bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of communications in nursing care for elderly people: a review of the literature
Authors: Caris‐Verhallen Wilma M.C.M. , Kerkstra Ada , Bensing Jozien M.
Published: March 2003

Communication in nursing care is an important topic assessing the specific needs of elderly patients and providing nursing care that is tailored to the individual patient's needs. In this review of the literature, we describe the role attributed to communication in theoretical nursing models and we report how research in communication in nursing elderly patients has taken place over the last ten years. It appears that since the eighties there has been an increase in observation studies into nurse‐patient communication. There still is, however, a lack of observation instruments to do justice to the interactive nature of nurse‐patient communication. Special attention should be paid to reliability and validity.
Nursing research: our world not theirs?
Authors: Mulhall Anne
Published: March 2003

From both a theoretical and a practical standpoint the research‐practice gap in nursing is as wide as ever. This, despite an increasing literature on the subject and a gamut of practical initiatives aimed at bridging the divide. This paper explores the two worlds of practice and research and the factors contingent on them. It suggests that academic researchers. These different cultures need to be recognized and made more explicit within current writing. The discordance between the worlds of research and practice forms the basis for extending the discussion to consider the principal conduit of research, i.e. the written world. The question is raised as to why research is typically reported as a seamless account, bereft of any information beyond details of the research process as it is currently legitimised within nursing ideology. Finally consideration is given to strategies which might facilitate the‘outing’ of both researchers and their research.
Integrative nursing research — an important strategy to further the development of nursing science and nursing practice
Authors: Kirkevold Marit
Published: March 2003

In this paper it is argued that integrative nursing research has a great potential for clarifying the theoretical perspective and substance of the nursing discipline as well as making research‐based knowledge more accessible to clinical nurses. Two general kinds of integrative research are introduced and illustration provided of how these have been practiced with in nursing. Significant strengths and weaknesses in current practice is highlighted. It is argues that nursing should pay more attention to this kind of research, specifically in terms of developing sound methodological approaches and overcoming the traditional schism between empirical and theoretical research. Sound integrative nursing research promises to improve the development of nursing science as well as making the products of nursing research more easily available for clinical nurses.
What do registered nurses and midwives fell and know about research?
Authors: McSherry Robert
Published: March 2003

This research is in the form of a quantitative study aimed at discovering‘What registered nurses and midwives feel and know about research'. Data were gathered on a fixed response questionnaire, with open spaces for comments to support the results with written factual qualitative evidence. The questionnaire was directed towards obtaining results associated with‘Attitudes’ towards research;‘Understandings’ about research, and‘Obstacles’ to implementing research. A sampling technique was used in which a total population of 765 registered nurses and midwives working in this district general hospital were involved in the study. The results demonstrate(inferential statistics chi‐square and correlation tests) that registered nurses and midwives are largely in agreement with research based practices, although understanding about research in minimal and dependent on grade, length qualified, shifts and numbers of hours worked.
When the patient causes the problem: the effect of patient responsibility on the nurse‐patient relationship
Authors: Olsen Douglas P.
Published: March 2003

A positive connection to the patient as a person within a nurse‐patient relationship provides the context for ethical treatment. The relationship characterized by caring concern for the patient is also a clinically effective resource. Ethical analysis shows that a nurse's caring and other health care resources should not be allocated based on the degree to which the patient is responsible for the clinical condition. Interviews were conducted with 51 nursing students and nurses about their feelings toward hypothetical patients. The theme of ‘patient responsibility for causing the clinical problem affecting the nurse‐patient relationship’ was identified and responses were categorized according to how the theme was illustrated. The categorization of the responses was validated by two nurse experts. When asked to briefly compare reactions to the vignettes 25 (49%) of the participants connected their feelings towards the patient with their perception of the patient's responsibility.
Research: promoting positive attitudes through education
Authors: Med Jane Dyson
Published: March 2003

This paper outlines a study which was undertaken to explore the relationship between nurses' attitudes towards research and their educational experience. A Likert‐type attitude questionnaire, using statements derived from themes emerging within the literature, was used prior to, and following, 61 students' learning experiences on research modules at diploma and degree levels. Teaching and learning strategies adopted within the modules focused on overcoming some of the main barriers to utilization of research findings identified within the literature. The results obtained identified a significant shift towards more positive attitudes to research following the modules. The conclusions exhort nurse educators to not only include research into curricula, but also to reflect on the teaching and learning strategies adopted.
Are children given insufficient pain‐relieving medication postoperatively?
Authors: Hamers Jan P.H. , Abu‐Saad Huda Huijer , Van Den Hout Marcel A. , Halfens Ruud J.G.
Published: March 2003

