bluuebunny/crossref_metadata_2025 huggingface dataset:
From novice to competent practitioner: tracking the progress of undergraduate mental health nursing students
Authors: Ferguson Kath , Hope Kevin
Published: March 2003

From novice to competent practitioner: a longitudinal study tracking the progress of undergraduate mental health nursing students¶ This study explores the perceptions of, and outcomes for, a group of undergraduate mental health nursing students over a 3‐year period from the point at which they made their choice to take the mental health branch of a 4‐year degree programme in nursing, to working in the practice setting as registered nurses. Semi‐structured interviews were completed at three points in their career: (a) at the end of the common foundation programme, when students had made their choice to take the mental health option; (b) at the end of the fourth year of the undergraduate programme; and (c) 1 year post‐qualification. Questions were generated around five main themes: career choice, personal change and development, evaluation of the curriculum, ideas about mental health nursing and career plans. Despite some initial ambivalence at the start of the branch, students were happy with their career choice at follow‐up, which was reinforced by significant clinical progress. All of the group were working in acute hospital settings despite being in possession of the community mental health qualification. Substantial evidence of these students' `fitness for purpose' is offered, although some disillusionment with the contrast between student life and the real world of work is noted. Questions are posed as to the role of clinical supervision and education in preventing negative professional socialization. Recommendations are also made about recruitment to and design of mental health nursing courses.
Nursing and the Research Assessment Exercise: past, present and future
Authors: Traynor Michael , Rafferty Anne Marie
Published: March 2003

Nursing and the Research Assessment Exercise: past, present and future

In this paper we examine approaches to undertaking nursing research and building research capacity in higher education institutions in the United Kingdom (UK). First we review some of the main responses in the literature to the last two Research Assessment Exercises (RAE), then we report findings from a small study of nursing departments which entered the last RAE and finally we speculate on the likely future of nursing research in the light of recent education and health policy. We suggest that many of the difficulties experienced are an effect of contradictory health and education policies and rival ways of assessing research performance. Nursing education is caught in the ‘pincer movement’ of stringency in both sectors. In addition, the challenges of the RAE and the necessity to earn income from contracting with National Health Service (NHS) education and training consortia for teaching represent an outworking of two rival views of the role of higher education, broadly an elitist view and one that sees higher education as a supplier of the workforce needs of industry. In addition to this, the NHS R&D (research and development) strategy provides an alternative arena for collaboration, funding and reputation to that constructed by the RAE.
Children visiting family and friends on adult intensive care units: the nurses’ perspective
Authors: Clarke Clare M.
Published: March 2003

Children visiting family and friends on adult intensive care units: the nurses’ perspective

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small‐scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in‐depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a District General Hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family‐centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family‐centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom’s health care system has also been identified and recommendations for further studies are proposed.
Sampling for a longitudinal study of the careers of nurses qualifying from the English pre‐registration Project 2000 diploma course
Authors: Marsland Louise , Murrells Trevor
Published: March 2003

Sampling for a longitudinal study of the careers of nurses qualifying from the English pre‐registration Project 2000 diploma course

This paper describes the processes involved in selecting a sample, from the eight English regional health authorities, of nurse qualifiers from all four branches of the Project 2000 pre‐registration diploma course, for a longitudinal study of nurses’ careers. A simple random sample was not feasible since accurate information about the population could not be obtained and the study design involved recruiting participants by personal visit. A multi‐stage approach was therefore adopted in which ‘college of nursing’ was taken as the primary sampling unit. Sampling was further complicated by the fact that adult branch students could generally only be visited in larger groups than was ideal. Information obtained during pilot work about the accuracy of data about the population, course completion rates and the proportion of students who were likely to agree to participate was used to calculate required sampling fractions. The final sample was therefore a function of this information and the practicalities of recruiting nurses into the study.
Interactive model of women’s stressors, personality traits and health problems
Authors: Kenney Janet W. , Bhattacharjee Anu
Published: March 2003

