bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuing professional education: luxury or necessity?
Authors: Perry Lin
Published: March 2003

The author sets out to define what is meant by continuing professional education, the implications of the terminology and the contribution that it makes to nursing She then moves on to discuss the distinction between education and learning, and the importance of ‘life‐long learning’ to nursing The relative merits of voluntary and compulsory education are considered and the attitudes and expectations of both nurses and their managers are examined. Obstacles to the up‐take of educational opportunities are outlined, and some of the issues behind this are explored The assessment of educational requirements and the evaluation of educational offerings are reviewed, along with the importance of assuring quality, not only in the context of proposals for post‐registration education and the current market ethos in the United Kingdom, but also with regard to the potential benefits to be gained in the health care of the general public
Planning nursing education for the 21st century
Authors: Duffy Nancy , Foster Carolyn D , Kuiper RuthAnne , Long Joyce T , Robison Lynn D
Published: March 2003

In looking towards the 21st century, the faculty at the Presbyterian Hospital School of Nursing, along with the Presbyterian Health Services Corporation and Queen's College, adopted a 1‐2‐1 programme The process of developing a new nursing curriculum is presented as the task force proceeded from the philosophy and goals to conceptual framework and curriculum objectives After discussions with nurse administrators and educators, extensive literature reviews and brainstorming sessions, concepts and subconcepts were chosen to form a philosophy The metaparadigm of nursing and other related concepts were then organized into a conceptual framework Ongoing communication and feedback from the faculty ensured group ownership of all documents The eclectic organizational scheme was a good fit for a large faculty with differing beliefs and values about a nursing curriculum The process of developing a future orientated nursing curriculum has been exciting, challenging and rewarding The faculty is committed to the new philosophy, goals and conceptual framework and believe that the 1–2–1 programme will educate future practitioners who are prepared to meet the challenges and changes in health care for the 21st century
Talking realistically about nursing: a thematic analysis of nursing course selection interview discourse
Authors: Moir James , Abraham Samuel Charles
Published: March 2003

This study examines the dialogue within selection interviews for places on a graduate nursing programme The analysis focuses upon the way in which a ‘realistic’ knowledge of nursing is tested for, and demonstrated through, particular discursive themes These themes reflect a wider social acceptance of accountable rational decision‐making It is argued that applicants who are able to draw upon the interpretative resources necessary to justify their nursing course application in these terms are more likely to be evaluated positively
Registered nurses' experiences of mentoring undergraduate nursing students
Authors: Atkins Sue , Williams Anne
Published: March 2003

This paper describes a research study undertaken by the first author, which explored and analysed registered nurses' experiences of mentoring undergraduate nursing students within a single health authority in England The study design was qualitative and data were collected through semi‐structured interviews with 12 mentors The findings of the study indicate that mentoring undergraduate nursing students is a complex and skilled activity, requiring educational preparation, support and recognition The potential for mentoring to further the personal and professional development of mentors is highlighted
Science, technology, caring and the professions: are they compatible?
Authors: Hawthorne Denise Lillian , Yurkovich Nancy Jane
Published: March 2003

There is concern expressed about a decreased level of caring in the professions today Many factors have been proposed to explain this, but the present authors believe it is due to an overemphasis on science and technology It is in caring that we connect with one another, are fulfilled and experience growth, a lack of caring diminishes both professional and client The professional‐client relationship is essential to the meaning of professional, therefore, a professional must care Shifting our focus to a paradigm which includes both science and technology and caring allows us to see life's experiences and our interconnectedness in a new way It is then that the truth will emerge that the essence of caring and profession are one
Progress in measuring nursing outcomes
Authors: Griffiths Peter
Published: March 2003

This paper examines the progress made in the measurement of the ‘outcomes’ of nursing Although nursing has a long history of outcome research which extends as far back as Florence Nightingale, an examination of the literature over the past 30 years gives little impression of progress Significant difficulties still remain in identifying outcomes relevant to nursing intervention, measurement techniques and appropriate study designs However, progress has been made The paper examines various recent trends which point to ways forward for outcome research In particular it is emphasized that future work should build upon the strengths of past work in the use of measurement tools and the identification of relevant variables Outcome research in nursing should not be limited to identifying the immediate results of nursing intervention, nor should research into ‘structure’ or ‘process’ variables be neglected Such concepts are vital to determining the nursing contribution to changes in a patient's health and well being The future of outcome research depends on a range of appropriate research methods and measurement techniques
Exploring the value of clinical nursing practice: the practitioner's perspective
Authors: Waterworth Susan
Published: March 2003