The literature often suggests and assumes that children are under‐medicated postoperatively. A review of the literature leads to the conclusion that only a few studies answer the question of whether children’s pain is relieved insufficiently. The lack of consensus on expected pain intensity after surgery and caution about prescribing analgesics could explain why analgesics are often prescribed on a pro re nata (prn) basis. Prescription on a prn basis, in fact, means that the nurse makes the decision whether or not an analgesic should be administered. Some studies suggest, however, that nurses under‐medicate children and that postoperative pain is relieved insufficiently. In some situations, nurses under‐estimate the child’s pain, while in others, nurses’ attitudes, beliefs and knowledge regarding pain relief strategies play an important role. On the basis of this review of the literature standard prescription of pain medication instead of prn is recommended. Furthermore, research on the incidence and prevalence of pain in children and on the effectiveness of analgesic administration postoperatively is warranted.
Critical thinking ability and clinical decision‐making skills among senior nursing students in associate and baccalaureate programmes in Korea
Authors: Shin Kyung Rim
Published: March 2003

This study compared Korean senior nursing students enrolled in associate degree programs (n=119) and baccalaureate programs (n=115) on measures of critical thinking ability and clinical decision‐making skills. Samples were drawn from three associate degree programmes and four baccalaureate programmes accredited by the Korean Ministry of Education. ‘Critical thinking ability’ was determined by the Watson–Glaser Critical Thinking Appraisal and ‘clinical decision‐making’ in nursing was measured by the Nursing Performance Stimulation Instrument. Independent sample t‐tests comparing the associate degree group (mean score 41·98) and baccalaureate group (mean score 47·22) on the critical thinking measure yielded significant mean differences favouring the baccalaureate group. The baccalaureate group (mean score 26·53) also scored significantly higher than the associate degree group (mean score 23·49) on clinical decision‐making. Within the total sample (n=234) the relationship between critical thinking and clinical decision‐making was weak but significant (r=0·19, P=<0·003).
Nurses’ responses to severity dependent errors: a study of the causal attributions made by nurses following an error
Authors: Meurier  , Vincent  , Parmar
Published: March 2003

Attribution theory attempts to understand how people explain events and their own role in them, particularly events which are unusual or unpleasant. Based on previous studies on attributions, it was suggested that nurses would make more external attributions (i.e. blaming others or the environment) following an error with a serious outcome than one with a non‐serious outcome. This would in turn suggest that they might be less likely to respond constructively and learn from serious errors. Sixty nurses were approached for this study. They were divided into two groups. One group (30 subjects) completed a questionnaire on the responses to a description of an error with a non‐serious outcome and the second group (also 30 subjects) responded to questions to an identical error but with a serious outcome. The findings from this study indicated that nurses behaved in an atypical manner in response to making an error. Although both groups of nurses tended to make slightly more internal attributions for the error, indicating that they are likely to take responsibility for their error, those nurses in the serious outcome condition blamed themselves more for the error. This may be due to the strong professional ethos which exists amongst nurses that expects them to take responsibility for their actions. This would inevitably include any error that they may make in the course of giving care. The conclusion that can be drawn is that nurses might be quite receptive to making constructive changes in their practice following an error, provided this situation is managed properly.
The clinical skills of community psychiatric nurses working with patients who have severe and enduring mental health problems: an empirical analysis
Authors: Devane Sheila M. , Haddock Gillian , Lancashire Stuart , Baguley Ian , Butterworth Tony , Tarrier Nicholas , James Abigail , Molyneux Phillip
Published: March 2003

This study describes the use of reliable scales to rate the clinical skills of mental health nurses when working with individuals and families with severe mental health problems. The Cognitive Therapy Scale and the Schizophrenia Family Work Scale were adapted for the study and were shown to have good inter‐rater reliability when assessing audio‐taped interviews carried out by mental health nurses during their usual course of work with patients with severe mental health problems and their families. The sample of mental health nurses studied were shown to have significantly better general therapy skills than specific cognitive therapy technical skills. The implications for training are discussed.
Severe mental illness, statutory supervision and mental health nursing in the United Kingdom: meeting the challenge
Authors: Wells John S.G.
Published: March 2003