Interactive model of women’s stressors, personality traits and health problems

Theories have linked various stressors with health problems, and some studies have identified personality traits that enhance health. However, few studies have examined the interaction among women’s stressors, personality traits and their health. This retrospective study (1996–1997) analysed the effects of women’s major stressors and personality traits on symptoms of health problems, and developed a model of women’s health based on the interaction among these factors. A convenience sample of 300 women aged between 18 and 66 years completed a questionnaire that measured three types of stressors, eight personality traits and 40 symptoms of health problems. Principle components and factor analyses identified the best items to measure the stressors, traits and problems. New reduced data subsets were constructed for classification tree analyses to identify the effects of stressors and personality traits on women’s health. Women with medium or high stressors and low assertiveness, low hardiness, or the inability to express their feelings, were more likely to report physical symptoms than women who were stronger in these personality traits. Also, women with medium or high stressors and low to medium trust or love relationships were very likely to report high emotional symptoms, as were women with high trust or love, who did not express their feelings. An interactive model of women’s health was supported. The amount of women’s stressors and their personality traits may increase or diminish their stress response and affect their health. Nurses can identify women with high stressors and unhealthy personality traits that increase their risk for stress‐related illnesses, and assist these women to modify their stressors or personality traits to enhance their health.
Minimizing postpartum pain: a review of research pertaining to perineal care in childbearing women
Authors: Calvert Susan , Fleming Valerie
Published: March 2003

Minimizing postpartum pain: a review of research pertaining to perineal care in childbearing women

This paper provides a review of literature that relates to perineal pain and care. Articles evaluated include systematic reviews and research papers from the disciplines of midwifery, physiotherapy and obstetrics. The major themes to emerge from the literature and be reviewed are the need for episiotomy, suturing methods and materials, assessment of perineal trauma, treatment of perineum in the postpartum period, and postpartum recovery. Research has highlighted that many practices relating to perineal care remain un‐researched and therefore the need for evaluation is urgent. Further postpartum morbidity has been seen to affect many women, but is often unrecognized by practitioners. It is also a topic that requires further evaluation through well‐designed and implemented research.
Woodlands therapy: an ethnographic analysis of a small‐group therapeutic activity for people with moderate or severe dementia
Authors: Pulsford David , Rushforth David , Connor Irene
Published: March 2003

Woodlands therapy: an ethnographic analysis of a small‐group therapeutic activity for people with moderate or severe dementia

This paper reports on an analysis of Woodlands therapy (WT), a sensory‐motor therapeutic activity that aims to encourage interaction with people with moderate or severe dementia. The aims of the study were to examine: the responses of patients to the sensory experiences and play‐based activities that make up a WT session; the factors that influenced their responses; and the verbal interventions employed by the staff who facilitated WT sessions. Methods derived from ethnography were used. The data comprised videotapes of five WT sessions, notes of other sessions, and discussions with staff involved with the approach. Thematic groups of patients’ responses were formulated. WT mainly appears to engender the responses of attention, participation and comment. Factors that influence patients’ responses are discussed. The findings indicate that staff facilitation strategies strongly influence patients’ responses to WT. Verbal interventions made by staff are grouped in terms of their relative helpfulness for promoting positive responses to WT. Suggestions for practice are made for professional carers undertaking sensory‐motor therapeutic activities for people with dementia.
Successful breast‐feeding as a result of a health education programme for mothers
Authors: Hoyer Silvestra , Horvat Ludvik
Published: March 2003

Successful breast‐feeding as a result of a health education programme for mothers

The present study aims to prove an improvement in breast‐feeding practices in mothers who received written instructions for successful breast‐feeding and had individual counselling at the time of taking this questionnaire. The instructions were based on the results of a study carried out in Slovenia in 1993 and published in the Journal of Advanced Nursing (1998), 27, 1250–1256 (Hoyer & Pokorn 1998). The variables that were then found statistically significant in the initial and continued breast‐feeding became the basis of written instructions for breast‐feeding. The results obtained in the new current study were compared with that basic study which included 881 mothers. This was possible because the conditions of breast‐feeding between 1993 and 1995 (when the new study was launched) had not changed. The idea of baby‐friendly hospital initiative (BFHI) had not yet come into force in Slovenia. The current study comprised 203 pregnant women who were first visited during their 8th month of pregnancy. In order to collect data on breast‐feeding and deliver instructions, a field nurse visited each mother eight times until the completion of first year and continued to visit them every third month and for all those who were still breast‐feeding after that time, until the end of the lactation period. Statistical analysis was carried out by means of SPSS statistical package and survival analysis. All mothers in the study started breast‐feeding. By the end of the first month 84·7% of them were still breast‐feeding, while by the end of the third month it dropped to 74·9%, and by the end of the sixth month to 45·8%. Among these, breast‐feeding alone was practised in the first week by 25·7%, by the end of the first month by 16·4%, and by the end of the third month by 9·5%. All the observed parameters were better than in the basic study. The mean duration of breast‐feeding was 217 days, while the longest duration was 852 days. The survival analysis showed a statistically significant difference in the duration of breast‐feeding. In the current study group, mothers weaned their infants at a slower rate than in the group from the year 1993. It has been found that the written instructions as well as personal encouragement by the field nurse exerted a favourable influence on breast‐feeding practices, which was taken as a guideline for our further professional work and change of standards in the field of breast‐feeding promotion.
The relation between quality of co‐ordination of nursing care and quality of life in Dutch nursing homes
Authors: Holtkamp Chantal C.M. , Kerkstra Ada , Ribbe Miel W. , Van Campen Crétien , Ooms Marcel E.
Published: March 2003