This paper describes a preliminary study which attempted to explore the value of nursing practice from the viewpoint of practitioners The objective was to further knowledge and develop insights into nursing practice, identifying concepts central to therapeutic care Integral to the study was the development of a model for reflective practice
How male nursing students learn to care
Authors: Paterson Barbara L , Crawford Marta , Saydak Marian , Venkatesh Pen , Tschikota Sharon , Aronowitz Ten
Published: March 2003

The current definitions of caring in nursing education denote a mutual relationship between teachers and students in which they interact to provide an environment which supports the students’ personal and professionaldevelopment The learning of caring in an interactional context is typical of the female experience It is unknown if this is representative of the male experience The lived experience of 20 male students as they learned to care as nurses was the focus of this phenomenological research study The participants concurred that, although caring as a nurse could be learned if one was ‘open to learning’, teachers could only facilitate this learning, they could not directly teach it The interactional strategies of storytelling, modelling, being cared for, the ‘aha’ encounter, and observing and giving care, were used by the participants in learning to care as nurses The implications of these findings for nursing education and research are presented
‘Mom, I have something to tell you’— disclosing HIV infection
Authors: Katz Anne
Published: March 2003

This paper explores the experience of disclosing HIV infection to family members. Information was obtained from secondary analysis of interviews conducted with 10 HIV‐positive men and women. Learning that one is HIV‐positive is a traumatic event, and disclosing this to family members can be difficult. Findings from this study suggest that family members generally overcome their own feelings and provide the infected individual with love and support. However, the resultant stress on the family may precipitate a crisis as addressed.
The Primary holisms in nursing
Authors: Kolcaba Raymond
Published: March 2003

Holistic thinking is so diverse that practically every theorist can claim holistic credentials. The challenge for nursing, then, is not whether holism but which holism? As a practice‐centred discipline, nursing gives a central role to whole‐person holism. In so far as nursing approximates medicine, nursing imports organismic holism. The three holisms are, however, incompatible because the concepts of person, system and organism contrast in complex and interesting ways. Discussion of the contrasts reveals points of metaphysical, scientific and ethical incompatibility. A construct based on whole‐person holism, but incorporating a partial synthesis of all three, reveals both promise and challenge for a unified holistic view in nursing.
Professionalization of nursing: development, difficulties and solutions
Authors: Keogh Johann
Published: March 2003

This paper re‐examines the claim of the profession of nursing to professional status. The criteria for professional recognition are used to determine whether nursing is indeed a profession, and the author could substantiate the professional status of nursing in certain countries. The problems encountered in the process of professionalization were explored and, in conclusion, a few solutions to the problems encountered were offered from the author's own paradigm.
Patient controlled analgesia and intramuscular injections: a comparison of patient pain experiences and postoperative outcomes
Authors: Snell Catherine Carter , Fothergill‐Bourbonnais Frances , Durocher‐Hendriks Suzie
Published: March 2003

Despite relatively widespread use of various forms of patient controlled analgesia (PCA), there remain conflicting results in the literature as to the efficacy of PCA. This study was conducted to assess the efficacy and postoperative outcomes of intravenous PCA compared to intramuscular (IM) injections in 73 patients who received major abdominal surgery. These patients were randomly selected and randomly assigned preoperatively to receiving IM or PCA modes of analgesia postoperatively. The following factors were compared: amount of pain; amount of analgesia use; degree of patient satisfaction with pain control both while on parenteral analgesia and after switching to oral; length of time to first ambulation; and length of stay in hospital. Results of the study did not demonstrate a statistically significant difference in any of these, using a P‐value of 0.01. The PCA patients took an average of 4.5 hours longer than the IM patients to ambulate postoperatively and the IM patients received at least three times as much antiemetic (P=0.001). Locus of control was not found to be a major factor in satisfaction or pain levels. Subsequent meta‐analyses have also failed to yield significant differences between IM and PCA groups except in patient satisfaction. It is recommended that expansion of PCA programmes with abdominal surgery patients be considered only in cases where there is fiscal advantage or where patient satisfaction can be a driving force.
Primary health care in Swaziland: is it working?
Authors: Sukati Nonhlanhla A.
Published: March 2003

A historical picture of health services in Swaziland and an analysis of primary health care services from 1983 to 1995 are presented. The paper gives background information on health and health services, including education and training of health workers and health status indicators. Evaluations of the primary health care strategy since its inception in 1983 are discussed. Successes are identified and areas where improvement is needed to achieve the WHO goal of‘Health For All’are suggested.
Managing change in nurse education: the introduction of Project 2000 in the community
Authors: Hallett Christine E.
Published: March 2003