Within the United Kingdom a combination of limited resources and public fears about the behaviour of mentally ill people living in the community has led the government to prioritize those with severe mental illness. In support of this legislation has been passed which provides for those mentally ill deemed ‘at risk’ to be supervized in the community against their will. This supervisory role will be mainly undertaken by mental health nurses. Through examination of relevant British and American literature, this paper argues that mental health nursing at a national level lacks a defined role which the new legislation may provide, thereby enhancing the profession’s voice in overall mental health policy formulation. Such a role, however, also poses important questions for mental health nurses’ practice, their relationships with users, colleagues and the wider society. Such issues may have unforeseen negative consequences for users. It is argued that the legislation will pose important dilemmas for mental health nurses in these domains. It is argued that a proactive research agenda needs to be established which is relevant and of use to practitioners when confronted with issues in their supervision role. Areas for future research are suggested.
Work and family role juggling and mood states of Hong Kong public health nurses with children
Authors: Shiu Ann T. Y.
Published: March 2003

This study aims to investigate the daily mood states of public health nurses (PHNs) in managerial roles with children in Hong Kong, as a result of multiple role juggling (i.e. simultaneously attending to demands of different roles) using the experience sampling method. Convenience sampling was used to recruit 20 subjects. A watch was worn that beeped at six random times each day for 7 days as a signal to complete an experience sampling diary. PHNs on average responded to 34 signals (80%) to complete the experience sampling diaries. Two major findings provide the focus of this paper. First, results show that PHNs had minimal inter‐role juggling between work and family as compared with previous studies in the United States. Cultural factors, sequentially dealing with family and work issues, having a domestic maid or a relative to see to household chores as well as strong spouse support are suggested as the reasons. These results have implications for nursing management and nursing practice. Second, the results also reveal PHNs as having an overall flat affect. It is suggested that PHNs may be using a ‘calm and detached’ coping style for occupational stress. This coping style has implications on the PHNs’ emotional health as well as nurse‐client relationships.
The distribution of community psychiatric nurses in England: are they where they should be?
Authors: Buck David , Smith Kirsteen
Published: March 2003

Given the substantial increase in the numbers of community psychiatric nurses (CPNs) in England in the last 15 years this paper asks the question: is CPN activity where it should be? In other words is activity distributed around the country according to need? Various indicators of need are suggested including population age structure, deprivation indices and suicide rates. We find no evidence — based on information from scatterplots, Spearman correlations and more innovative measures of inequality — that CPNs are distributed according to need. If this is confirmed by further research it is cause for alarm — CPNs should be where they are most needed.
Acts, omissions, intentions and motives: a philosophical examination of the moral distinction between killing and letting die
Authors: Begley Ann‐Marie
Published: March 2003

Acts, omissions, intentions and motives:a philosophical examination of the moral distinction between killing and letting die Health care professionals frequently justify moral decisions by appealing to the acts and omissions distinction and the principle of double effect. These principles are often quoted and criticised in the nursing literature, particularly in relation to active and passive euthanasia. Authors are, however, inclined to acknowledge the fact that they are a philosophical minefield, but fall short of providing a substantial critical analysis. Those who uphold the acts and omissions distinction claim that we are morally less responsible for our omissions than for our acts. The principle of double effect suggests that there is a moral distinction between direct and indirect intention and that we are morally less responsible for that which we intend indirectly. This article offers an examination of these often quoted, but sometimes little understood, principles and it is hoped that it will serve as a basis for debate. Since the intention is to challenge assumptions which can lull us into believing that our moral decisions can be justified by appealing to principles such as these, it is necessary to examine them critically and to go beyond a superficial grasp of the implications of such distinctions. There is a tendency to appeal to the acts and omissions doctrine and the principle of double effect in life and death situations such as euthanasia, infanticide and abortion, but are they valuable tools which should be used in moral decision making, or are they so flawed that they can seriously mislead us when it comes to hard cases? The conclusion reached in this paper is that there is no significant moral difference between an act and an omission, particularly within the context of killing and letting die, and that the principle of double effect encourages hypocrisy rather than honesty.
Health care reform and the transformation of nursing in Hong Kong
Authors: Wong Frances Kam Yuet
Published: March 2003