The relation between quality of co‐ordination of nursing care and quality of life in Dutch nursing homes

Quality of life of nursing home residents is a critical consideration in international health care policies and health care decisions. Yet, there is little relevant research to support decisions about client‐tailored and effective nursing care for this population. Because of the permanency of their stay, the care received affects the quality of daily life. This study investigated the quality of co‐ordination of care and the way it is related to gaps between needs and care supply, the quality of life and health status of residents living in Dutch nursing homes. To assess the perceived quality of life and experienced discrepancies between needs and care supply, 337 residents of 10 different nursing homes were interviewed. The quality of co‐ordination of nursing care was assessed by judgements of the residents and nurses and by analysing the care documents. The results showed a relation between the co‐ordination of care and care discrepancies; the higher the quality of co‐ordination of care, the fewer the gaps between residents’ needs and the care they received. The psycho‐social aspects in particular showed a gap between the needs and care supply. As regards the relation between co‐ordination of care and quality of life, the strongest positive relations were found between taking case histories, patient allocation and dimensions of quality of life. No direct relations were found between the co‐ordination of care and care discrepancies on the one hand and the health status of the residents on the other. In conclusion, this study showed that the quality of co‐ordination of care can affect the perceived quality of life of nursing home residents. To meet the residents’ needs it is important to assess their physical and psycho‐social needs accurately. More research focusing on this assessment is needed in order to improve the quality of life of nursing home residents.
Relatives of hospitalized stroke patients: their needs for information, counselling and accessibility
Authors: Van Der Smagt‐Duijnstee Miebet E. , Hamers Jan P.H. , Abu‐Saad Huda Huijer , Zuidhof Arjan
Published: March 2003

Relatives of hospitalized stroke patients: their needs for information, counselling and accessibility

Aim of the study.  The purpose of this study is to explore the needs of stroke patients’ relatives during the hospitalization period.

Background.  In the Netherlands, the consequences of a stroke, and the needs of stroke patients and their relatives are becoming increasingly important. In hospital, however, nursing care is still focused on the patients. A previous qualitative study on the needs of relatives of stroke patients identified four categories of needs. This present study aims to test the results of the previous study in a larger setting and to identify the factors that influence the needs of the relatives.

Design/methods.  This study uses a cross‐sectional design. A questionnaire was designed for the purpose of data collection. This questionnaire was completed by 106 relatives of stroke patients admitted to the neurology wards of 19 Dutch hospitals (response rate 64%). The data were analysed using descriptive and multivariate analyses.

Results/findings.  The findings of the study indicate that the needs of the relatives of stroke patients are best divided into three categories. These are the need for information, counselling (a combination of communication and support) and accessibility. In all cases, the most important need of the relatives of stroke patients is that their questions are answered honestly. The findings show a discrepancy between the importance of the needs and the degree to which these needs are met. Multivariate data analyses show that female relatives requested most information, whereas highly educated relatives needed less counselling. Satisfaction about the care provided is positively influenced by the period of hospitalization and negatively influenced by prior experiences of hospitalization.
Sources of support for older people after discharge from hospital: 10 years on
Authors: Waters Karen , Allsopp David , Davidson Ian , Dennis Alex
Published: March 2003

Sources of support for older people after discharge from hospital: 10 years on

Aims of the study. The aim of this research was to find out who supports older people at home after discharge from hospital and if sources of support have changed between the 1980s and the 1990s.

Background. More and more older people are being discharged from hospital earlier and this creates additional pressures on families, community health and social services and the independent care sector. The research was concerned with how sources of support may have changed in a 10‐year period.

Methods. A comparison is made of two separate nonrandom samples, taken 10 years apart, of older people following discharge from hospital. Interviews were conducted in participants’ homes to establish levels of dependence and the source of support given in response to the need for help with personal and domestic activities of daily living.

Results. Although limited by the use of relatively small, nonrandom samples, the research found that proportions needing help with domestic activities were higher than those needing help with personal activities of daily living. Although dependence for help with bathing had declined between the 1980s and 1990s, help was still needed with bathing and dressing. Unmet need for help with bathing remained a problem in the 1990s. A growing role for home helps was identified, especially in personal care (bathing and dressing), where support from district nurses had declined. By the 1990s, home helps were doing less cooking and housework, including heavy laundry. Relatives were doing more of most domestic activities except shopping, which was being carried out by home helps.