The United Kingdom Central Council's proposals for nurse education (Project 2000: A New Preparation for Practice) were implemented in 13 demonstration districts in England in 1989. In 1991, as part of an English National Board‐funded research study, the author conducted 15 interviews with first line managers from three of these demonstration districts. The data were reinterpreted in 1995; the experience of implementing educational change in the community setting was discovered to be a complex and difficult process for the managers involved. They found themselves confronted with sometimes conflicting responsibilities; their perception of their role encompassed the meeting of a range of needs, which are presented in this paper within three categories. Firstly, the managers felt they had an obligation to meet the needs of students and of education in general in order both to provide an adequate experience for each individual student and to safeguard standards in community nursing in the long term. Secondly, they were confronted with the need to mitigate the pressures Project 2000 placed on‘their’staff. The new educational programme meant that community nurses spent much more time with students than formerly, and the difficulties they encountered were exacerbated by uncertainty about their role with these students. Finally, and most importantly, managers were responsible for ensuring that clients’needs were met. In particular, they saw it as their role to ensure that the presence of large numbers of students in the community for long periods of time did not compromise standards in the delivery of community nursing services.
Patients' perceptions of pre‐operative preparation for day surgery
Authors: Mitchell Mark
Published: March 2003

While the quality of medical intervention associated with day surgery has greatly improved, the position of psychological preparation has remained virtually unchanged. Recent evidence, however, has suggested that anxiety levels can be significantly reduced if preparatory information can be matched with individual coping styles. As choice of coping style has been strongly linked with locus of control, two questionnaires were given to 150 subjects undergoing minor gynaecological day surgery in order to compare their health locus of control (HLC) with their preferred level of preparatory information. No correlation was established between the HLC measures and the selected level of preparatory information although information requirements were established. The results are discussed and recommendations made for future pre‐operative psycho‐educational programmes.
Preconditions for and consequences of self‐determination: the psychiatric patient’s point of view
Authors: Välimäki Maritta , Leino‐Kilpi Helena
Published: March 2003

In the context of an interview study concerned with self‐determination in psychiatric patients, this paper describes the preconditions for and consequences of self‐determination from the point of view of psychiatric patients themselves. The data were collected in semi‐structured interviews with long‐term psychiatric patients (n=72) and analysed using the method of content analysis. Responses on the preconditions for self‐determination were grouped into three categories: firstly, there were those who said that reference to self‐determination in the case of psychiatric patients is nonsense; secondly, there were those who said that self‐determination requires no preconditions; and thirdly, there were those who said that there are certain preconditions, such as the ability to think and make decisions, activity, obedience, and illness. Both positive and negative consequences were identified in situations where self‐determination is maintained, but only negative consequences in situations where self‐determination is lost. On the basis of these tentative results, self‐determination seemed to be relevant in psychiatric nursing. We are continuing to develop and test an instrument for the evaluation of the opportunity for self‐determination in clinical practice.
Predictors of psychological distress in chronic pain patients
Authors: Walker Jan , Sofaer Beatrice
Published: March 2003

The purpose of this study was to identify sources of psychological distress in patients attending pain clinics. Patients attending two pain clinics in the UK completed a self‐report assessment questionnaire which included a 12‐item, 5‐point semantic differential measure of psychological well‐being/distress, together with a range of single‐item measures of pain and psychosocial factors measured using 5‐point verbal report scales. Multiple regression analysis identified that 60% of the variance associated with psychological distress was explained by a combination of fears about the future, regrets about the past, age (younger people were more distressed), practical help (more help was associated with more distress), feeling unoccupied and personal relationship problems. These results support previous findings which have suggested that a significant proportion of the emotional disturbance in chronic pain patients is associated with psychosocial factors which are either secondary to, or concurrent with, the pain. The method described provides a simple and quick method of assessment which may be used by nurses in clinical settings to identify sources of psychological distress in patients with chronic pain and opportunities for therapeutic intervention.
The co‐existence of psychiatric disorders and substance misuse: working with dual diagnosis patients
Authors: Gafoor Mike , Hussein Rassool
Published: March 2003

The co‐existence of substance misuse and psychiatric disorders is often referred to by the term ‘dual diagnosis’. The health‐related problems associated with dual diagnosis has received growing attention by clinicians and researchers alike. Severely mentally ill patients who misuse drugs (prescribed and illicit) or alcohol have complex health and social needs. Mental health nurses have a key role to play in the early recognition and management of this group of patients. This paper examines the nature and extent of dual diagnosis and its implications for mental health nurses. It also addresses treatment strategies that are required to meet the needs of this cohort of patients.
‘The buck stops here’: accepting responsibility for learning and actions after graduation from a problem‐based learning nursing education curriculum
Authors: Biley Francis C. , Smith Keri L.
Published: March 2003