Health care reform in Hong Kong in the 1990s has brought about dramatic change to the nursing discipline. This paper reports an ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform. In the study, the restructuring of nursing work, its associated dynamics and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to be subject to medical dominance and are under management control. The emphasis on cost‐effective care has however, fostered qualified nurses to claim more ownership of their professional judgement and autonomy. The health care reform has confirmed the status of two newly established groups of nurses, the nurse specialists and nurse managers. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study, needs to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.
Providing appropriate information to patients and carers following a stroke
Authors: Wiles Rose , Pain Helen , Buckland Sarah , McLellan Lindsay
Published: March 2003

Providing appropriate information to patients and carers following a stroke This paper reports on a study which sought to identify the information needs of patients and their informal carers at various stages post‐stroke with the aim of developing a database from which individualized information packages could be provided. The study used in‐depth qualitative interviews with a total of 31 interviewees (both patients and carers) to explore information needs at three different points post‐stroke: during hospitalization; up to 1 month post‐discharge; and 2–12 months post‐discharge. The information needs identified related to: recovery, treatment and prognosis; practical caring tasks; social activities; and resources available in the community. The study indicated that the information needs of patients and carers following stroke are not currently met and a desire for individualized information was identified. It is concluded that it may not be possible to meet patients’ and carers’ desire for information about recovery and prognosis but that a customized database covering the other areas highlighted by this study would facilitate improved information provision. It is anticipated that the process of providing such packages would improve communication within the rehabilitation team.
Farmers’ occupational health: cause for concern, cause for action
Authors: Gerrard Catherine Elizabeth
Published: March 2003

This study examines occupational health and safety provision from farmers’ perspectives, to address the question ‘Are farmers’ health and safety needs being met?’ Given that farmers encounter a variety of health and safety risks in the course of their daily work, and that available statistics clearly indicate they are a high risk group, a review of the literature suggests that this area has attracted little research attention. No study has critically examined the system of occupational health and safety provision for farmers and no attempts have been made to elicit farmers’ perspectives on the subject. A telephone survey using a questionnaire divided into four sections, involving a random sample of 150 farmers from the counties of Cumbria, Cheshire and Cambridgeshire in England, found that farmers considered the system of occupational health and safety provision to be inadequate and that their occupational health and safety needs were not being met. Recommendations for improvements are made based on the results of the survey.
Nurse characteristics and attitudes to active voluntary euthanasia: a survey in the Australian Capital Territory
Authors: Kitchener Betty A.
Published: March 2003

While surveys of Australian nurses’ attitudes to active voluntary euthanasia (AVE) have found that the majority are in favour, there may be important differences between subgroups of nurses. This paper investigates the role of the following nurse characteristics on nurses’ attitudes to AVE: age, gender, religion, amount of contact with terminally ill patients, area of specialty, and degree of interest taken in the issue of AVE. A postal survey on AVE was carried out in late 1996 of 2000 randomly selected registered nurses from the Australian Capital Territory. Responses were received from 1218 nurses (61%). The survey included a question asking whether the law should be changed to allow doctors to take active steps to bring about a patient's death under some circumstances. Overall, 69% of respondents agreed that the law should be changed. Those nurses who were more likely to agree were under the age of 40 years, agnostic, atheist or of the Anglican religion, to have less contact with terminally ill patients, to work in the area of critical care or mental health, and to take less interest in the issue of AVE. Palliative care nurses were the only subgroup without a majority in favour (33%). There is other evidence in the euthanasia literature, that nurses and doctors are less in favour of AVE than the general public. Taken together with the present findings, it can be concluded that attitudes towards AVE are more favourable in people who have less contact with the terminally ill.
Can paternalism be justified in mental health care?
Authors: Breeze Jayne
Published: March 2003