Conclusions. The paper concludes by arguing that hospitals should consider if pressures to discharge older people more quickly might hinder the discharge planning process and communication between hospital and community sectors.
Fragmented sleep and tiredness in males and females one year after percutaneous transluminal coronary angioplasty (PTCA)*
Authors: Edéll‐Gustafsson Ulla M. , Hetta Jerker E.
Published: March 2003

Fragmented sleep and tiredness in males and females one year after percutaneous transluminal coronary angioplasty (PTCA)

Aim. Reported sleep quality was examined in relation to anxiety, depression, selected psycho‐physiological sleep disturbing symptoms, daytime dysfunctions according to poor sleep, and quality of life 1 year after percutaneous transluminal coronary angioplasty (PTCA). Furthermore, females were compared with age‐matched males to examine any differences in sleep quality, psycho‐physiological symptoms and quality of life.

Study design. A descriptive comparative study.

Sample. Twenty‐two females, mean age 62·7 (SD5·7) and 70 men, mean age 60·4 (SD6·7), were consecutively recruited.

Method. A mailed questionnaire was distributed, including the Uppsala Sleep Inventory, Spielberger State Anxiety scale, Zung's Self‐rating Depression Scale and the Nottingham Health Profile instrument.

Results. Forty‐six per cent of the patients had a history of myocardial infarction and 40·2% hypertension. Seventy‐two per cent of the patients were anxious and 30·4% depressed. Difficulty in getting to sleep was related to intrusive thoughts with increased feelings of anxiety and sensitivity. Difficulty in maintaining sleep was the most common sleep complaint (42·4%) and physical tiredness/fatigue was the greatest consequence of disturbed sleep (51·1%). Those with pain, palpitations or respiratory nocturnal sleep‐disturbing symptoms were characterised by shorter sleep duration, emotional distress, cognitive dysfunction, tiredness and reduced quality of life. Greater difficulties initiating sleep and worse health related quality of life were revealed in females compared with aged‐matched males.

Conclusion. fragmented sleep is a problem partly because of psycho‐physiological symptoms 1 year after PTCA, with reduced resilience to stress, increasing vulnerability or diminished coping ability and poorer quality of life.
The lived experience of clinical development unit (nursing) leadership in Western Sydney, Australia
Authors: Atsalos Christine , Greenwood Jennifer
Published: March 2003

The lived experience of clinical development unit (nursing) leadership in Western Sydney, Australia

Background. A network of nine Clinical Development Units (Nursing) (CDU(N)) were recently created in the Western Sydney Area Health Service. These units are designed to develop patient‐focused nursing practice through group process and action research, based on principles of transformational leadership.

Aims of the study. Although there is documented evidence from Australia and the United Kingdom (UK) that CDUs and Nursing Development Units (NDUs) are very successful in improving both patient and staff satisfaction, there is also growing evidence that the stressors experienced by nurse leaders are threatening the survival of some of these units. This study set out to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership when these stressors were likely to impinge.

Study design.  Hermeneutic phenomenology was employed in order to identify how these experiences changed over time. Two rounds of interviews were conducted: approximately 4–6 months after the launch and, again, 12 months later.

Findings.  The Clinical Development Unit (Nursing) philosophy provided a framework on which these very motivated leaders began to enhance nursing accountability in their units through reflective practice and participatory governance. While reinforcing many previously published positive and negative aspects of Clinical Development Units and Nursing Development Units, this paper also highlights how the expectations and experiences of these leaders changed over time with␣unanticipated pressures of work, a high turnover of clinical leaders, a perceived diminution of management support and unrealistic self‐expectations. A significant theme that emerged as these stressors began to impinge was the leaders’ own need for leadership in order to sustain their confidence and motivation.

Implications for nursing.  Insights harvested from this study have since been incorporated into a revised leadership preparation programme and support mechanisms for the leaders of eight new Clinical Development Units (Nursing) in the Western Sydney Area Health Service.
Reflection as a transforming process: student advanced nurse practitioners’ experiences of developing reflective skills as part of an MSc programme
Authors: Glaze Jane E.
Published: March 2003

Reflection as a transforming process: student advanced nurse practitioners’ experiences of developing reflective skills as part of an MSc programme

Aim of the study. The aim of this study was to explore student advanced nurse practitioners’ (ANPs) experiences of reflection.