Despite the increased attention that problem‐based learning has received as an appropriate pedagogical technique for educating adults for professional practice, reports that evaluate the process are rare and usually relate to professions other than nursing. A study was undertaken in order to discover the graduates’ own perceptions of a problem‐based learning programme and its effectiveness in preparing them for the reality of their chosen profession. Twelve practising graduate nurses who had completed the programme were interviewed according to the ethnographic method. Three categories were identified from the data: ‘and all of a sudden…’, which describes the transition from PBL student to staff nurse; ‘not an unthinking assistant’, where the characteristics that the PBL graduates believe make them different from traditionally trained nurses are described; and ‘the buck stops here’, which describes the sense of personal responsibility that the graduates experience in terms of their learning and actions.
The professional identity of the nurse: concept analysis and development
Authors: Öhlén Joakim , Segesten Kerstin
Published: March 2003

The professional identity of the nurse: concept analysis and developmentThe aim of this paper is to highlight the concept of professional identity of the nurse in order to promote theoretical clarity and examine implications for nursing practice. A modification of the hybrid model for concept development was followed. Accordingly, the theoretical analysis of conceptualizations and corresponding theoretical frameworks were combined with empirical data gathered from the field, from semi‐structured interviews with eight registered nurses. The sampling was strategic and continuous. Personal and interpersonal dimensions and socio‐historical aspects of the concept were found in the literature review as well as in the interview data. Attributes, antecedents and consequences of professional identity of the nurse in relation to the identified dimensions were stated. The analysis ends with a comprehensive description of the concept. Further, the relations to the concepts of self‐esteem, self‐image, professionalism and professional self‐image, as well as professional function and roles of the nurse, are outlined. Finally, the importance of the developed concept is discussed, and suggestions for further research are presented.
The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland
Authors: Cowman Seamus
Published: March 2003

The approaches to learning of student nurses in the Republic of Ireland and Northern Ireland In recent years during a period of change in nurse education, there has been an increased interest in educational theory and nurse educators have examined and questioned the fundamental principles upon which the system of education is constructed. In nurse education it is likely that no single theory of learning can account for all aspects of learning and there are reflections of many learning theories in the nursing curriculum. The literature in the area of student learning is complex and wide ranging and is poorly represented in the nurse education literature. In recognition of a lack of understanding and clarity on learning approaches in nurse education during a period of unprecedented change in Irish and United Kingdom (UK) nurse education, this paper aims to highlight the importance of understanding student nurse learning. A study is described which investigated the approaches to learning of student nurses from the Republic of Ireland, who were receiving a traditional apprenticeship training, and student nurses from Northern Ireland in a Project 2000 programme. On comparative statistical analysis significant differences were identified between the two groups in their approaches to learning. It is concluded that students’ constructs of learning in nurse education are primarily dependent on their interpretation of the demands of the task, on assessment, teaching and the learning environment. The study provides nurse educationalists with important evaluative information from the students’ perspective. It suggests that the way forward is to identify the significant contextual factors influencing student learning and to incorporate them into the nursing curriculum. Such an approach will serve to focus the system on variability in the quality of learning rather than on stability in human attributes.
Nursing models: extant or extinct?
Authors: Tierney Alison J.
Published: March 2003

Although nursing models have always had their sceptics, they are now being subjected to more sustained criticism. Critiques have tended to focus mostly on the value of models for nursing practice but, increasingly, their place in nursing science is also being questioned. Reed believes that the growing disparagement of nursing models is symptomatic of the tensions between modernist and post‐modernist perspectives on nursing. Drawing its title from Reed's discussion, this paper — from the opposite side of the Atlantic — reflects on the original purpose of nursing models and critically examines their relevance now, using the first and best‐known British nursing model (the Roper‐Logan‐Tierney model for nursing) as the particular example for scrutiny. Although the popularity of this model is acknowledged, Fraser highlights the concern that it has not been tested. Can, and should, models be tested? This question is addressed in view of its apparent importance to the debate about whether or not nursing models have any continuing, legitimate role in theory or in practice.
Nurse practitioners and the problem of discounting
Authors: Martin Patricia D. , Hutchinson Sally A.
Published: March 2003