Whilst current mental health care provision has made a substantial move towards empowering its users it retains a paternalistic approach with legislation such as ‘supervised discharge’. This apparent paradox creates potential dilemmas for the mental health nurse and suggests there is a need for critical analysis of the justification for paternalism within mental health care. This paper discusses the conflict between the ethical principles of autonomy and beneficence which paternalism invokes. On reviewing the ethical theories of deontology and utilitarianism it appears that a prerequisite for autonomy is rationality, the absence of which provides justification of ‘weak’ paternalism. However, this paper contends that the assessment of rationality has the potential to be subjective and value laden. The use of competency tests can also be problematic by masking the essential ethical dilemma that is intrinsic to such assessment. A case study is used to illustrate the strengths and weaknesses of the competing arguments. This leads to the conclusion that whilst there may be some situations when the use of paternalism can be justified in mental health care, it should be exercised with caution. When there is disagreement between nurse and patient on what is considered to be in the patient’s best interests, it should not be assumed that the patient is wrong or irrational.
Factors related to successful breast feeding by first‐time mothers when the child is 3 months old
Authors: Tarkka Marja‐Terttu , Paunonen Marita , Laippala Pekka
Published: March 2003

Factors related to successful breast feeding by first‐time mothers when the child is 3 months old¶ The aim of the reported study was to gain information on those factors which contribute to the success of breast feeding in first‐time mothers when the child is 3 months old. The study is part of a wider longitudinal project which follows‐up the growth to motherhood of first‐time mothers in Finland over a period of 8 months postpartum. Data collection was by questionnaires distributed between March and September 1995. The sample comprised 271 first‐time mothers. The mothers completed the questionnaires when their infants were 3 months old. The analysis applied was a polychotomic logistic regression analysis. When the child was 3 months old those mothers who perceived themselves competent as mothers and who felt that society appreciated motherhood appropriately coped better with breast feeding. Also, those mothers who had worked at home prior to the birth of the child and who felt that breast feeding was important in motherhood coped better with breast feeding. Those mothers whose state of mind was more balanced after the birth coped better with breast feeding. The more affirmation the mother received from members of her social network the better she coped with breast feeding. The research findings suggest that factors influencing successful breast feeding in first‐time mothers at 3 months postpartum are the mother’s own resources and attitude to breast feeding, support from the social network and the current appreciation of breast feeding in society.
Dimensions of health‐related quality of life in persons living with HIV disease
Authors: Sousa Karen H. , Holzemer William L. , Bakken Henry Suzanne , Slaughter Robert
Published: March 2003

Dimensions of health‐related quality of life in persons living with HIV disease¶ The purpose of this secondary analysis was to test empirically the influence of biological and physiological variables, symptom status, functional status, general health perceptions, characteristics of the individual and characteristics of the environment on overall quality of life in persons living with HIV disease. Path analysis, using multiple linear regression, was used to examine the fit between a health‐related quality of life (HRQOL) theoretical model and data from a sample of 142 persons with an AIDS diagnosis. Thirty‐two per cent of the variance in overall quality of life was explained by the HRQOL model with symptom status having the greatest influence (β =−0·237, R2Y×2 = 5%). This analysis suggests that symptom status, functional status and general health perceptions are key dimensions of HRQOL. With a focus on prevention, health promotion, symptom management, and the alleviation of acute and chronic illness effects, HRQOL may be appropriate for capturing the outcomes of nursing interventions.
Measuring patient satisfaction with nursing care: experience of using the Newcastle Satisfaction with Nursing Scale
Authors: Walsh Mike , Walsh Anna
Published: March 2003

Measuring patient satisfaction with nursing care: experiences of using the Newcastle Satisfaction with Nursing Scale¶ Patient satisfaction with care has frequently been used as a measurement of quality, especially in attempts to demonstrate the benefits of changes in nursing practice. Unfortunately such attempts have frequently failed as patient satisfaction ratings have lacked sensitivity, consistently achieving very high scores. They have also failed to isolate the nursing component from the whole health care experience. The Newcastle Satisfaction with Nursing Scale (NSNS) has been developed after extensive research work as an attempt to establish reliable and valid measures of patients' experiences of and satisfaction with nursing care. This study evaluated the use of the NSNS in practice and found that it was readily understood by patients and easily administered by clinical staff. However, several lessons were learnt which could help its administration. The results demonstrated a very high degree of satisfaction with nursing care which left the discriminatory ability of the scale open to question, although its potential benefits in standard setting were demonstrated. Further evaluative studies are needed if the potential benefits of the NSNS are to be fully realised.
Social support and antenatal clinic attendance among Thai pregnant women in Hatyai, a city in southern Thailand
Authors: Jirojwong Sansnee , Dunt David , Goldsworthy Diane
Published: March 2003