Background. The implementation of a National Health Service (NHS) Executive initiative to develop a Master’s Course in advanced nursing practice at Wolverhampton University provided the background to the study. The course was designed to enable experienced nurses to take on activities previously considered the province of physicians. The aim was to extend practice within a holistic nursing framework. Reflection was perceived as central to this process. A pre‐entry degree level reflective practice module and a reflective component for the level 4 (Master’s level) Practice Module were devised to enhance practitioners’ reflective skills.

Rationale. The rationale for the study was that it should explore student ANPs’ perceptions of reflection following completion of these modules, to evaluate their experiences and inform curriculum development.

Design/Methods. A qualitative methodology was used. The sample comprised 14 ANP students. Interviews and reflective learning contracts were used to collect the data. Colaizzi’s (1978) seven‐stage model guided data analysis.

Findings. The findings indicated that all but one of the students described the development of their reflective skills positively. Changes are described in students’ thinking and behaviour.

Conclusions. The conclusions have implications for ANPs, for patient care, and for others seeking to develop the ANP role.
Rationing scarce life‐sustaining resources on the basis of age
Authors: Clarke Clare M.
Published: March 2003

Rationing scarce life‐sustaining resources on the basis of age

Aims. The aim of this paper is to analyse critically the use of age as a criterion to ration scarce life‐sustaining resources within the intensive care environment.

Background. Insufficient funding to meet the escalating costs of health care has resulted in a scarcity of life‐sustaining resources. Although an explicit policy of rationing by age within the United Kingdom (UK) has not been formulated, decisions to withhold or withdraw treatment are already being made on the basis of patients’ biological age rather than medical need.

Method. Three contrasting arguments are analysed: the ‘equal worth’, ‘fair innings’ and ‘prudential lifespan’ arguments.

Conclusions. In certain circumstances rationing by age is both morally permissible and justified. However, the capacity to benefit from treatment has to be considered whatever the age of the individual and any measure of benefit needs to take a broad range of medical, ethical and economic factors into account. If age is to be used, as a criterion to ration limited resources explicit, national guidelines need to be developed and applied consistently to ensure that arbitrary differences in the treatment older people receive does not occur.
Nurse endoscopists in United Kingdom health care: a survey of prevalence, skills and attitudes
Authors: Pathmakanthan Shri , Murray Iain , Smith Karen , Heeley Rebecca , Donnelly Mark
Published: March 2003

Nurse endoscopists in United Kingdom health care: a survey of prevalence, skills and attitudes

Objectives. To assess the prevalence and potential benefits of attitudes towards nurse endoscopy in the United Kingdom (UK).

Design. Postal questionnaire.

Subjects. All hospitals in the UK with accident and emergency, general medical and general surgical services in October 2000.

Main outcome measures. Number of teaching or district general hospitals employing nurse endoscopists, range of diagnostic and therapeutic endoscopic skills and potential benefits to the endoscopy unit and patients.

Results. Seventy‐six hospitals employed 102 nurse endoscopists. Forty‐four nurse endoscopists performed both oesophago‐gastroduodenoscopy (OGD) and flexible sigmoidoscopy with solitary OGD and flexible sigmoidoscopy performed by 17 and 31, respectively. Three performed full colonoscopy while seven could perform all three procedures. Nurse endoscopists were found to provide good patient care in the majority of endoscopy units with no compromise in safety. Lead clinicians were keen to restrict nurse endoscopy to diagnostic OGD and flexible sigmoidoscopy only in the majority of units.

Conclusions. Nurse endoscopy is widely practised in the UK and is not limited to one procedure or solely for diagnostic purposes. Benefits include good patient acceptability, improved care and safety. Most clinicians predict an important but restricted role for nurse endoscopy in contributing to endoscopic services.
A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non‐toilet‐trained children for microbiological examination
Authors: Farrell Michael , Devine Karen , Lancaster Gillian , Judd B.
Published: March 2003

A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non‐toilet‐trained children for microbiological examination

Background. In young, non‐toilet‐trained children, the collection of a urine sample for microbiology can be challenging, with the application of a urine bag being the main method of collection. However, recent research has shown that absorbent pads can be used yielding similar results to bag specimens. However, weaknesses in study design erode confidence in research findings. Therefore, improvements in research design are required to fully evaluate the reliability of pad collection.

Aims of the study. This pilot study sought to test the feasibility of a technique for the collection of concurrent bag/pad urine samples from non‐toilet‐trained children, and to assess the reliability of urine pads over bags as a collection method for urine specimens for microbiological evaluation.