Nurse practitioners and the problem of discounting¶ Nurse practitioners (NPs) are key primary care providers in health care reform. The purpose of this paper is to discuss discounting, a social problem for NPs discovered in this grounded theory study. Discounting refers to behaviours directed towards NPs that they perceived as degrading. Data collection included open‐ended, in‐depth interviews on the nature of NP practice with 23 NPs, and 10 key members representing the Florida State Board of Nursing, Florida Nurses Association, American Nurses Association, and National Council of State Boards of Nursing. Excerpts that illuminated discounting were obtained from field notes about organizational documents, state legislative committee hearings, and professional NP association meetings. Data analysis using the grounded theory method revealed that NPs in this study struggled to establish their roles from a position of marginality in a context of conflict and negativity. NPs were subjected to social psychological and social structural discounting. This research serves to raise the consciousness of NPs with the hope that such awareness will facilitate personal and group action to combat discounting in their daily work and at local, state and national levels.
Nursing acute psychiatric patients: a quantitative and qualitative study
Authors: Higgins Ray , Hurst Keith , Wistow Gerald
Published: March 2003

Nursing acute psychiatric patients: a quantitative and qualitative study¶ Political and managerial attention has focused on the consequences of the failure of community services to provide effective care to a small number of people with severe mental illness. However, the nature and value of care in hospitals have received less scrutiny. This paper addresses deficiencies in our knowledge about nursing care in acute psychiatric wards. It reports the findings from a recently completed study for the United Kingdom Department of Health. Four key developments are identified which, together, pose significant problems for nursing in acute wards: the increasingly diverse patient mix in wards; the volume of administrative duties performed by nurses; the weakness of multidisciplinary team working; and inappropriate education. In conclusion, the challenges for managers and clinicians responsible for local policy and practice and, by extension, those at the centre responsible for such services, are examined.
A telephone intervention to reduce fatigue and symptom distress in mothers with difficult infants in the community
Authors: Thome Marga , Alder Beth
Published: March 2003

A telephone intervention to reduce fatigue and symptom distress in mothers with difficult infants in the community¶ The purpose of this study was to test the effectiveness of a telephone intervention to reduce fatigue and the resulting symptom distress of mothers in Iceland who reported having a behaviourally difficult infant of 2‐3 months of age. A sample of 78 mothers who reached distress criteria of depressive symptoms and parental stress was selected and randomly allocated in a controlled experimental study. In a brief intervention both maternal distress and infant difficulty were discussed. Results indicate a significant (P < 0·001) intervention effect on fatigue and its side‐effects. It is concluded that intervention by telephone can be effective with fatigued mothers caring for a difficult infant.
Post‐operative pain, nausea and vomiting: qualitative perspectives from telephone interviews
Authors: Waterman Heather , Leatherbarrow Brian , Slater Roger , Waterman Christine
Published: March 2003

Post‐operative pain, nausea and vomiting: qualitative perspectives from telephone interviews¶Previous studies on post‐operative pain, nausea and vomiting tend to be quantitative in method and focus on in‐patient or day case surgery. The objectives of this study carried out in one specialist eye hospital in England were to consider post‐operative pain, nausea and vomiting from a qualitative perspective. Fifty‐five patients undergoing general anaesthetic short‐stay ophthalmic surgery (orbital hydroxyapatite implantation) consented to participate in telephone interviews 8 days post‐surgery. The interviews lasted between 20 and 60 minutes. Data were analysed thematically and offer insight into varying experiences of pain, nausea and vomiting in hospital, on discharge and at home. Results indicate that not all patients were discharged home in optimum condition. The needs of post‐operative short‐stay patients should come before financial imperatives to vacate beds. Patient education and information giving is discussed in the light of the findings.
Maternal depression and child behaviour problems: a meta‐analysis
Authors: Beck Cheryl Tatano
Published: March 2003

Maternal depression and child behaviour problems: a meta‐analysis¶Children of depressed mothers are not only at risk for the development of psychopathology, but also for behaviour problems. A meta‐analysis of 33 studies was conducted to determine the magnitude of the relationship between maternal depression and behaviour problems in children 1 year of age and older. Substantive, methodological, and miscellaneous variables were extracted and coded by both the researcher and a research assistant. The initial inter‐rater agreement reached in coding these variables ranged from 85% to 100%. Effect sizes were calculated in three ways: unweighted, weighted by sample size, and weighted by quality index score. The mean effect size for the r index ranged from 0·29 when weighted by sample size to 0·35 when unweighted, indicating a moderate relationship between maternal depression and child behaviour problems. Children between the ages of 1–18 whose mothers were depressed displayed more conduct behaviour problems than children whose mothers were not depressed. The magnitude of this relationship covaried significantly with the predictors of sample size and quality index scores. Implications for future research are addressed.
Effects of psycho‐educational interventions on sexual health risks and psycho‐social adaptation in young adults with genital herpes
Authors: Swanson Janice M. , Dibble Suzanne L. , Chapman Linda
Published: March 2003