Social support and antenatal clinic attendance among Thai pregnant women in Hatyai, a city in southern Thailand¶ Many studies in western countries have shown that persons who have a high level of social support are likely to have better health behaviours, including use of preventive health services, than those who have low support. The present study aims to investigate the impact of level of social support among Thai pregnant women on their attendance at antenatal care (ANC) clinics. The study was conducted in Hatyai, a city in Southern Thailand, between 1990 and 1991. Relationships between various measures of the women's social support and their use of antenatal clinics were assessed. Open ended and closed ended questions were used to gather information relating to these women's level of social support, including the number of supporters and their age, the percentage of females among the supporters, the sources of support (spouse, kin, friend and health professionals), the frequency of contact, the types of support and the sufficiency of support. Social support indices were constructed: sources of support indices, a social network index, a subjective support index, and a social support index. One hundred and seventy‐seven postpartum women were interviewed at their homes. Spouses, relatives and friends were important sources of the four principle types of support, namely emotional, instrumental, information and appraisal supports. Less than 10% of the women studied identified health personnel as providing support. The majority of supporters were women who had daily, face‐to‐face communication with the women studied. Approximately 76% of the women studied had sufficient support. The majority of supporters, except health personnel, provided all four types of support. Only 47% of the women studied made four or more antenatal clinic visits as recommended by the Thai government. No significant relationship between the indices of social support and the use of ANC clinics was identified. The Thai extended family by its nature generates large numbers of supporters. Little variation in support levels among all the women therefore occurred. Support to the women could have positive and/or negative effects on the women's use of ANC clinics. It was concluded that in Thai communities, social support is not an important determinant of the use of ANC clinics and the indices of social support were not the most appropriate techniques to use in the communities.
Conceptualizing disability in nursing: some evidence from students and their teachers
Authors: Scullion Philip A.
Published: March 2003

Conceptualizing disability in nursing: some evidence from students and their teachers¶This paper reports on part of a larger study which examined the nature and influence of a pre‐registration nursing curriculum on the preparation of student nurses to work with disabled people. Following case study methodology it focuses on how `disability' is conceptualized by teachers and adult branch students involved in a particular curriculum. Definitions and working assumptions concerning disability held by nurses are likely to influence ways in which disabled people are cared for. The experiences of disabled people suggest that their contact with nurses is demeaning and disempowering. Some disabled people support a reconceptualization of `disability', from a largely medical perspective to one which embraces its social dimensions. The results of thematic analysis of data from 16 semi‐structured interviews are reported; these support the need for the social dimensions of disability to be given greater emphasis within nursing. Disability was found to be conceptualized as a form of deviation, a condition of dependency or a notion which defies definition. Language associated with disability was also highlighted as an area of concern. Implications for practice and education are alluded to in the light of increasing recognition of disability as an equality opportunity issue.
Nursing leadership: influencing and shaping health policy and nursing practice
Authors: Antrobus Sue , Kitson Alison
Published: March 2003

Nursing leadership: influencing and shaping health policy and nursing practice¶ The leadership discourse in the United Kingdom has to date been concerned with professional issues and as a result has focused upon developing nurses and nursing. This paper reports on the findings of a research study which examined the broader socio‐political factors impacting upon nursing leadership. The study forms an integral part of the Royal College of Nursing's leadership programme. The principal aim of the research was to examine critically contemporary nursing leadership within the context of health policy. An ethnographic approach was used. Informal semi‐structured interviews were undertaken with a purposive sample of 24 leaders who were recognized for their effectiveness in leading nursing. Data were analysed for themes. The main themes are presented and discussed here. The findings of the study question the political success which the internally focused nature of leadership has had for the profession. Nursing and therefore nursing leadership is shaped dramatically by the impact of politics and policy. The research discovered that in recognition of this, contemporary nursing leadership has both an internal and an external focus. That is, effective nursing leadership currently is a vehicle through which both nursing practice and health policy can be influenced and shaped. The research also identified the profile of the effective nurse leader, together with the processes through which leaders interpret and translate between the macro issues of policy and the micro issues of practice. In addition, an understanding of what nursing leadership is, has been proposed. Appropriate recommendations for the future of nursing and nursing leadership are outlined.
The experiences of new fatherhood: a socio‐cultural analysis
Authors: Barclay Lesley , Lupton Deborah
Published: March 2003