Design. A pilot, method comparison study.

Methods. Twenty concurrent bag and pad specimens were collected from non‐toilet‐trained children, following parental consent. Urine specimens were analysed for presence or absence of white cell count (WBC), and bacterial growth, using standard laboratory methods.

Data analysis. The Kappa (κ) statistics and confidence interval (CI) estimation were used to assess agreement between the two collection methods.

Results. Despite concurrent samples there was a lack of agreement between bag and pad specimens on both main outcome measures. Agreement between bag and pad specimens for the presence of WBC yielded a κ=0·10 (95% CI: 0·19, 0·39), indicating poor agreement, while a κ of 0·5 (95% CI: 0·12, 0·88) was calculated for the degree of agreement in bacterial growth reflecting moderate agreement. Differences in proportions of the presence of WBC between bag and pad did not quite reach significance at the 5% level 0·2 (95% CI: 0·00, 0·42, P=0·062). For cultures the difference was calculated as 0·15 (95% CI: 0·05, 0·35, P=0·125).

Conclusion. The pilot study demonstrates that concurrent urine samples can be obtained without difficulty. Despite poor to moderate agreement on outcome measures the level of agreement is greater than reported in those other studies, that use non‐current methods of urine collection, suggesting an advantage of the concurrent technique. It is recommended that larger scale studies be undertaken using the concurrent collection technique to assess reliability of these findings.
Swiss nurses' knowledge related to health care reforms: an exploratory study
Authors: Spitzer Ada , Perrenoud Béatrice , Desaulles Cécile , Camus Didier , Van Gele Patrick , Périer Jacques
Published: March 2003

Swiss nurses' knowledge related to health care reforms: an exploratory study

Background. This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Swiss (Canton Vaud) context, where health care reforms have been initiated, on the National (Federal) level, in 1996.

Objectives. Three research questions were formulated: (a) What is the level of nurses' knowledge regarding the basic principles of LAMal (Loi fédérale sur l'assurance maladie, Federal Health Insurance Law)? (b) What is the level of nurses' knowledge concerning the principles of health care reforms in Canton Vaud (NOPS, Nouvelles Orientations de la Politique Sanitaire)? and (c) Are there knowledge differences relating to employment setting (hospital, community, and education), nurses' roles (managerial vs. staff nurses) and level of education?

Methods. The sample consisted of a total of 74 nurses. Of these, 20 were employed in the community, 30 in hospital settings and 24 worked in schools of nursing. The research tool utilized was 40‐items nurses' knowledge questionnaire developed for the purpose of this study. Three knowledge subscales and a subscale of certainty were constructed.

Results. Overall, data showed a moderate to high mean level of knowledge (around 70% correct responses) on all knowledge scales considered. Community setting, managerial position, and a nonacademic nursing degree were all positively related to higher levels of reforms' knowledge. On the contrary, employment in a hospital setting and having a university degree had both negative impacts on achieving a high score of knowledge. Levels of certainty were significantly higher for LAMal than NOPS and for correct rather than for wrong responses.
Can staff attitudes to team working in stroke care be improved?
Authors: Gibbon Bernard , Watkins Caroline , Barer David , Waters Karen , Davies Steve , Lightbody Liz , Leathley Michael
Published: March 2003

Background.  Teamwork is regarded as the cornerstone of rehabilitation. It is recognized that the skills of a multiprofessional team are required to provide the care and interventions necessary to maximize the patient's potential to recover from his/her stroke.

Literature review.  Critical evaluation of team working is lacking in the literature. Indeed, there is no consensus on a precise definition of teamwork or on the best way of implementing it, beyond a general exhortation to members to work to the same therapeutic plan in a cohesive manner. The literature has highlighted many problems in team working, including petty jealousies, ignorance and a perceived loss of autonomy and threat to professional status.

Aim.  To determine if the use of team co‐ordinated approaches to stroke care and rehabilitation would improve staff attitudes to team working.

Method.  A pre‐post design was adopted using ‘The Team Climate Inventory’ to explore attitudes to team working before and after introducing the interventions. Local Research Ethics Committee approval was obtained.

Results.  Improvements in attitudes towards team working suggest that the introduction of team co‐ordinated approaches (integrated care pathways and team notes) did not result in greater team working.

Limitations.  The introduction of an integrated care pathway and team notes is based on an assumption that they would enhance team working.