Effects of psycho‐educational interventions on sexual health risks and psycho‐social adaptation in young adults with genital herpes¶The purpose of this study was to test the outcomes of group psycho‐educational intervention (PEI) led by nurses on sexual health risks (knowledge, behaviour, disease burden) and psycho‐social adaptation (depression, mood states, self‐efficacy) in young adults with the chronic disease, genital herpes. Two hundred and fifty‐two young adults with symptomatic genital herpes participated in a randomized controlled trial (RCT). The intervention was participation in a three‐session group PEI facilitated by a nurse in the community. Participants completed questionnaires measuring sexual health risks (herpes knowledge, sexual risk behaviour, disease burden of patterns of recurrences of outbreaks of the disease), and psycho‐social adaptation (depression using the Beck Depression Inventory [BDI], mood states using the Profile of Mood States [POMS], and feelings of self‐efficacy for protection from sexually transmitted diseases [PSTD]) at induction into the study, and at 3 and 6 months. Participants were mainly employed, Caucasian, single women in their twenties (X = 27·1 years, SD = 4·3), with some college education; 23% of the sample were men. After controlling for baseline knowledge about genital herpes, the experimental group had significantly more knowledge than the control group at 3 and 6 months' post‐intervention. They also reported using condoms and spermicides to prevent the spread of genital herpes more often than did the control group. The implications for nurses in the community include the following: (a) PEI is an intervention that can be used by nurses in the community with a high‐risk population; (b) group intervention is a viable treatment for people with a highly stigmatized, chronic sexually transmitted disease (STD); and (c) further testing of the use of PEI by nurses in the community with other high‐risk populations is needed.
Attitudes towards, and knowledge of, clinical effectiveness in nurses, midwives, practice nurses and health visitors
Authors: Upton Dominic , Psychol
Published: March 2003

Attitudes towards, and knowledge of, clinical effectiveness in nurses, midwives, practice nurses and health visitors¶ The dual concepts of evidence‐based practice and clinical effectiveness have become ever more important for nurses, midwives and health visitors in recent years. In order that suitable initiatives can be derived and future policy shaped and evaluated it is important that the current level of knowledge and attitudes towards these concepts are recorded. The current study set out to examine these variables in a large, representative sample (n = 370, response rate = 74%) of nurses, midwives and health visitors. Results indicated that although a positive attitude towards evidence‐based practice exists, individuals consider themselves to be lacking in certain key skills. Specifically, these appeared to be related to research‐based skills. However, despite this, respondents indicated a large take up of evidence‐based practice, although this may have been greater were it not for the considerable clinical workload. The necessity for greater dissemination of key research principles to nurses, midwives and health visitors by members of their own profession is emphasized.
Health and illness beliefs of Greek Cypriots living in London
Authors: Papadopoulos Irena
Published: March 2003

Health and illness beliefs of Greek Cypriots living in London

This paper describes some of the findings of a qualitative study into the health and illness beliefs of Greek Cypriots living in London. Data were collected through group and individual in‐depth interviews and were analysed using the grounded theory approach of constant comparison and saturation. Two of the six themes which were identified are discussed in this paper. The findings provide the reader with important insights into Greek Cypriots' beliefs of health and illness. The paper argues that the understanding of such beliefs from a cultural perspective is vitally important for all those involved in the provision of health care to this group.
Patients’ views on quality of care: do they merely reflect their sense of coherence?
Authors: Larsson Bodil Wilde , Larsson Gerry
Published: March 2003

Patients’ views on quality of care: do they merely reflect their sense of coherence?

The aim was to explore the relationship between patients’ perceptions of the quality of care and their sense of coherence. The sample consisted of 782 Swedish in‐patients at a gynaecological, a medical, an orthopaedic, and a surgical department. The median age was 59 years and 55% of the patients were women. Data were collected using the Quality from the Patient’s Perspective (QPP) Questionnaire and the Sense of Coherence Questionnaire. The QPP consists of 61 items designed to measure the following four quality dimensions: the medical‐technical competence and the degree of identity‐orientation in the actions of the caregivers, the physical‐technical conditions and the socio‐cultural atmosphere of the care organization. Each question is posed in two different ways in the QPP; one measures perceived reality of the item in question and one the subjective importance the patient ascribes to it. Results showed that patients’ ratings of perceived reality covaried systematically with their sense of coherence. This was particularly the case on questions rated by experts to be more abstract and emotionally loaded. Patients’ ratings of the subjective importance of the items were weakly related to their sense of coherence. The results are discussed in terms of negative affectivity and culturally shared ideals regarding quality of care.
Clinical guidelines in nursing, midwifery and the therapies: a systematic review
Authors: Thomas  , McColl  , Cullum  , Rousseau  , Soutter
Published: March 2003