The experiences of new fatherhood: a socio‐cultural analysis¶ For most men, first‐time fatherhood involves significant changes in self‐identity and their relationship with their female partner. This paper presents some findings from a longitudinal, qualitative study into the first 6 months of new fatherhood for a group of 15 Australian men. The discussion draws on a series of semistructured interviews undertaken on a minimum of four occasions from a few days before the child was born until 5–6 months after birth. We found that first‐time fathering in contemporary western society requires men to be simultaneously provider, guide, household help and nurturer. The demands of these roles, and the tensions they sometimes produce, challenge men's relationships with their female partners, the meaning and place of work in their lives and their sense of self as competent adults. Almost all the men we interviewed found the early weeks and months of fatherhood more uncomfortable than rewarding, despite looking forward to fatherhood very positively. Their experience appeared more closely aligned to their difficulties with meeting social expectations and roles rather than individual deficits.
Evidence‐based nursing: a stereotyped view of quantitative and experimental research could work against professional autonomy and authority
Authors: Bonell Chris
Published: March 2003

Evidence‐based nursing: a stereotyped view of quantitative and experimental research could work against professional autonomy and authority

In recent years, there have been calls within the United Kingdom’s National Health Service (NHS) for evidence‐based health care. These resonate with long‐standing calls for nursing to become a research‐based profession. Evidence‐based practice could enable nurses to demonstrate their unique contribution to health care outcomes, and support their seeking greater professionalization, in terms of enhanced authority and autonomy. Nursing’s professionalization project, and, within this, various practices comprising the ‘new nursing’, whilst sometimes not delivering all that was hoped of them, have been important in developing certain conditions conducive to developing evidence‐based practice, notably a critical perspective on practice and a reluctance merely to follow physicians’ orders. However, nursing has often been hesitant in its adoption of quantitative and experimental research. This hesitancy, it is argued, has been influenced by the propounding by some authors within the new nursing of a stereotyped view of quantitative/experimental methods which equates them with a number of methodological and philosophical points which are deemed, by at least some of these authors, as inimical to, or problematic within, nursing research. It is argued that, not only is the logic on which the various stereotyped views are based flawed, but further, that the wider influence of these viewpoints on nurses could lead to a greater marginalization of nurses in research and evidence‐based practice initiatives, thus perhaps leading to evidence‐based nursing being led by other groups. In the longer term, this might result in a form of evidence‐based nursing emphasizing routinization, thus — ironically — working against strategies of professional authority and autonomy embedded in the new nursing. Nursing research should instead follow the example of nurse researchers who already embrace multiple methods. While the paper describes United Kingdom experiences and debates, points raised about the importance of questioning stereotyped views of research should have international relevance.
Investigating and implementing change within the primary health care nursing team
Authors: Galvin Kathleen , Andrewes Clive , Jackson Dawn , Cheesman Sarah , Fudge Tracy , Ferris Robert , Graham Iain
Published: March 2003

Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter‐professional team‐working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south‐west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team’s reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team‐working in primary health care.
Feelings of oncology patients about being nursed in protective isolation as a consequence of cancer chemotherapy treatment
Authors: Campbell Tanya
Published: March 2003

Feelings of oncology patients about being nursed in protective isolation as a consequence of cancer chemotherapy treatment

This qualitative research explores the feelings of oncology patients nursed in protective isolation following high‐dose chemotherapy. Five patients described their feelings about the isolation experience during audio‐taped interviews lasting between a half and one hour. Tapes were transcribed and analysed, with emergent themes considered in relation to the other interviews and to the literature. The research findings indicate that cancer patients have specific concerns with regard to their experience in the isolation environment, which fall into four distinct categories of: ‘being shut in’; ‘coping with the experience’; ‘being alone’; and ‘maintaining contact with the outside world’. In addition, patients have concerns with regard to the experience of having cancer, that impinge upon the isolation experience. These are: ‘having cancer’; ‘suffering chemotherapy’; ‘knowing what to expect’; and ‘developing relationships with the health professionals’. The core variable is ‘something that I have to go through’. The nature of the relationship between the categories led to the development of an integrative model for exploring the feelings of cancer patients nursed in isolation. Most of the informants coped well with the isolation experience and described feeling supported by the nursing staff. Their overriding concern in fact, reflected a desire to receive information about their disease and reassurance regarding their treatment. Being in isolation appears to inhibit communication about these issues.
Minimal interventions for problem drinkers: a review of the literature
Authors: Watson Hazel E.
Published: March 2003