Conclusions.  The results suggest that the introduction of team co‐ordinated approaches (team notes and care pathways) do not improve attitudes to team working, teams appear to take a long time to establish cohesion and develop shared values.
Evaluating the use of developmental action inquiry in constructing a problem‐based learning curriculum for pre‐registration nursing education in Hong Kong: a student perspective
Authors: Pang Samantha M.C. , Wong Thomas K.S. , Dorcas Allen , Lai Claudia K.Y. , Lee Regina L.T. , Lee Wai‐man , Mok Esther S.B. , Wong Frances K.Y.
Published: March 2003

Background.  Developmental action inquiry (DAI) was chosen as the change strategy for introducing problem‐based learning (PBL) in a pre‐registration nursing programme. The central task was to transform the tutor and student participants to become collaborators in this curriculum reconstruction project.

Aim.  This paper expounds the way in which the action inquiry was constructed and in light of students’ feedback analysis, the way in which PBL has made a difference in student learning was evaluated.

Design.  Taking into consideration the change context and different group characteristics, the DAI was conducted in terms of two dynamically interlinked circles that formed partnerships between PBL core group members and tutors, and between tutors and students in coconstructing knowledge useful for PBL curriculum development.

Findings.  The findings of the student evaluation questionnaire reveal that the majority of students felt PBL made a difference to their expectations of self, the student group and the teacher role in creating a facilitative environment to enhance learning. However, there was a significant difference among individual student group responses. The students’ positive and negative PBL experience in self‐learning, tutor–student interaction, and group‐learning were identified as crucial factors contributing to these group variations.

Conclusion.  The evaluation findings show that a paradigm shift from teacher‐centred to student‐centred learning, from valuing self‐learning to co‐operative group‐learning, and from theory‐based to practice‐based learning occurred among the students. DAI was found to be an effective change strategy for transforming participants to become collaborators in searching for useful knowledge and coconstructing the PBL learning context.
What areas of cancer care do Norwegian nurses experience as problems?
Authors: Rustøen Tone , Schjølberg Tore K. , Wahl Astrid K.
Published: March 2003

Background. As the number of people diagnosed with cancer increases and the treatment of cancer changes and improves, the challenges and problems nurses experience in clinical practice are also changing.

Aim. To describe the problems that nurses in cancer care face in their day‐to‐day practice. Such information can be used to improve the quality of nursing care.

Design. A questionnaire was distributed to half of the members of the Norwegian Society of Nurses in Cancer Care (n  = 464).

Instrument. The survey questionnaire had previously been used in a Canadian study. The nurses were asked to consider 80 different areas relevant to cancer nursing and to indicate the extent to which each posed a problem for them in clinical practice. The sex, age and educational level of the nurses were also recorded, together with the work setting and number of years they had been employed in nursing.

Results. The response rate was 43% (199 of 464). The area the nurses experienced as being the greatest problem in their clinical practice was patients' anxiety. Problems connected with nutrition, the development of the cancer itself and grieving, and symptoms like nausea and vomiting and fatigue were also frequently rated as problems. The results also show some significant correlations between the rating of problems and variables such as work setting, years in practice and educational level.

Conclusion. The present study shows that nurses in cancer care mainly experience psychological issues as problems in their clinical practice, which confirms previous research. The impact of work setting, years in clinical practice and education was surprisingly small. As the majority of nurses today will meet cancer patients during their professional careers, further research is needed in this area.
The adaptation of written self‐management plans for children with asthma
Authors: Milnes Linda J , Callery Peter
Published: March 2003

milnes l.j. & callery p. (2003) Journal of Advanced Nursing 41(5), 444–453

 The adaptation of written self‐management plans for children with asthma

Background. Self‐management plans are an important element of asthma care. Although asthma is common in children, there is limited guidance for adaptation of self‐management plans for children.

Aims. A study was conducted in order to develop a set of criteria for adaptation of asthma self‐management plans for school aged children; and to use these criteria to review self‐management plans used in United Kingdom (UK) centres.

Methods. Self‐management plans were obtained by telephone survey (response rate: 81%) of 47 selected UK paediatric, respiratory and community centres during the period between March and October 2001. The content of self‐management plans was analysed according to criteria developed from a review of the literature, including objectives, opportunities for individualization, and the implied roles of parent and child in asthma management. Agreement was achieved between the authors and a third independent rater.

Results. The majority of centres (31 of 47) used or planned to use adapted self‐management plans while the remainder used the standard National Asthma Campaign self‐management plan. There were wide variations in self‐management plans, including variation in the person to whom plans were addressed, criteria for treatment and the objectives stated for self‐management. Few opportunities were provided for individualization of self‐management.

Limitations. The study was limited to the documents used in self‐management in selected centres.