Clinical guidelines in nursing, midwifery and the therapies: a systematic review

Background While nursing, midwifery and professions allied to medicine (PAMs) are increasingly using clinical guidelines to reduce inappropriate variations in practice and ensure higher quality care, there have been no rigorous overviews of their effectiveness in relation to these professions. We identified 18 evaluations of guidelines which met established quality for evaluations of interventions aimed at changing professional practice. This paper describes characteristics of guidelines evaluated and the effectiveness of different dissemination and implementation strategies used. Methods Guideline evaluations conducted since 1975 which used a randomized controlled trial, controlled before‐and‐after, or interrupted time‐series design, were identified using a combination of database and hand searching. Findings It is mostly impossible to tell whether the guidelines evaluated were based on evidence. The most common method of guideline dissemination was the distribution of printed educational materials. Three studies compared different dissemination and/or implementation strategies: findings suggest educational interventions may be of value in the dissemination of guidelines and confer a benefit over passive dissemination.
The psychometric properties of the diabetes management self‐efficacy scale for patients with type 2 diabetes mellitus
Authors: Bijl Jaap van der , Poelgeest‐Eeltink Ada van , Shortridge‐Baggett Lillie
Published: March 2003

This article summarizes the development and validation of a scale to measure the level of self‐efficacy of patients with type 2 diabetes mellitus. Self‐efficacy is described as people’s belief in their capability to organize and execute the course of action required to deal with prospective situations. This self‐efficacy scale was developed based on the self‐care activities these patients have to carry out in order to manage their diabetes. The following psychometric properties of this scale were established: content validity, construct validity, internal consistency and stability. The original scale contained 42 items. A panel of five experts in diabetes and four self‐efficacy experts evaluated the original scale two times for relevance and clarity. This content validity procedure resulted in a final scale which consisted of 20 items. Subsequently, patients with type 2 diabetes were asked to complete this 20‐item scale and further tests were done with the 94 usable responses. Factor analysis identified four factors, all of which were related to clusters of self‐care activities used to manage diabetes which comprised this scale. The internal consistency of the total scale was α=0·81 and the test–retest reliability with a 5‐week time interval was r=0·79 (P < 0·001).
An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer
Authors: Balneaves Lynda G. , Long Bonita
Published: March 2003

An embedded decisional model of stress and coping: implications for exploring treatment decision making by women with breast cancer

Treatment decision making by women with breast cancer has been recognized to be an inherently stressful process. However, past decisional theory and research has failed to fully elucidate the personal, transactional and relational nature of choice behaviour. The purpose of this paper is to explore an embedded decisional model of stress and coping that locates key assumptions of Janis and Mann’s conflict‐theory model (CTM) of decision making within Lazarus and Folkman’s transactional framework. Through combining decisional and stress and coping theories, a model is developed that addresses the theoretical limitations of the CTM and provides greater specificity within decision‐making research. The paper examines the complexity of treatment decision making within the context of the constructs of causal antecedents, primary appraisal, secondary appraisal, coping and adaptational outcomes. Examples specific to women with breast cancer are provided to illustrate the potential application of the embedded model. The implications of this inclusive and comprehensive decisional theory for future knowledge development and research in the area of treatment decision making are also discussed.
Patients’ evaluation of pain and nurses’ management of analgesics after surgery. The effect of a study day on the subject of pain for nurses working at the thorax surgery department
Authors: Dahlman Gull‐Britt , Dykes Anna‐Karin , Elander Gunnel
Published: March 2003

Patients’ evaluation of pain and nurses’ management of analgesics after surgery. The effect of a study day on the subject of pain for nurses working at the thorax surgery department

The aims of this investigation were: to describe patients’ evaluation of pain and the treatment of pain after thorax surgery via sternotomy; to repeat the evaluation with another group of patients following a study day for nurses, featuring pain and pain treatment; and to examine whether the study day influenced the nurses in their treatment of pain. The investigation included daily evaluation of pain using a visual analogue scale (VAS), and an interview with the patients before discharge, where they were asked to review their experience of pain and its treatment. The nurses on the thorax surgery ward and on the intensive care unit (ICU) completed a questionnaire before and after the study day. Finally, a retrospective study of the case notes of the patients taking part was carried out. The results of the investigation showed a low assessment of pain by most patients during the daily evaluation. Asked to recall their pain when interviewed, the rating was higher. A small group of patients had more evident pain than others. When administering opiates the ICU nurses often chose a lower dose than the standing order prescribed. After the study day the nurses gave larger doses of intravenous opioids and the patients experienced less pain.
Vital signs and nurses’ choices of titrated dosages of intravenous morphine for relieving pain following cardiac surgery
Authors: Chuk Peter Kai‐Cheung
Published: March 2003