Minimal interventions for problem drinkers: a review of the literature

There is an increasing body of literature concerning the role in health promotion for nurses working in many health care settings. It has been argued that this role should include identifying those individuals whose life‐style increases their risk of developing health problems, as well as providing appropriate advice and information. Life‐style factors which may contribute to ill‐health include problem drinking. This literature review presents a critique of studies of brief, or minimal, interventions for problem drinkers which have been conducted in both primary care and acute settings. The concept of minimal interventions is explored and the potential for nurses to assume a role in delivering such interventions is discussed.
Non‐response in survey research: a methodological discussion and development of an explanatory model
Authors: Barriball K. Louise , While Alison E.
Published: March 2003

Non‐response in survey research: a methodological discussion and development of an explanatory model

This paper demonstrates that the different sources of non‐response in survey research must be considered by researchers in order to minimize the potential for bias, and that careful planning and management during sample selection, sample recruitment and data collection can control the extent of response failure. The findings of an interview survey of nurses and nurses’ aides illustrate, however, that the success of strategies designed to reduce the loss of data in survey research depends upon researchers acknowledging the complex relationships that exist between non‐response phenomena throughout the research process.
Emotional and physical health of spouse caregivers of persons with Alzheimer’s disease and stroke
Authors: Wright Lore K. , Hickey Joanne V. , Buckwalter Kathleen C. , Hendrix Shirley A. , Kelechi Teresa
Published: March 2003

Emotional and physical health of spouse caregivers of persons with Alzheimer’s disease and stroke

Providing care for a cognitively impaired spouse can adversely affect caregivers’ health. It is not known how early in the caregiver’s ‘career’ emotional and physical health deteriorates. The progressive deterioration associated with Alzheimer’s disease (AD) may have different effects on caregivers’ health when compared with the potential recovery following a stroke. An exploratory study was conducted with 42 couples, equally divided among early phase AD, ischaemic stroke after hospital discharge, and well controls. Couples were evaluated at baseline (time 1), 6 months (time 2) and 1 year (time 3). At time 1, depression was significantly higher in AD and stroke caregivers when compared to controls. Over time, depression increased significantly for AD caregivers with 21% evidencing moderate to severe depression at time 1 and 50% at time 3. For stroke caregivers there was a significant interaction effect with race: white stroke caregivers’ depression increased over time while African American stroke caregivers’ depression decreased. Physical health was not significantly different for the three groups and remained stable over time. Cognitive and functional impairment levels of care recipients were significantly related to stroke caregivers’ but not AD caregivers’ depression. Long‐term counselling and support to family caregivers is advocated.
The culture of midwifery in the National Health Service in England
Authors: Kirkham Mavis
Published: March 2003

The culture of midwifery in the National Health Service in England

The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In‐depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. There was a lack of mutual support and of positive role models of support with considerable pressure to conform. Guilt and self‐blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.
Improving patients’ postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient‐controlled analgesia
Authors: Dawson Lisa , Brockbank Katrina , Carr Eloise C.J. , Barrett Richard F.
Published: March 2003

Improving patients’ postoperative sleep: a randomized control study comparing subcutaneous with intravenous patient‐controlled analgesia

One hundred female patients undergoing major reconstructive plastic or gynaecological surgery were randomized to either receive subcutaneous patient‐controlled analgesia (PCA) (bolus dose 2·5 mg diamorphine in 1 ml with a 20‐minute lockout) or intravenous PCA (bolus dose 0·5 mg diamorphine in 1 ml with a 5‐minute lockout). Data were collected by questionnaire and interview to evaluate the intervention on pain scores, quality of sleep on the first postoperative night, postoperative nausea and vomiting (PONV) and overall patient acceptability. The subcutaneous PCA group experienced less ‘worse pain’ (P < 0·01) and less sleep disturbance due to pain (P < 0·001). Subcutaneous PCA would appear to offer patients a safe and effective means of analgesia and may offer significant advantages over the intravenous route of administration.