Conclusion. The results suggest that many practitioners believe that self‐management education requires adaptation for children. There is little consistency in the adaptation of self‐management plans for children. Principles for devising adapted self‐management plans are proposed.
Genotype by environment interactions in winter survival in red deer
Authors: COULSON  , ALBON  , PEMBERTON  , SLATE  , GUINNESS  , CLUTTON‐BROCK
Published: March 2003

1.  The extent to which environmental heterogeneity interacts with genetic hetero geneity to affect individual fitness within populations has the potential to affect the dynamics of natural populations and the amount of genetic variation maintained in natural populations, yet is a relatively poorly investigated topic in either ecology or evolutionary biology.

2.  Many individual‐based studies are precluded from such investigations by the practical problems of measuring heritability of traits affecting fitness and the difficulties of experimental manipulation of the study population. One way of demonstrating how commonly genotype by environmental interactions affect fitness, though not their overall importance in determining fitness, is to investigate fitness in a population subdivided by genotype at one or more marker loci.

3.  We analyse data on calf winter survival from a population of red deer from the Isle of Rum, Scotland. Data on individual survival, environmental fluctuations and genotype at 13 loci were collected from 1982 to 1994.

4.  We found associations between survival over the first winter of life and calf genotype at two out of three allozyme loci and five out of 10 microsatellite loci. All of the results remained significant under randomization tests. Other genotypes that initially appeared to have an association with survival were rejected when bootstrapped, usually due to insufficient data or anomalies in the data.

5.  Our results suggest that associations between fitness and genotype are common. Five out of the seven associations found involved interactions with environmental variables. Four of these showed density‐dependent selection with different genotypes showing high survival at high population size compared to low population size and one interacted with autumn rainfall. In a sixth case, genotype interacted with sex.
Coexistence and collapse: an experimental investigation of the persistent communities of a protist species pool
Authors: WEATHERBY ANITA J. , WARREN PHILIP H. , LAW RICHARD
Published: March 2003

1.  Using protists in laboratory microcosms we investigated the long‐term coexistence of combinations of species from a six species set to address the following questions: (i) What proportion of the possible communities from the species pool are persistent? (ii) From how many initial states are each of these persistent communities obtained? (iii) What are the impacts of individual species on community collapse? (iv) Can the behaviour of the system be characterized by a simple set of rules? (v) To what extent does knowledge of the results from the pairwise species combinations allow prediction of the outcomes of the more species‐rich sets?2.  Replicated microcosms were set up with each of the 63 possible combinations of species from a pool of six protist species (three bacterivores, two predators and one omnivore) along with a mixed bacterial flora. Microcosms were maintained, with nutrient replenishment, for over 100 days until a constant species composition was reached.3.  Forty‐seven of the 63 starting combinations showed a repeatable collapse to one of eight communities (including the ‘empty’ community – containing just bacteria). The number of starting combinations leading to each of these persistent communities varied from 17 down to one. Extinction rates were higher in more species‐rich systems.4.  The effects of each species in determining the composition of the persistent community were characterized as to whether they were present in the final set or not, and whether their occurrence in the starting combination had any effect on the eventual presence or absence of others. Under this classification the larger species seem to be more influential in shaping the final community.5.  The collapse from the initial species composition to that at the end could be stated in terms of four simple rules in 34 of the 47 starting combinations for which a persistent community could be defined.6.  Using the outcomes from the single‐species and two‐species starting sets only, the eventual states to which the larger communities collapsed could be correctly predicted in 27 out of the 31 starting combinations containing three or more species for which persistent communities could be defined.
Fitness‐dependent dispersal in metapopulations and its consequences for persistence and synchrony
Authors: Ruxton Graeme D. , Rohani Pejman
Published: March 2003

1. We present a novel metapopulation model where dispersal is fitness dependent: the strength of migration from a site is dependent on the expected reproductive fitness of individuals there. Furthermore, individuals continue to migrate until they reach a suitable habitat where their expected fitness is above a threshold value.

2. Fitness‐dependent dispersal has a very strong stabilizing effect on population dynamics, even when the intrinsic dynamics of populations in the absence of dispersal exhibit complex high‐amplitude oscillations. This stabilizing effect is much stronger than that of the density‐independent dispersal normally considered in metapopulation models.

3. Even when fitness‐dependent dispersal does not stabilize the dynamics in a formal sense, it generally leads to simplification, with complex or even chaotic fluctuations being reduced to simple cycles.

4. This form of dispersal also has a strong tendency to synchronize local population dynamics across the spatial extent of the metapopulation.

5. These conclusions are robust to the addition of strong stochasticity in the migration threshold.