Vital signs and nurses’ choices of titrated dosages of intravenous morphine for relieving pain following cardiac surgery

Postoperative pain, if unrelieved, will impede patients’ recovery. A theoretical model of factors which influence nurses’ choices of titrated dosages of intravenous (IV) morphine was constructed for this study. This study aimed to examine whether or not a patient’s vital signs would influence nurses’ choices of titrated dosages of IV morphine for relieving pain following cardiac surgery. A survey design with a vignette and questionnaire method was used to collect data. The vignette developed by McCaffery & Ferrell was modified and adapted for this study. It described the pain reports and vital signs of two patients on postoperative day 1 following cardiac surgery. Convenience sampling was used to seek voluntary participation from 29 registered nurses working in the cardio‐thoracic intensive care unit of a private hospital in Sydney, Australia. A protocol of the unit allowed nurses to titrate IV morphine against the pain of patients following cardiac surgery. The results showed that the pain assessment of the two patients in the vignette documented by the nurses were not consistent. The titrated dosages (a bolus dosage and a maintenance dosage) chosen by the nurses for the patient with slightly elevated vital signs differed significantly from the titrated dosages chosen by the same group of nurses for another patient with vital signs at the lower end of the stable range (t=3·33, d.f.=25, P < 0·01 for a bolus dosage and t=3·73, d.f.=25, P < 0·01 for a maintenance dosage). Different risk factors were stated by the nurses in titrating the bolus and maintenance dosages of IV morphine. The importance of accepting patients’ verbal reports of pain as well as the provision of optimal dosages of IV morphine for pain relief is highlighted. A disadvantage of using a vignette and questions method is that the patients’ clinical status is somewhat unreal. Further studies, however, were also recommended.
Testing a rating scale of video‐taped consultations to assess performance of trainee nurse practitioners in general practice
Authors: Bond Senga , Beck Sian , Cunningham William F. , Derrick Sally , Healy Barbara , Holdsworth Sue , Lawson Justin , Rawes Geoffrey , Sargeant Jean , Steen Nick
Published: March 2003

Testing a rating scale of video‐taped consultations to assess performance of trainee nurse practitioners in general practice

Background: Nurse practitioners (NPs) in the United Kingdom are taking on some of the consultation work previously done by general practitioners (GPs) without there being any established professional standards that they must achieve before doing so. There is a need to develop and test methods of assessing their consultation performance for reasons of professional accreditation and patient safety. Aims: 1. To make independent summative assessments of trainee nurse practitioners’ (TNPs) consultation performance. 2. To assess the validity and reliability of an existing video‐taped assessment tool. Method: Four TNPs taking part in the EROS (extended roles of staff) study video recorded seven or eight consecutive consultations with typical patients during one surgery. Each consultation was rated nine times by members of a panel comprising eight independent GP trainers, four NPs and the GPs and TNPs in the EROS practices. A rating scale developed by Cox & Mulholland was used for the purpose. Results: Eight of the 37 items and four consultations had more than 10% missing data, mean = 7·7 items per rater. Factor analysis yielded a single factor solution explaining 32·6% of the variance and indicated that items could be summed to provide a single score. Internal consistency was high, alpha coefficient = 0·92. Individual differences between raters in scoring consultations were taken into account in providing a score for each consultation. Scores obtained were found to cluster at the positive end of the distribution indicating a high level of performance. Greater differences were found between scorers than between consultations. Conclusions: This instrument is appropriate for scoring NP consultations and this small sample was rated as showing a uniformly high standard of performance. Some items could be deleted since they do not feature in the range of consultations currently performed. If this or a similar tool was to be adopted more widely for summative rating purposes then it should be tested rigorously for validity and reliability, training should be given to raters and criteria provided by which to make judgements.
Evaluation of an innovative curriculum: nursing education in the next century
Authors: Ben‐Zur Hasida , Yagil Dana , Spitzer Ada
Published: March 2003

Evaluation of an innovative curriculum: nursing education in the next century

The present research focused on an interim evaluation of a new nursing curriculum made by first‐ and second‐year undergraduates. Study 1 examined the assessments made by 90 students of the new, actual programme of their studies, as well as an ideal one, on 21 bipolar criteria reflecting the developing changes in health care practices and higher educational processes in western society. The results of study 1 indicated that students perceived the actual programme as compatible with health care changes, but lacking in terms of the learning process. Study 2 investigated the same assessments among 105 registered nurses who evaluated the traditional nursing programme under which they were trained as well as an ideal one. The results of study 2 showed that registered nurses perceived past curricula as lower than the ideal on both health care and process of learning. The results of this interim evaluation imply that the new nursing curriculum follows health care trends, but a shift in the educational process is required.