‐related quality of life of patients suffering from the late effects of polio (post‐polio)
Authors: Kling  , Persson  , Gardulf
Published: March 2003

The health‐related quality of life of patients suffering from the late effects of polio (post‐polio)

In Sweden alone, there are today approximately 10 000–16 500 polio survivors. Between 60% and 80% experience new symptoms several years after the initial attack of poliomyelitis. The aims of this study were to investigate and describe the self‐rated health‐related quality of life and functional status of a group of Swedish patients with post‐polio, to investigate whether any differences within the group could be related to demographic or disease‐specific data and to compare the post‐polio patients with individuals sampled from the general population. Data were obtained by using two questionnaires, the Swedish Health‐Related Quality of Life Questionnaire (SWED‐QUAL) and the Sickness Impact Profile (SIP). A total of 150 patients, 86 women and 64 men with median age 61 (20–82) years, were consecutively included. The study showed that the patients mainly reported that their physical, functional status was affected by their post‐polio condition. Factors found to be associated with the physical, functional status were age and the number of parts of the body affected by the polio. On comparing the post‐polio patients with two samples from the Swedish general population, it was found that the patients reported a poorer functional status and health‐related quality of life. The women with post‐polio reported more pain, as compared with both the men with post‐polio and the women in the general population sample. The family life of the patients — in contrast to their physical abilities — did not seem to be affected by the new deteriorating condition. It is concluded that, owing to the wide range of symptoms, the patients with post‐polio need care and support from multidisciplinary teams, including nurses and occupational therapists.
Developing a concept analysis of control for use in child and adolescent mental health nursing
Authors: Croom Susan , Procter Susan , Couteur Ann Le
Published: March 2003

Developing a concept analysis of control for use in child and adolescent mental health nursing

The need to help children and young people with significant mental health problems develop a sense of personal control in their everyday lives, in a manner which does not endanger themselves or others, was recognized by nurse practitioners working in an English regional multidisciplinary child and adolescent mental health residential unit. A concept analysis of control was undertaken and used to develop a framework for analysing control. This deductive framework was modified iteratively by nurses who developed new knowledge from a qualitative exploration of current practice and the application of the evolving framework to practice problems. The paper describes this process and highlights three main findings: (i) the evolving attributes of the concept analysis helped nurses steer a course through the complexities of practice; (ii) the research highlighted and enabled nurses to confront the paradoxical nature of control; (iii) the process enabled nurses to recognize the mutuality of feelings aroused simultaneously when both the nurse and the child are challenged to maintain personal control.
Feeling of ‘lacking’ as the core of envy: a conceptual analysis of envy
Authors: Maijala Hanna , Munnukka Terttu , Nikkonen Merja
Published: March 2003

Feeling of ‘lacking’ as the core of envy: a conceptual analysis of envy

The aim of this paper is to explore the subjective experience of envy through concept analysis. Further, the study on which it is based aimed to answer questions about the composition and manifestations of envy. From the viewpoint of nursing science, the analysis of envy is based on a desire to understand human beings from the perspective of subjective health and illness and thus from a health promotion perspective. Envy is conceived of as a dimension of a person’s health and illness. The concept is therefore meaningful from the viewpoint of nursing; it describes a phenomenon which enables us to deepen our understanding in a way relevant to nursing science. In the study the hybrid model developed by Schwartz‐Barcott et al. was used for conceptual elaboration. In the theoretical phase of the study the subjective experience of envy was explored from the viewpoints of philosophy, religion, Finnish folklore and psychoanalysis, as well as nursing science. As a synthesis of these, a conceptual analysis of envy adapted from Wilson was conducted and a working definition of envy was proposed. In the fieldwork phase, envy was examined by means of an empirical analysis using a phenomenological approach. As a result, a classification describing the experience of envy was presented. The core experience of envy has been defined as a ‘lacking’, and the object of envy as something good possessed by someone else. Envy manifests itself in both destructiveness and creativity. The trends of development of envy are inflexibility and emancipation, and the essence of envy is multidimensional. Finally, the working definition of the concept was elaborated on the basis of the empirical phase and a new definition reflecting the composition and manifestations of envy was proposed.
Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set
Authors: Evers Georges , Viane Annemie , Sermeus Walter , Simoens‐De Smet Anita , Delesie Luc
Published: March 2003

Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set

This study describes the frequency of and indications used for total feeding assistance and tube feeding in a national representative sample of Belgian hospital patients (n = 421 314). Data from the 1990 national minimum nursing data registration was used. Orem’s self‐care model was used to describe and categorize types of nursing care and related indications. The scope of wholly compensatory nursing care was limited to total feeding assistance and tube feeding. This type of nursing care is indicated when self‐care agency is undeveloped or cannot be used and when self‐care demands are significantly increased. Based on review of the literature, hypotheses to indicate nursing care were formulated and tested. Wholly compensatory nursing care related to enteral food intake is given to 14·4% of the total patient population in Belgian hospitals. If self‐care demand increases due to malnutrition, then this is an indication for total feeding assistance. If self‐care agency decreases due to blindness, mental retardation, disorientation or upper extremity dysfunction, then this is also an indication for total feeding assistance. If self‐care agency decreases due to impaired chewing, then this is an indication for tube feeding. This study has generated the first representative national nursing statistics about total feeding assistance and tube feeding in hospitals.